CoChat
Sign Up
Cited by 69Opioid Use Disorder TreatmentPrenatal Substance Exposure EffectsSubstance Abuse Treatment and Outcomes

Methadone and buprenorphine discontinuation among postpartum women with opioid use disorder

Open access
Schiff, Davida M., Nielsen, Timothy C., Hoeppner, Bettina B., Terplan, Mishka, Hadland, Scott E., Bernson, Dana, Greenfield, Shelly F., Bernstein, Judith +5 more·2021·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2021.04.210PMC PMC8492487
Open this paper in CoChat — free account

Abstract

Background The postpartum year is a vulnerable period for women with opioid use disorder, with increased rates of fatal and nonfatal overdose; however, data on the continuation of medications for opioid use disorder on a population level are limited.Objective This study aimed to examine the effect of discontinuing methadone and buprenorphine in women with opioid use disorder in the year following delivery and determine the extent to which maternal and infant characteristics are associated with time to discontinuation of medications for opioid use disorder.Study design This population-based retrospective cohort study used linked administrative data of 211,096 deliveries in Massachusetts between 2011 and 2014 to examine the adherence to medications for opioid use disorder. Individuals receiving medications for opioid use disorder after delivery were included in the study. Here, demographic, psychosocial, prenatal, and delivery characteristics are described. Kaplan-Meier survival analysis and Cox regression modeling were used to examine factors associated with medication discontinuation.Results A total of 2314 women who received medications for opioid use disorder at delivery were included in our study. Overall, 1484 women (64.1%) continued receiving medications for opioid use disorder for a full 12 months following delivery. The rate of continued medication use varied from 34% if women started on medications for opioid use disorder the month before delivery to 80% if the medications were used throughout pregnancy. Kaplan-Meier survival curves differed by maternal race and ethnicity (the 12-month continuation probability was .65 for White non-Hispanic women and .51 for non-White women; P<.001) and duration of use of prenatal medications for opioid use disorder (12-month continuation probability was .78 for women with full prenatal engagement and .60 and .44 for those receiving medications for opioid use disorder ≥5 months [but not throughout pregnancy] and ≤4 months prenatally, respectively; P<.001). In all multivariable models, duration of receipt of prenatal medications for opioid use disorder (≤4 months vs throughout pregnancy: adjusted hazard ratio, 3.26; 95% confidence interval, 2.72-3.91) and incarceration (incarceration during pregnancy or after delivery vs none: adjusted hazard ratio, 1.79; 95% confidence interval, 1.52-2.12) were most strongly associated with the discontinuation of medications for opioid use disorder.Conclusion Almost two-thirds of women with opioid use disorder continued using medications for opioid use disorder for a full year after delivery; however, the rates of medication continuation varied significantly by race and ethnicity, degree of use of prenatal medications for opioid use disorder, and incarceration status. Prioritizing medication continuation across the perinatal continuum, enhancing sex-specific and family-friendly recovery supports, and expanding access to medications for opioid use disorder despite being incarcerated can help improve postpartum medication adherence.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.ajog.2021.04.210

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Retention in opioid use disorder treatment is low and decreases most precipitously during the early postpartum period.

    “Even when treatment is initiated, retention in treatment is low, decreasing most precipitously during the early postpartum period [2–6].”

    From Mindful moms: acceptability and impact of co-designed and digitally delivered video meditations for pregnant and parenting women with opioid use disorder (2025) · cites this paper as [5]

    The Results (Study Characteristics; page not provided) report that 35.9% of women receiving medication for opioid use disorder at delivery discontinued it within the postpartum year, supporting a concern about retention. However, 64.1% continued for the full year, and the Results (Postpartum Monthly MOUD Discontinuation; page not provided) do not establish that retention fell most precipitously in the early postpartum period. Calling retention generally low also overstates this cohort’s finding. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 48 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [4]Hogan L, Rutherford BK, Schrader DR. Maryland Maternal Mortality Review 2016 Annual Report Health – General Article 13- 1203– 1207.
  2. [5]Kavanaugh V Pregnancy-Associated Deaths From Drug Overdose in Virginia, 1999-2007: A Report from the Virginia Maternal Mortality Review Team.; 2015.
  3. [27]Peles E, Schreiber S, Bloch M, Dollberg S, Adelson M. Duration of Methadone Maintenance Treatment During Pregnancy and Pregnancy Outcome Parameters in Women With Opiate Addiction. J Addict Med. 2012; 6(1): 18– 23. doi: 10.1097/ADM.0b013e318229bb25 21817914 · DOI

Cited by

Sorted by citations

Related

Authors
Schiff, D. M., Nielsen, T. C., Hoeppner, B. B., Terplan, M., Hadland, S. E., Bernson, D., Greenfield, S. F., Bernstein, J., Bharel, M., Reddy, J., Taveras, E. M., Kelly, J. F., & Wilens, T. E.
Affiliations
  • Harvard University (US)
  • The University of Sydney (AU)
  • Massachusetts General Hospital (US)
  • Friends Research Institute (US)
  • Boston University (US)
  • Massachusetts Department of Public Health (US)
Corresponding author
Schiff, Davida M.
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2021-10
Volume
225
Issue
4
Pages
424.e1-424.e12
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2021.04.210
PMC
PMC8492487
OpenAlex
W3156888684
Cited by
69
References
48
Citations by year
2026: 9 · 2025: 13 · 2024: 15 · 2023: 20 · 2022: 10 · 2021: 2
FWCI
10.16
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institute on Drug Abuse (K12 DA043490, K23DA045085, K23DA048169, L40DA042434)
  • National Institute on Alcohol Abuse and Alcoholism (K24AA022136)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK105989, R01 DA050252)
  • Major League Baseball
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
opioid use disorder, methadone, buprenorphine, drug discontinuation, postpartum women, maternal opioid treatment, incarceration, maternal race/ethnicity, opioid overdose, pregnancy outcomes, medication adherence, criminal justice involvement, infant outcomes, maternal mortality, maternal morbidity
MeSH terms
Correctional Facilities, Adult, Analgesics, Opioid, Black or African American, Buprenorphine, Ethnicity, Female, Hispanic or Latino, Humans, Methadone, Opioid-Related Disorders, Pregnancy, Pregnancy Complications, Proportional Hazards Models, Drug Monitoring, White People, Postpartum Period, Kaplan-Meier Estimate, Young Adult, Opiate Substitution Treatment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review