Weighing Risks and Benefits: Patient Perceptions on Using Medications for Opioid Use Disorder During and After Pregnancy.

Abstract

Background: 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.