PDF(Pubmed)
Abstract：
BACKGROUND: The number of pregnant women with opioid use disorder (OUD) has increased over time. Although effective treatment options exist, little is known about the extent to which women receive treatment during pregnancy and at what stage of pregnancy care is initiated.
METHODS: Using a national private health insurance claims database, we identified women aged 13-49 who gave birth in 2006-2019 and had an OUD or nonfatal opioid overdose (NFOO) diagnosis during the year prior to or at delivery. We then identified women who received their first OUD treatment prior to or during pregnancy. In this cross-sectional study, we investigated how rates and timing of the initial OUD treatment changed over time. Furthermore, we examined factors associated with early initiation of OUD treatment among birthing people.
RESULTS: Of the 7057 deliveries from 6747 women with OUD or NFOO, 63.3 % received any OUD treatment. Rates of OUD treatment increased from 42.9 % in 2006 to 69 % in 2019. Of those treated, in 2006, 54.5 % received their first treatment prior to conception and 24.2 % initiated care during the 1st trimester. In 2019, 68.9 % received their first treatment prior to conception, and 15.1 % initiated care during the 1st trimester. The percentage of women who were first treated in the 2nd trimester or later decreased from 21.2 % in 2006 to 16.1 % in 2019. Factors associated with early treatment initiation include being 25 years or older (age 25-34: aOR, 1.51, 95 % CI, 1.28-1.78; age 35-49: aOR, 1.82, 95 % CI, 1.39-2.37), living in urban areas (aOR, 1.28; 95 % CI, 1.05-1.56), having pre-existing behavioral health comorbidities such as anxiety disorders (aOR, 1.8; 95 % CI, 1.40-2.32), mood disorders (aOR, 1.63; 95 % CI, 1.02-2.61), and substance use disorder other than OUD (aOR, 2.56; 95 % CI, 2.03-3.32).
CONCLUSIONS: Overall, rates of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD/NFOO either received no treatment or did not initiate care until the 3rd trimester in 2019. Future research should examine barriers to OUD treatment initiation among pregnant women.
METHODS: Using a national private health insurance claims database, we identified women aged 13-49 who gave birth in 2006-2019 and had an OUD or nonfatal opioid overdose (NFOO) diagnosis during the year prior to or at delivery. We then identified women who received their first OUD treatment prior to or during pregnancy. In this cross-sectional study, we investigated how rates and timing of the initial OUD treatment changed over time. Furthermore, we examined factors associated with early initiation of OUD treatment among birthing people.
RESULTS: Of the 7057 deliveries from 6747 women with OUD or NFOO, 63.3 % received any OUD treatment. Rates of OUD treatment increased from 42.9 % in 2006 to 69 % in 2019. Of those treated, in 2006, 54.5 % received their first treatment prior to conception and 24.2 % initiated care during the 1st trimester. In 2019, 68.9 % received their first treatment prior to conception, and 15.1 % initiated care during the 1st trimester. The percentage of women who were first treated in the 2nd trimester or later decreased from 21.2 % in 2006 to 16.1 % in 2019. Factors associated with early treatment initiation include being 25 years or older (age 25-34: aOR, 1.51, 95 % CI, 1.28-1.78; age 35-49: aOR, 1.82, 95 % CI, 1.39-2.37), living in urban areas (aOR, 1.28; 95 % CI, 1.05-1.56), having pre-existing behavioral health comorbidities such as anxiety disorders (aOR, 1.8; 95 % CI, 1.40-2.32), mood disorders (aOR, 1.63; 95 % CI, 1.02-2.61), and substance use disorder other than OUD (aOR, 2.56; 95 % CI, 2.03-3.32).
CONCLUSIONS: Overall, rates of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD/NFOO either received no treatment or did not initiate care until the 3rd trimester in 2019. Future research should examine barriers to OUD treatment initiation among pregnant women.
摘要：
背景：患有阿片类药物使用障碍（OUD）的孕妇数量随着时间的推移而增加。尽管存在有效的治疗选择，关于妇女在怀孕期间接受治疗的程度以及开始怀孕护理的阶段知之甚少。
方法：使用国家私人健康保险索赔数据库，我们确定了年龄在13~49岁的女性,她们在2006~2019年分娩,并且在分娩前一年或分娩时诊断为OUD或非致命性阿片类药物过量(NFO).然后，我们确定了在怀孕前或怀孕期间接受首次OUD治疗的妇女。在这项横断面研究中，我们调查了初始OUD治疗的速率和时间如何随时间变化.此外，我们研究了与分娩者早期开始OUD治疗相关的因素。
结果：在6747名OUD或NFO妇女的7057次分娩中，63.3%接受过任何OUD治疗。OUD治疗率从2006年的42.9%上升到2019年的69%。在接受治疗的人中，2006年,54.5%的人在受孕前接受了首次治疗,24.2%的人在孕早期开始接受治疗.2019年，68.9%的人在受孕前接受了第一次治疗，15.1%在妊娠早期开始护理。在妊娠中期或之后首次接受治疗的女性比例从2006年的21.2％下降到2019年的16.1％。与早期开始治疗相关的因素包括25岁或以上(年龄25-34：aOR，1.51，95%CI，1.28-1.78；年龄35-49岁：aOR，1.82，95%CI，1.39-2.37），生活在城市地区(AOR，1.28；95%CI，1.05-1.56），具有预先存在的行为健康合并症，如焦虑症(AOR，1.8；95%CI，1.40-2.32），心境障碍（AOR，1.63；95%CI，1.02-2.61），和OUD以外的物质使用障碍(aOR，2.56；95%CI，2.03-3.32）。
结论：总体而言，OUD治疗率随着时间的推移而增加，更多的妇女在受孕前开始OUD治疗。尽管有这些改进,超过三分之一的OUD/NFOO孕妇在2019年妊娠晚期之前未接受治疗或未开始治疗.未来的研究应该检查孕妇开始OUD治疗的障碍。
方法：使用国家私人健康保险索赔数据库，我们确定了年龄在13~49岁的女性,她们在2006~2019年分娩,并且在分娩前一年或分娩时诊断为OUD或非致命性阿片类药物过量(NFO).然后，我们确定了在怀孕前或怀孕期间接受首次OUD治疗的妇女。在这项横断面研究中，我们调查了初始OUD治疗的速率和时间如何随时间变化.此外，我们研究了与分娩者早期开始OUD治疗相关的因素。
结果：在6747名OUD或NFO妇女的7057次分娩中，63.3%接受过任何OUD治疗。OUD治疗率从2006年的42.9%上升到2019年的69%。在接受治疗的人中，2006年,54.5%的人在受孕前接受了首次治疗,24.2%的人在孕早期开始接受治疗.2019年，68.9%的人在受孕前接受了第一次治疗，15.1%在妊娠早期开始护理。在妊娠中期或之后首次接受治疗的女性比例从2006年的21.2％下降到2019年的16.1％。与早期开始治疗相关的因素包括25岁或以上(年龄25-34：aOR，1.51，95%CI，1.28-1.78；年龄35-49岁：aOR，1.82，95%CI，1.39-2.37），生活在城市地区(AOR，1.28；95%CI，1.05-1.56），具有预先存在的行为健康合并症，如焦虑症(AOR，1.8；95%CI，1.40-2.32），心境障碍（AOR，1.63；95%CI，1.02-2.61），和OUD以外的物质使用障碍(aOR，2.56；95%CI，2.03-3.32）。
结论：总体而言，OUD治疗率随着时间的推移而增加，更多的妇女在受孕前开始OUD治疗。尽管有这些改进,超过三分之一的OUD/NFOO孕妇在2019年妊娠晚期之前未接受治疗或未开始治疗.未来的研究应该检查孕妇开始OUD治疗的障碍。
