Opioid use disorder (OUD) among pregnant and postpartum persons has increased in the last 20 years and poses risks to both birthing parent and fetus/child. Medication for opioid use disorder (MOUD) can reduce these risks, yet engagement is limited among pregnant and postpartum persons with over half discontinuing in the postpartum year. Little research has explored pregnant and postpartum persons’ reasons for using MOUD in pregnancy and decisions around (dis)continuing after childbirth. We sought to gain a deeper understanding of the reasons pregnant and postpartum persons use MOUD in pregnancy and motivations for continued use or discontinuation postpartum.
Methods:
Individual interviews (n = 4) and focus groups (2 focus groups with total n = 6) were conducted with 10 participants with OUD aged 18 to 45 years who were currently pregnant (50%) or postpartum (50%) and had been treated with MOUD. Interviews and focus groups were transcribed, and a codebook was iteratively created using thematic analysis.
Results:
Five themes and 7 subthemes emerged within 2 domains representing experiences with MOUD during pregnancy (domain 1) and postpartum (domain 2). Participants were highly motivated toward MOUD in pregnancy for the benefits to themselves and their unborn children but acknowledged several drawbacks including the possibility of fetal/neonatal withdrawal. Reasons for MOUD use postpartum shifted toward improving maternal mental health and parenting. Several participants anticipated eventually tapering MOUD within the postpartum year as they no longer saw a distinct need for it.
Conclusion:
Despite perceived risks, pregnant and postpartum persons with OUD have many motivations to use MOUD during pregnancy that may shift in the postpartum period. Our findings underscore the importance of education and shared decision-making and emphasize the need for leveraging pre- and postnatal motivation for MOUD during these conversations and throughout course of treatment.
HiraiAHKoJYOwensPLStocksCPatrickSW.Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010-2017. JAMA. 2021;325(2):146-155. doi:10.1001/jama.2020.24991
2.
Lo-CiganicWHDonohueJMKimJY, et al. Adherence trajectories of buprenorphine therapy among pregnant women in a large state Medicaid program in the United States. Pharmacoepidemiol Drug Saf. 2019;28(1):80-89. doi:10.1002/pds.4647
3.
KransEEKimJYJamesAEKelleyDJarlenskiMP.Medication-assisted treatment use among pregnant women with opioid use disorder. Obstet Gynecol. 2019;133(5):943-951. doi:10.1097/AOG.0000000000003231
4.
KransEEKimJYChenQ, et al. Outcomes associated with the use of medications for opioid use disorder during pregnancy. Addiction. 2021;116(12):3504-3514. doi:10.1111/add.15582
KimJBusseMKantrowitz-GordonIAltmanMR.Health care experiences during pregnancy and parenting with an opioid use disorder. MCN Am J Matern Child Nurs. 2022;47(2):100-106. doi:10.1097/NMC.0000000000000805
7.
SuarezEAHuybrechtsKFStraubL, et al. Buprenorphine versus methadone for opioid use disorder in pregnancy. N Engl J Med. 2022;387(22):2033-2044. doi:10.1056/NEJMoa2203318
8.
BruzeliusEMartinsSS.US trends in drug overdose mortality among pregnant and postpartum persons, 2017-2020. JAMA. 2022;328(21):2159-2161. doi:10.1001/jama.2022.17045
9.
GannonMShortVBeckerM, et al. Doula engagement and maternal opioid use disorder (OUD): experiences of women in OUD recovery during the perinatal period. Midwifery. 2022;106:103243. doi:10.1016/j.midw.2021.103243
10.
KotelchuckMChengERBelanoffC, et al. The prevalence and impact of substance use disorder and treatment on maternal obstetric experiences and birth outcomes among singleton deliveries in Massachusetts. Matern Child Health J. 2017;21(4):893-902. doi:10.1007/s10995-016-2190-y
11.
BaerRJChambersCDRyckmanKKOltmanSPRandLJelliffe-PawlowskiLL.Risk of preterm and early term birth by maternal drug use. J Perinatol. 2019;39(2):286-294. doi:10.1038/s41372-018-0299-0
12.
BosworthOMPadilla-AzainMCAdgentMA, et al. Prescription opioid exposure during pregnancy and risk of spontaneous preterm delivery. JAMA Netw Open. 2024;7(2):e2355990. doi:10.1001/jamanetworkopen.2023.55990
13.
PatrickSWSchumacherREBenneyworthBDKransEEMcAllisterJMDavisMM.Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA. 2012;307(18):1934-1940. doi:10.1001/jama.2012.3951
14.
CioeKBiondiBEEaslyRSimardAZhengXSpringerSA.A systematic review of patients’ and providers’ perspectives of medications for treatment of opioid use disorder. J Subst Abuse Treat. 2020;119:108146. doi:10.1016/j.jsat.2020.108146
15.
WilderCLewisDWinhusenT.Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder. Drug Alcohol Depend. 2015;149:225-231. doi:10.1016/j.drugalcdep.2015.02.012
16.
SchiffDMNielsenTTerplanM, et al. Fatal and nonfatal overdose among pregnant and postpartum women in Massachusetts. Obstet Gynecol. 2018;132(2):466-474. doi:10.1097/AOG.0000000000002734
17.
ACOG Committee on Health Care for Underserved Women, American Society of Addiction Medicine. ACOG Committee Opinion No. 524: opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol. 2012;119(5):1070-1076. doi:10.1097/AOG.0b013e318256496e
18.
ReddyUMDavisJMRenZGreeneMF, Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes Workshop Invited Speakers. Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstet Gynecol. 2017;130(1):10-28. doi:10.1097/AOG.0000000000002054
19.
Fiddian-GreenAGubriumAHarringtonCEvansEA.Women-reported barriers and facilitators of continued engagement with medications for opioid use disorder. Int J Environ Res Public Health. 2022;19(15):9346. doi:10.3390/ijerph19159346
20.
GoodmanDJSaundersECWolffKB.In their own words: a qualitative study of factors promoting resilience and recovery among postpartum women with opioid use disorders. BMC Pregnancy Childbirth. 2020;20(1):178. doi:10.1186/s12884-020-02872-5
21.
AustinAEBonaVDCoxMEProescholdbellSKNaumannRB.Differences in mortality among infants with neonatal opioid withdrawal syndrome. Am J Prev Med. 2022;63(4):619-623. doi:10.1016/j.amepre.2022.03.018
22.
AlexanderKShortVGannonMGoyalNNaegleMAbatemarcoDJ.Identified gaps and opportunities in perinatal healthcare delivery for women in treatment for opioid use disorder. Subst Abus. 2021;42(4):552-558. doi:10.1080/08897077.2020.1803178
FrazerZMcConnellKJanssonLM.Treatment for substance use disorders in pregnant women: motivators and barriers. Drug Alcohol Depend. 2019;205:107652. doi:10.1016/j.drugalcdep.2019.107652
25.
ShadowenCWheelerRTerplanM.Patient and provider knowledge of and attitudes toward medical conditions and medication during pregnancy. Addict Sci Clin Pract. 2021;16(1):22. doi:10.1186/s13722-021-00228-8
26.
Colson-FearonDAntoineDGPeirceJMKidorfMHammondAS.The impact of child protective services involvement on pregnant and postpartum women in substance use disorder treatment. Subst Use Misuse. 2023;58(9):1110-1114. doi:10.1080/10826084.2023.2212074
27.
WooJBhaleraoABaworM, et al. “Don’t Judge a Book by Its Cover”: a qualitative study of methadone patients’ experiences of stigma. Subst Abuse. 2017;11:1178221816685087. doi:10.1177/1178221816685087
28.
EllisJDCairncrossMStrubleCACarrMMLedgerwoodDMLundahlLH.Correlates of treatment retention and opioid misuse among postpartum women in methadone treatment. J Addict Med. 2019;13(2):153-158. doi:10.1097/ADM.0000000000000467
29.
CrawfordADMcGlothen-BellKRectoP, et al. Stigmatization of pregnant individuals with opioid use disorder. Womens Health Rep. 2022;3(1):172-179. doi:10.1089/whr.2021.0112
30.
WeberAMiskleBLynchAArndtSAcionL.Substance use in pregnancy: identifying stigma and improving care. Subst Abuse Rehabil. 2021;12:105-121. doi:10.2147/SAR.S319180
31.
BehnkeMSmithVC, Committee on Substance Abuse, Committee on Fetus and Newborn. Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics. 2013;131(3):e1009-1024. doi:10.1542/peds.2012-3931
32.
Tsuda-McCaieFKoteraY.A qualitative meta-synthesis of pregnant women’s experiences of accessing and receiving treatment for opioid use disorder. Drug Alcohol Rev. 2022;41(4):851-862. doi:10.1111/dar.13421
33.
KuoCSchonbrunYCZlotnickC, et al. A qualitative study of treatment needs among pregnant and postpartum women with substance use and depression. Subst Use Misuse. 2013;48(14):1498-1508. doi:10.3109/10826084.2013.800116
34.
BraunVClarkeV.Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa
35.
BoyatzisRE.An overview of intentional change from a complexity perspective. J Manag Dev. 2006;25(7):607-623. doi:10.1108/02621710610678445
LegaultL. Intrinsic and extrinsic motivation. In: Zeigler-HillVShackelfordTK, eds. Encyclopedia of Personality and Individual Differences. Springer International Publishing; 2020:2416-2419. doi:10.1007/978-3-319-24612-3_1139
39.
MooreDJButzlaffA.“Will My Baby Be OK?” a qualitative analysis of pregnant women’s Suboxone® online forum posts. J Am Psychiatr Nurses Assoc. 2023;29(3):185-193. doi:10.1177/10783903231166670
40.
SchiffDMWorkECMuftuS, et al. “You have to take this medication, but then you get punished for taking it”: lack of agency, choice, and fear of medications to treat opioid use disorder across the perinatal period. J Subst Abuse Treat. 2022;139:108765. doi:10.1016/j.jsat.2022.108765
41.
KaltenbachKO’GradyKEHeilSH, et al. Prenatal exposure to methadone or buprenorphine: early childhood developmental outcomes. Drug Alcohol Depend. 2018;185:40-49. doi:10.1016/j.drugalcdep.2017.11.030
42.
WitcraftSMJohnsonCGuilleC.The psychiatrist’s role in treating perinatal opioid use disorder and reducing maternal mortality. Focus. 2024;22(1):25-34. doi:10.1176/appi.focus.20230018
43.
ZwebenJESorensenJLShingleMBlazesCK.Discontinuing methadone and buprenorphine: a review and clinical challenges. J Addict Med. 2021;15(6):454-460. doi:10.1097/ADM.0000000000000789
44.
FareedAVayalapalliSByrd-SellersJCasarellaJDrexlerK.Safety and efficacy of long-term buprenorphine maintenance treatment. Addict Disord Their Treat. 2011;10(3):123. doi:10.1097/ADT.0b013e318211ba0a
45.
WilliamsARSamplesHCrystalSOlfsonM.Acute Care, Prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder. Am J Psychiatry. 2020;177(2):117-124. doi:10.1176/appi.ajp.2019.19060612
46.
KellyLERiederMJBridgman-AckerKLauwersAMadadiPKorenG.Are infants exposed to methadone in utero at an increased risk for mortality?J Popul Ther Clin Pharmacol. 2012;19(2):e160-e165.
47.
KoJY.Vital Signs: Prescription opioid pain reliever use during pregnancy—34 U.S. Jurisdictions, 2019. MMWR Morb Mortal Wkly Rep. 2020;69:897-903. doi:10.15585/mmwr.mm6928a1
48.
Titus-GloverDShayaFTWelshCRoaneL.The lived experiences of pregnant and parenting women in recovery toward medication treatment for opioid use disorder. Subst Use Addctn J. 2024;45(3):367-377. doi:10.1177/29767342231221055
O’HaraMW.Postpartum depression: what we know. J Clin Psychol. 2009;65(12):1258-1269. doi:10.1002/jclp.20644
51.
van DraanenJTsangCMitraS, et al. Mental disorder and opioid overdose: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2022;57(4):647-671. doi:10.1007/s00127-021-02199-2
GuilleCJonesHEAbuhamadABradyKT.Shared decision-making tool for treatment of perinatal opioid use disorder. Psychiatr Res Clin Pract. 2019;1(1):27-31. doi:10.1176/appi.prcp.20180004
GirardiGLongoMBremerAA.Social determinants of health in pregnant individuals from underrepresented, understudied, and underreported populations in the United States. Int J Equity Health. 2023;22(1):186. doi:10.1186/s12939-023-01963-x
56.
VarmaDSKukretiPChandraPS.Social and cultural factors in perinatal mental health. In: BhugraDMoussaouiDCraigTJBhugraDMoussaouiDCraigTJ eds. Oxford Textbook of Social Psychiatry. Oxford University Press; 2022:433-445. doi:10.1093/med/9780198861478.003.0045
57.
Crear-PerryJCorrea-de-AraujoRLewis JohnsonTMcLemoreMRNeilsonEWallaceM.Social and structural determinants of health inequities in maternal health. J Womens Health. 2021;30(2):230-235. doi:10.1089/jwh.2020.8882
58.
WitcraftSMJohnsonEEitelAE, et al. Listening to black pregnant and postpartum people: using technology to enhance equity in screening and treatment of perinatal mental health and substance use disorders. J Racial Ethn Health Disparities. Published online April11, 2024. doi:10.1007/s40615-024-01989-z
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
