Association between pregnancy intention and postpartum contraceptive interest among pregnant people with opioid use...

Identify sociodemographic and substance use characteristics associated with pregnancy intention and explore the relationship between pregnancy intent and postpartum contraception interest among pregnant individuals with opioid use disorder (OUD).

Secondary analysis of baseline data collected in the Medication Treatment for OUD in Expectant Mothers trial, which evaluated injectable versus sublingual buprenorphine. Current pregnancy intention was classified as "intended," "mistimed," "unwanted," or "ambivalent." Postpartum contraceptive interest was categorized into highly effective, effective, less effective, or none. Participant characteristics and contraceptive interest was compared across intention categories using Fisher's Exact and Kruskal-Wallis tests.

Of 155 participants who completed baseline screening, 137 (88%) did not report any contraceptive use prior to their current pregnancy. Twenty-eight percent reported intended pregnancies, 27% mistimed, 15% never wanted, and 30% were ambivalent towards their current pregnancy. Individuals reporting intended pregnancies disclosed less substance use in the past ninety days and twelve months compared to other categories. Forty-seven percent of participants desired highly effective contraception after delivery, 28% desired effective contraception, 4% desired less effective contraception, and 21% did not desire any contraception. Participants reporting an unwanted pregnancy were significantly more interested in sterilization, while participants reporting a mistimed pregnancy were significantly more interested in a postpartum long-acting reversible contraception.

Our findings that individuals with intended pregnancies report less recent substance use suggests that reproductive health decision-making may be difficult to prioritize during periods of active addiction. In addition, the lack of association between pregnancy intention and postpartum contraceptive interest underscores a need for novel ways to support perinatal individuals with OUD in family planning conversations that honor their reproductive autonomy, values, and desires.