Contraception, Unintended Pregnancy and Substance Use Disorder

Abstract

Background

Little is known about how unintended pregnancy (UIP) and substance use disorder (SUD) intersect to impact pregnancy and birth outcomes. In Australia, little is documented about rate of SUD in pregnant women, their risk of UIP, and interventions to increase access to contraception and reduce UIP for women with SUD.

Methods

A scoping review investigated the impact of UIP on outcomes in women who use alcohol and other drugs (AOD). Retrospective cohort studies using maternity datasets examined the rate of SUD in pregnancy, and in those with SUD, the rate of UIP, the association on pregnancy and birth outcomes, and initiation of postpartum contraception in hospital. Finally, a pilot study tested a contraception pathway at NSW AOD services.

Results

No existing studies were identified examining the relationship between UIP and AOD use on pregnancy and birth outcomes. Using maternity datasets 0.8% of pregnant women had a SUD. Of those, 73.9% had an UIP, which was associated with 2.27 the odds of a maternal, and 1.96 the odds of neonatal, length of stay >five days, and 0.69 the odds of use of intrapartum anaesthesia. More women with SUD (12.5%) initiated contraception in hospital than women without SUD (1.4%). At AOD treatment services 28.1% of those not planning to conceive initiated highly reliable contraception, with unequal distribution amongst study sites.

Conclusions

The intersection between UIP and AOD use on outcomes is poorly understood. In women with SUD, UIP was not associated with most pregnancy and birth outcomes. Less than 1% of SUD in pregnant women in NSW have a known SUD, and most of these have an UIP. Whilst initiation of postpartum contraception in hospital was highest in women with SUD, it was low in all women, suggesting maternity services may not focus on provision of contraception. Contraception pathways in Australian AOD treatment services can improve access, however differences between study sites require further evaluation.