title: Prenatal care, pregnancy outcomes, and postpartum birth control plans among pregnant women with opiate addictions.
abstract: OBJECTIVE
  To describe how effectively we provided adequate prenatal care and postpartum contraception to prevent repeat, unintended pregnancies to women using opiates or medication maintenance therapy (MMT) during pregnancy.
  
  
  METHODS
  We conducted a retrospective chart review of 94 women using opiates or MMT during 96 pregnancies while receiving prenatal care in the regional high-risk maternity care clinic between July 2010 and June 2012. We examined prenatal care usage, birth outcomes, and postpartum contraception using χ(2), Kruskal-Wallis, and binary logistic regression modeling.
  
  
  RESULTS
  Patients were predominately white (93.6%), multiparous (75.5%), and in their 20s; 71 (74%) used MMT and 25 (26%) used prescribed or illicit opiates. Fewer than half (44% [46.2%]) received any documented prenatal counseling about postpartum contraception. Sixteen (17%) babies were premature. Sixty-four (66.7%) infants were diagnosed as having neonatal abstinence syndrome (NAS). Only 42 (43.8%) women attended their postpartum visits. Overall, 60 (62.5%) women received postpartum contraception. The only significant predictors of postpartum contraception use were preterm birth and postpartum appointment attendance.
  
  
  CONCLUSIONS
  Alternative strategies for providing postpartum care should be explored because women using opiates or MMT during pregnancy are significantly more likely to use postpartum contraception if they attend their postpartum appointments.
authors.affiliation: From the Center for Research, Division of Family Medicine, and the Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, North Carolina.
authors.forename: Anna Beth
authors.initials: AB
authors.lastname: Parlier
authors.affiliation: From the Center for Research, Division of Family Medicine, and the Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, North Carolina.
authors.forename: Blake
authors.initials: B
authors.lastname: Fagan
authors.affiliation: From the Center for Research, Division of Family Medicine, and the Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, North Carolina.
authors.forename: Melinda
authors.initials: M
authors.lastname: Ramage
authors.affiliation: From the Center for Research, Division of Family Medicine, and the Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, North Carolina.
authors.forename: Shelley
authors.initials: S
authors.lastname: Galvin
mesh_terms: D003268:Contraception Behavior; D003376:Counseling; D005260:Female; D006801:Humans; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology; D009293:Opioid-Related Disorders; D011181:Postnatal Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D049168:Pregnancy, Unplanned; D011295:Prenatal Care