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Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder

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Abstract

Background

Treatment-seeking people with opioid use disorder (OUD) who are capable of pregnancy need accurate information about the potential impact of medication to treat OUD (MOUD) on fertility to make informed choices about treatment that are consistent with their reproductive wishes. There is a dearth of research on fertility associated with MOUD receipt in birthing people with OUD.

Objective

To estimate the association between treatment with MOUD and odds of conception among birthing people using national administrative claims.

Design

Retrospective case-crossover study using multi-state US administrative data (2006–2016). Dates of conception were estimated from delivery dates and served as “case” days for which MOUD exposures were compared to those on all other (“control”) days of insurance enrollment.

Participants

Treatment-seeking people with OUD with a delivery during the observation period.

Main measures

Odds ratios for conception from within-person fixed effects models were modeled as a function of exposure to MOUD (buprenorphine, methadone, extended-release depot naltrexone, or oral naltrexone) using conditional logistic regression.

Key Results

A total of 21,928 births among 19,133 people with OUD were identified. In the sample, 5873 people received buprenorphine, 1825 methadone, 486 extended-release naltrexone, and 714 oral naltrexone. Participants could receive more than one type of MOUD. Mean age was 28.2 years (SD = 2.2; range = 16–45), with 76.2% having Medicaid. vs. commercial insurance. Compared to no MOUD, periods of methadone (aOR = 0.55 [95% CI = 0.48–0.63]) or buprenorphine receipt (aOR = 0.84 [0.77–0.91]) were associated with fewer conceptions. Treatment periods with extended-release depot naltrexone compared to no medication were associated with higher odds of conception (aOR = 1.75 [1.22–2.50]) and there was no significant difference in conception with oral naltrexone (aOR = 1.02 [0.67–1.54]).

Conclusions

The association between MOUD and odds of conception among birthing people varied by type of MOUD, with extended-release naltrexone associated with higher odds of conceiving compared to no treatment. Clinical studies are urgently needed to investigate these findings further.

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Data Availability

No additional data available. We intend to provide relevant code on written reasonable request.

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Funding

This project was funded by R21 DA044744 (PI: Richard Grucza/Laura Bierut). Effort for some personnel was supported by grants K23 DA053433 (Jennifer K. Bello) and T32 DA015035 (Kevin Xu, PI: Kathleen Bucholz, Jeremy Goldbach) and St. Louis University Research Institute Fellowship (Richard Grucza), but these grants did not fund the analyses of the Merative™ MarketScan® Commercial and Multi-State Medicaid Database data performed by Dr. Xu. In addition, we acknowledge Matt Keller MS, John Sahrmann MS, Dustin Stwalley MA, and the Center for Administrative Data Research (CADR) at Washington University for assistance with data acquisition, management, and storage. Merative and MarketScan are trademarks of Merative Corporation in the US, other countries, or both. CADR is supported in part by the Washington University Institute of Clinical and Translational Sciences via grants UL1 TR002345 (from the National Center for Advancing Translational Sciences of the National Institutes of Health).

Author information

Author notes

  1. Jennifer K. Bello and Kevin Y. Xu have equal contribution.

Authors and Affiliations

  1. Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA

    Jennifer K. Bello MD, MS & Richard A. Grucza PhD

  2. Health and Behavior Research Center, Division of Addiction Science, Prevention and Treatment, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA

    Kevin Y. Xu MD, MPH

  3. Advanced Health Data Institute, Department of Health and Outcomes Research, Saint Louis University, St. Louis, MO, USA

    Joanne Salas MPH & Richard A. Grucza PhD

  4. Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Bronwyn S. Bedrick MD, MSCI

Authors
  1. Jennifer K. Bello MD, MS
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  2. Kevin Y. Xu MD, MPH
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  3. Joanne Salas MPH
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  4. Bronwyn S. Bedrick MD, MSCI
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Contributions

Patricia Cavazos-Rehg PhD and Laura Bierut MD of the NIDA K12 Program of Washington University for obtaining funding to support effort for personnel (Dr. Xu); Matthew Keller MS, John Sahrmann MS, Dustin Stwalley MA from the Center for Administrative Data Research (CADR) of Washington University for technical support of the MarketScan Databases. Merative and MarketScan are trademarks of Merative Corporation in the US, other countries, or both.

Corresponding author

Correspondence to Jennifer K. Bello MD, MS.

Ethics declarations

Conflict of Interest:

Dr Grucza reported receiving grants from the NIH and Arnold Ventures LLC during the conduct of the study, consulting for Janssen Pharmaceuticals, and receiving personal fees for grant reviews from the NIH and Washington University outside the submitted work. Dr. Bello reported receiving personal fees for grant reviews from the NIH outside of the submitted work.

Additional information

Prior Presentations

Bello JK, Xu K, Grucza R. (May 2023) Association between Medications for Opioid Use Disorder (MOUD) and Pregnancy. 5th Annual Institute of Clinical and Translational Sciences Symposium and Poster Display. Washington University in Saint Louis, MO. Poster presentation.

Bello, JK, Xu K, Grucza R. (September 2023) Using Big Data to Optimize Reproductive Health in Pregnant Women with Opioid Use Disorder. Institute of Clinical and Translational Sciences Big Data Research Symposium. The Advanced Health Data Institute, Saint Louis University and the Administrative Data Core Services, Washington University in Saint. Louis, MO. Oral presentation.

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Bello, J., Xu, K., Salas, J. et al. Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08689-8

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