Admissions for Treatment of Opioid Use Disorder at a Safety-net Hospital Labor and Delivery Unit in San Francisco

Pregnant and postpartum individuals' opioid overdose rates in the United States continue to rise, despite having safe and effective treatments in pregnancy and postpartum. This study examines the role of inpatient admissions to labor and delivery units for initiating or titrating medication for opioid use disorders (MOUD).

We conducted a retrospective review of all pregnant and postpartum (up to 1 y) patients admitted to a public safety-net hospital in San Francisco, for MOUD initiation or titration from 2019 to 2023. We excluded patients stable on MOUD.

Among 124 individuals, 130 pregnancies met inclusion criteria. Ninety percent of individuals were unstably housed or homeless, and 78% had mental illness. The majority of patients (82%) initiated methadone and 18% initiated buprenorphine. The median admission length was 6 days. Patients were initiated or titrated on MOUD a median of 2 times during pregnancy/postpartum. Those with fentanyl OUD (defined as fentanyl being the primary opioid used) required longer admissions and higher MOUD doses compared with non-fentanyl OUD, and were more likely to initiate methadone over buprenorphine. The majority of patients experienced child protective services (CPS) involvement (79%), remained united as a parent-infant dyad at discharge (57%), and transitioned directly to residential treatment (63%).

In this study, admissions for opioid use complicating pregnancy increased among a diverse population with high rates of homelessness and mental illness. Inpatient labor and delivery units serve as critical access points for OUD treatment in the perinatal period, particularly for individuals facing structural barriers to care.