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
TAP TO GO
BACK TO
KIOSK MENU
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
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%
30%
40%
50%
60%
70%
80%
90%
100%
Overall No Opioid Dependence Opioid Dependence
Opioid Dependence and Pregnancy Planning
Planned Unplanned Unknown
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
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
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
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
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.
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Overall No Opioid Dependence Opioid Dependence
Opioid Dependence and Pregnancy Planning
Planned Unplanned Unknown
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)
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
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
**
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Opioid Dependence-In Treatment Opioid Dependence-No Treatment
Opioid Dependence Care and Pregnancy Planning
Planned Unplanned Unknown
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Overall No OpioidDependence
Opioid Dependence-In Treatment
Opioid Dep-Not InTreatment
Opioid Dependence Care and Pregnancy Planning
Planned Unplanned Unknown
*** ***
*** *
**
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
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
RESULTS
Back to Main Poster
Back 1 Slide
More Results
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
0%
10%
20%
30%
40%
50%
60%
70%
80%
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.
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME
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.
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
1 Maine-Dartmouth FMR, Augusta ME; 2 Colby College, Waterville ME; 3 University of New England COM, Biddeford ME