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Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder

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...

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Published in:Journal of general internal medicine : JGIM 2024-06, Vol.39 (8), p.1342-1348
Main Authors: Bello, Jennifer K., Xu, Kevin Y., Salas, Joanne, Bedrick, Bronwyn S., Grucza, Richard A.
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Xu, Kevin Y.
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Grucza, Richard A.
description 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.
doi_str_mv 10.1007/s11606-024-08689-8
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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.</description><identifier>ISSN: 0884-8734</identifier><identifier>ISSN: 1525-1497</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-024-08689-8</identifier><identifier>PMID: 38424347</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject><![CDATA[Adolescent ; Adult ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - therapeutic use ; Buprenorphine ; Buprenorphine - administration & dosage ; Buprenorphine - therapeutic use ; Cross-Over Studies ; Drug abuse ; Drug addiction ; Female ; Fertility ; Humans ; Insurance ; Internal Medicine ; Medicine ; Medicine & Public Health ; Methadone ; Methadone - administration & dosage ; Methadone - therapeutic use ; Naltrexone ; Naltrexone - administration & dosage ; Naltrexone - therapeutic use ; Narcotic Antagonists - administration & dosage ; Narcotic Antagonists - therapeutic use ; Narcotics ; Opiate Substitution Treatment - methods ; Opioid-Related Disorders - drug therapy ; Opioid-Related Disorders - epidemiology ; Opioids ; Original Research ; Pregnancy ; Pregnancy Complications - drug therapy ; Pregnancy Rate ; Retrospective Studies ; Substance use disorder ; United States - epidemiology ; Young Adult]]></subject><ispartof>Journal of general internal medicine : JGIM, 2024-06, Vol.39 (8), p.1342-1348</ispartof><rights>The Author(s), under exclusive licence to Society of General Internal Medicine 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Society of General Internal Medicine.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-a55d33e69d04218062740290d93d4ada5ff69a4667f56910abe5fb7fbdbc2a4c3</cites><orcidid>0000-0002-0323-0624</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38424347$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bello, Jennifer K.</creatorcontrib><creatorcontrib>Xu, Kevin Y.</creatorcontrib><creatorcontrib>Salas, Joanne</creatorcontrib><creatorcontrib>Bedrick, Bronwyn S.</creatorcontrib><creatorcontrib>Grucza, Richard A.</creatorcontrib><title>Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>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. 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dosage</topic><topic>Naltrexone - therapeutic use</topic><topic>Narcotic Antagonists - administration &amp; dosage</topic><topic>Narcotic Antagonists - therapeutic use</topic><topic>Narcotics</topic><topic>Opiate Substitution Treatment - methods</topic><topic>Opioid-Related Disorders - drug therapy</topic><topic>Opioid-Related Disorders - epidemiology</topic><topic>Opioids</topic><topic>Original Research</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - drug therapy</topic><topic>Pregnancy Rate</topic><topic>Retrospective Studies</topic><topic>Substance use disorder</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bello, Jennifer K.</creatorcontrib><creatorcontrib>Xu, Kevin Y.</creatorcontrib><creatorcontrib>Salas, Joanne</creatorcontrib><creatorcontrib>Bedrick, Bronwyn S.</creatorcontrib><creatorcontrib>Grucza, Richard A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bello, Jennifer K.</au><au>Xu, Kevin Y.</au><au>Salas, Joanne</au><au>Bedrick, Bronwyn S.</au><au>Grucza, Richard A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2024-06-01</date><risdate>2024</risdate><volume>39</volume><issue>8</issue><spage>1342</spage><epage>1348</epage><pages>1342-1348</pages><issn>0884-8734</issn><issn>1525-1497</issn><eissn>1525-1497</eissn><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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>38424347</pmid><doi>10.1007/s11606-024-08689-8</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0323-0624</orcidid></addata></record>
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subjects Adolescent
Adult
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Buprenorphine
Buprenorphine - administration & dosage
Buprenorphine - therapeutic use
Cross-Over Studies
Drug abuse
Drug addiction
Female
Fertility
Humans
Insurance
Internal Medicine
Medicine
Medicine & Public Health
Methadone
Methadone - administration & dosage
Methadone - therapeutic use
Naltrexone
Naltrexone - administration & dosage
Naltrexone - therapeutic use
Narcotic Antagonists - administration & dosage
Narcotic Antagonists - therapeutic use
Narcotics
Opiate Substitution Treatment - methods
Opioid-Related Disorders - drug therapy
Opioid-Related Disorders - epidemiology
Opioids
Original Research
Pregnancy
Pregnancy Complications - drug therapy
Pregnancy Rate
Retrospective Studies
Substance use disorder
United States - epidemiology
Young Adult
title Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder
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