Trajectories of Medication Utilization for Opioid Use Disorder in Pregnancy and Associated Maternal Outcomes

To characterize distinct medications for opioid use disorder (MOUD) trajectories during pregnancy and evaluate their associations with adverse perinatal maternal outcomes.

A retrospective cohort study was conducted among Wisconsin Medicaid-covered singleton births from 2011 to 2019. Primary outcomes were intensive care unit (ICU) admission, an emergency department (ED) visit, and severe maternal morbidity (SMM) from delivery through 6 weeks postpartum. Weekly MOUD use during gestation was classified into trajectories by using repeated measures latent class analysis. Associations between MOUD trajectory and outcomes were estimated by using logistic regression after propensity score matching.

Of 4,442 pregnant individuals with opioid use disorder, 2,944 (66.3%) received MOUD and 1,498 (33.7%) did not receive MOUD. Four trajectories were identified: 1) consistent treatment (n=1,387), 2) early initiation (n=596), 3) late initiation (n=481), and 4) declining treatment (n=480). Compared with the consistent treatment, early initiation was not significantly associated with ICU admission, ED visits, or SMM. Late initiation was associated with higher odds of ED visits (adjusted odds ratio [aOR] 1.28; 95% CI, 1.01-1.63), and declining treatment was associated with higher odds of ICU admission (aOR 2.70; 95% CI, 1.26-5.76), ED visits (aOR 1.26; 95% CI, 1.00-1.59), and SMM (aOR 2.16; 95% CI, 1.10-4.21). No MOUD was associated with higher odds of ED visits (aOR 2.00; 95% CI, 1.67-2.39) and SMM (aOR 1.67; 95% CI, 1.07-2.63) compared with consistent treatment.

Consistent treatment and early initiation of MOUD were associated with the most favorable maternal outcomes, whereas late initiation, declining engagement, or no treatment corresponded to higher odds of adverse outcomes. Findings support efforts to initiate MOUD early in pregnancy and maintain continuity through gestation.