EXPLORING UNINTENDED PREGNANCY AMONG WOMEN WITH … · EXPLORING UNINTENDED PREGNANCY AMONG WOMEN...

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HYPOTHESIS

This is an observational study using retrospective chart reviews to collect electronic

health record (EHR) data.

Primary chart reviews were conducted by family medicine residents, OMSIII & OMSIV

from University of New England College of Osteopathic Medicine (UNECOM), along with

undergraduate students from Colby College, over a 4-year period.

Secondary chart reviews were conducted by resident & attending physicians to ensure

data integrity.

SETTING

Among reproductive-age female patients of two central

Maine family medicine practices, those with a diagnosis

of opiate dependency experience unplanned pregnancy

more than those without this diagnosis.

We are exploring the following questions:

1. Are there differences in the incidence of planned vs.

unplanned pregnancy that are associated with being in

active substance abuse treatment versus not in

substance abuse treatment?

2. Are there differences in the incidence of planned vs.

unplanned pregnancy that are associated with type of

current opiate dependence treatment (buprenorphine vs.

methadone)?

3. Are other variables associated with unintentional

pregnancy, such as mental health conditions, age,

gravidity/parity, or payer (federal, commercial, self-pay)?

Maine-Dartmouth Family Medicine Residency clinics serve patients across central Maine:

POPULATION: Female patients, 18 – 40 years old (Date of birth 1/1/95-12/31/75),

positive pregnancy test 1/1/2013 – 12/31/2015

SELECTION: 1024 potential patients identified using billing charges and problem

lists, with 960 found to fit inclusion criteria. In order to be eligible, women had to be

patients of either the FMI or MDFP practice at the time of the positive pregnancy test,

so further exclusion of ineligible charts was determined through primary and

secondary chart reviews. Of the 828 primary chart reviews completed, a random

sample of 323 pregnancies were selected for secondary review with 251 found to be

eligible and 72 found to be ineligible, and this sample was used for this preliminary

data analysis.

METHODS

CLICK HERE FOR MORE INFORMATION

EXPLORING UNINTENDED PREGNANCY AMONG WOMEN WITH OPIATE DEPENDENCE Kelley Harmon DO1, Nancy Fischer MPH1, Maggie White2, Meghan May PhD3, Caroline LaFave DO1, Samantha Stephen OMSIV 3

1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME

Maine-Dartmouth Family Practice

(MDFP), Waterville, ME

Family Medicine Institute (FMI),

Augusta, ME

BACKGROUND: The opiate epidemic has greatly impacted our local communities in

central Maine. Of infants born in Maine in 2015, 995 of ~12,400 births were substance

exposed, representing 8% of births and requiring longer hospital stays adding significant

financial and social cost to our state. 1 Among opiate users, contraception utilization is low,

and 87% of births are unplanned. 2 Lundsberg et al. (2018) found that opioid use in the

month before conception led to a nearly 3-fold greater risk of poorly timed or unplanned

pregnancy compared to those who did not use opioids.3

RATIONALE: This retrospective study is designed to collect baseline data on unintended

pregnancy and associated characteristics in women with opiate use disorder (OUD) in our

family practice settings. We anticipate this data will inform future interventions that could

ultimately improve maternal, fetal and newborn health in the setting of OUD and related

co-morbidities. This study values the first of the Tenets of Osteopathy which recognizes

the importance of considering the body as a unit, including body, mind and spirit. 4

BACKGROUND

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EXPLORING UNINTENDED PREGNANCY AMONG WOMEN WITH OPIATE DEPENDENCE Kelley Harmon DO1, Nancy Fischer MPH1, Maggie White2, Meghan May PhD3, Caroline LaFave DO1, Samantha Stephen OMSIV3


REFERENCES 1.Maine Department of Health and Human Services Office of Substance Abuse and Mental Health Services. Substance Abuse Trends in Maine: State Epidemiological Profile 2014. South Portland, ME: Hornby Zeller Associates, Inc. Available from: http://www.maine.gov/dhhs/samhs/osa/pubs/data/2014/SA_Trends_2014.pdf

2. Heil SH, Jones HE, Arria A, et al. Unintended pregnancy in opioid-abusing women. Journal of Substance Abuse Treatment. 2011;40(2):199-202. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/

3. Lundsberg LS, Peglow S, Qasba N, Yonkers KA, Gariepy AM. Is preconception substance use associated with unplanned or poorly timed pregnancy? J Addict Med 2018; 12(4): 321-328.

4. https://osteopathic.org/about/leadership/aoa-governance-documents/tenets-of-osteopathic-medicine/

5. Hall KS, Jones HE, Arria A, et al. Unintended pregnancy in opioid-abusing women. Journal of Substance Abuse Treatment. 2011; 40(2): 199-202. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/

Preliminary results found significantly more pregnancies were unplanned

among opiate dependent women than among women without opiate

dependence.

(55% opiate dependent vs. 36% non-opiate dependent with P<0.002)

CLICK BOXES BELOW FOR MORE RESULTS. CLICK GRAPHS TO ENLARGE.

DATA ANALYSIS RESULTS & GRAPHS OTHER FINDINGS

RESULTS CONCLUSION

A random sample of 251 pregnancies suggests that unplanned

pregnancy in our patient population is more likely among women with

opiate dependence as compared to their peers without this diagnosis.

This research study is a work in progress, and further analysis of the

complete data is needed.

See additional conclusions by clicking HERE.

CLICK GRAPHS

TO ENLARGE

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Overall No OpioidDependence

OpioidDependence-In

Treatment

Opioid Dep-Not InTreatment

Opioid Dependence Care and Pregnancy Planning

Planned Unplanned Unknown

0%

10%

20%

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Overall No Opioid Dependence Opioid Dependence

Opioid Dependence and Pregnancy Planning


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwiBzrjxxMvkAhUPhuAKHaGoCc8QjRx6BAgBEAQ&url=https://www.pinterest.com/pin/531072981032838001/&psig=AOvVaw2lIYRp9rokaVPL259c70GS&ust=1568386426460803

METHODS

Study Design: Retrospective study involving a chart review of Maine

Dartmouth Family Practice (MDFP) and Family Medicine Institute

(FMI) patients, two residency-based practices in central Maine.

Report generated identifying all female patients between age 18 and

40 with confirmed pregnancy between Jan 1, 2013 and Dec 31, 2015.

• Collected variables:

• gravidity and parity

• ICD9/10 codes related to:

• substance use

• pregnancy

• mental illness

• patient-reported intentionality of pregnancy

• means of pregnancy diagnosis

Primary chart reviews were conducted by

• family medicine residents

• third and fourth-year UNECOM medical students

• undergraduate students at Colby College

Secondary chart reviews of completed chart reviews were

conducted by senior resident and attending physicians to ensure data

integrity. Back to Main Poster

Click for more Methods



Data Collection Sheet


METHODS

Back to Main Poster

Click for Data Analysis

Total Patients Identified

N= 960

Total Pregnancies Identified

N= 1,101

Primary Reviews conducted to

date

N = 828

Eligible pregnancies

N = 251



Random Sample of 323 charts for

Secondary Chart Review

Ineligible pregnancies

N= 72


DATA ANALYSIS

Back to Main Poster

Chi squared analysis was performed to explore the

intentionality of pregnancy stratified by the following variables:

• Age

• Opiate dependence

• Engagement in Medication Assisted Treatment (MAT)

• Type of active treatment (buprenorphine vs. methadone)

• Payer type (as proxy for income level: federal/self-

pay/commercial)

• Gravidity/Parity

• Presence/absence of co-occurring mental health

• Practice Location

• Pregnancy Outcome

A preliminary analysis of 251 charts (69 opiate-dependent, 182

non-opiate-dependent) has been conducted to date.




0%

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90%

100%

Overall No Opioid Dependence Opioid Dependence

Opioid Dependence and Pregnancy Planning


RESULTS

Back to Main Poster

More Results

78

104

69 57

66*

59

12**

38***

19

***P<0.002

**P<0.02

*P<0.05

This is a graphic representation of data comparing

planned versus unplanned pregnancy rates in those with

and without opioid dependence.

A significantly higher proportion of pregnancies among

opiate dependent women were unplanned than among

women without opiate dependence:

55% Unplanned in Opiate Dependent

vs.

36% Unplanned in Non-Opiate Dependent

(with P<0.002)




RESULTS

Back to Main Poster

More Results

Back 1 Slide Among women with opiate dependence, those who were not in medication assisted

treatment were more likely to have an unplanned pregnancy (P<0.02).

***P <0.002

** P<0.02

* P<0.05

**



0%

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100%

Opioid Dependence-In Treatment Opioid Dependence-No Treatment



0%

10%

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30%

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100%

Overall No OpioidDependence

Opioid Dependence-In Treatment

Opioid Dep-Not InTreatment



*** ***

*** *

**


RESULTS

Back to Main Poster

More Results

Depression in Opiate Dependent Patients

Depression in Non-Opiate Dependent Patients

Anxiety in Opiate Dependent Patients

Anxiety in Non-Opiate Dependent Patients

Back 1 Slide

Women with opiate dependence appear to be more likely to have a diagnosis of

depression (55% in opiate dependent vs. 42% in non-opiate dependent)

And were significantly more likely to have a diagnosis of anxiety

(61% in opiate dependent vs. 39% non-opiate dependent).

Depression

55% N=38

No

Depression

45% N=31

Depression

42% N=76

No

Depression

58% N=105

Anxiety

61% N=42

No

Anxiety

39% N=27

Anxiety

39% N=71

No

Anxiety

61% N=110




RESULTS

Back to Main Poster

Back 1 Slide

More Results



0%

10%

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30%

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90%

100%

Pregnancy Outcomes

Unknown

7

17

177

5

13

125

11 16

28 34

52

5 6

4

2

Preterm Elective Termination Term Miscarriage

Pregnancy Outcomes between the Non-Opiate

Dependent and Opiate Dependent populations were

similar.

Overall No Opioid

Dependence Opioid Dependence


INTERESTING FINDINGS

Back to Main Poster

Back 1 Slide

Opiate Dependent

(N=69)

Non-opiate Dependent

(N=182)

Age 27.5 26.6

Multips 60 (87%) 134 (74%)

Primips 8 (12%) 44 (24%)

Public Insurance 56 (81%) 97 (54%)

Private

Insurance 8 (12%) 76 (42%)

No Insurance 5 (7%) 8 (4%)

Tobacco 51 (74%) 53 (29%)

Cannabis 20 (29%) 21 (12%)

Cocaine 8 (12%) 2 (1%)

Benzo 2 (3%) 1 (0.05%)

Alcohol 4 (6%) 10 (6%)

Despite a small N, our preliminary data describes some interesting trends which call for further exploration as we extend our

analysis to the complete data set.




CONCLUSION

Back to Main Poster

This study is a work in progress. The data we’ve gathered from a random

sample of 251 charts suggest the following preliminary results:

1) Unplanned pregnancy in our patient population is more likely among women

with opiate dependence as compared to their peers without this diagnosis.

2) Initial data analysis suggests a greater number of intentional pregnancies

among women with opiate dependence receiving medication assisted

treatment (MAT) for opiate use disorder compared to those not receiving

MAT at the time of pregnancy diagnosis.

3) The data suggest higher rates of anxiety among women with opiate

dependence, but analysis of the full data set is necessary to confirm a link

between opiate dependence and mental health diagnoses.

4) Analysis of the full data set is incomplete, so final conclusions cannot be

drawn at this time noting that observations may change and further study is

warranted.




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