Comparison of Pregnancy Complication Rates: Does Opioid Agonist Pharmacotherapy Make A Difference?

Background: Over the past decade, the prevalence of opioid use disorder (OUD) in pregnant patients has increased by 131% with an associated increase in pregnancy complications. Opioid agonist pharmacotherapy (OAP) with methadone or buprenorphine is recommended by ACOG for the management of OUD. The objectives of our study are to compare the incidence of pregnancy complications among patients who at the time of their delivery used OAP, OAP plus any additional substance (OAP+), illicit or prescribed opioids, and no opioids. Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA, between January 1, 2018, through December 31, 2020, to compare the incidence of nine pregnancy complications in patients who at the time of their delivery were using OAP, OAP+, illicit or prescribed opioids, and no opioids. The data was analyzed with Chi-squared tests and a Bonferroni correction of the p-value was used to adjust for comparison of the rates. The significance level used was p ≤ 0.025. Results: There were 1979 deliveries during the 3-year study period with a total complication incidence of 23%. The complication incidence was 11% for OAP, 15% for OAP+, 42% for illicit or prescribed opioids, and 24% for no opioids. The incidence of complications in the OAP group was significantly lower than the incidence in the no opioids group (11% vs 24%, p = 0.01). There was no significant difference in the comparisons between other groups. Discussion: Our study investigated nine pregnancy complications; no other single study included all of these complications. Patients who used OAP had a significantly lower incidence of pregnancy complications compared to those who used no opioids. A multisite cohort study showed a low incidence of placental abruption in patients using methadone (3%), which was a similar outcome to the MOTHER study (2.3%) and our study (1.4%). The results of this research could assist providers in counseling their patients on the use of OAP in pregnancy.