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Retention in opioid agonist treatment during pregnancy and variations according to treatment and maternal characteristics.

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Title: Retention in opioid agonist treatment during pregnancy and variations according to treatment and maternal characteristics.
Authors: Varney, Bianca, Jones, Nicola, Bharat, Chrianna, Brett, Jonathan, Degenhardt, Louisa, Oei, Ju‐Lee, Pearson, Sallie‐Anne, Havard, Alys, Tran, Duong T.
Source: Addiction. Jun2026, Vol. 121 Issue 6, p1520-1529. 10p.
Subjects: Methadone treatment programs, Research funding, Population-based case control, Drug addiction, Substance abuse treatment, Scientific observation, Logistic regression analysis, Psychology of women, Retrospective studies, Multivariate analysis, Descriptive statistics, Longitudinal method, Odds ratio, Opioid analgesics, Medical records, Acquisition of data, Treatment programs, Confidence intervals, Data analysis software, Buprenorphine, Pregnancy
Geographic Terms: New South Wales
Abstract: Background and aims: To measure the proportion of women in New South Wales, Australia, retained in opioid agonist treatment (OAT) for opioid dependence (OD) during pregnancy and examine how this varies according to treatment and maternal characteristics. Design: Retrospective cohort study using linked population‐based data, including OAT records, perinatal, hospital admissions, mental health outpatient services and criminal justice data. Setting: New South Wales, Australia, January 2004–December 2021. Participants: Pregnancies resulting in childbirth among women receiving OAT during pregnancy. The cohort included 4472 pregnancies among 2821 women receiving OAT during pregnancy. Measurements We defined retention as continuous receipt of OAT from the date of OAT initiation during pregnancy or date of conception (whichever came last) until childbirth. We calculated the proportion of women retained in treatment and 95% confidence intervals (CI) overall, by timing of initiation (pre‐conception, first, second and third trimester) and medication type (methadone, buprenorphine) at initiation. We used logistic regression to assess retention variation according to maternal socio‐demographic and clinical factors, including morbidities commonly co‐occurring with OD, stratified by timing of initiation. Data on dosing, other substance use and psychopharmacological medications were unavailable. Findings OAT was initiated pre‐conception in 74.8% (3346) of pregnancies, during the first trimester in 11.1% (n = 497), second trimester in 8.8% (n = 394) and third trimester in 5.3% (n = 237). Overall, women were retained in OAT for 84.3% (3771) of all pregnancies. Retention was 87.4% (95% CI = 86.3–88.6) with pre‐conception initiation; 65.8% (95% CI = 61.6–70.0) in the first trimester; 80.5% (95% CI = 76.5–84.4) second trimester; and 85.2% (95% CI = 80.8–89.7) third trimester. Retention was 72.4% (95% CI = 69.5–75.3) with buprenorphine and 87.7% (95% CI = 86.6–88.9) with methadone. Pregnancies delivered during 2019–2021 were less likely to be retained in treatment compared with those delivered during 2004–2006, regardless of the timing of initiation [pre‐conception initiation odds ratio (OR) = 0.49, 95% CI = 0.30–0.79; first trimester initiation OR = 0.29, 95% CI = 0.08–1.07; second/third trimester initiation OR = 0.29, 95% CI = 0.10–0.91). Among women who initiated OAT pre‐conception, retention was lower among those whose first antenatal visit occurred after 20 gestational weeks (OR = 0.68, 95% CI = 0.53–0.86), those in their first (OR = 0.72, 95% CI = 0.54–0.97) or second pregnancy (OR = 0.73, 95% CI = 0.56–0.96) and those who initiated on buprenorphine (OR = 0.31, 95% CI = 0.24–0.40) or in a custodial setting (OR = 0.66, 95% CI = 0.44–1.01). Conclusions: In New South Wales, Australia, from 2004 to 2021, over 84% of women receiving opioid agonist treatment during pregnancy were retained in treatment until childbirth; however, lower retention in later study years and among women initiating buprenorphine, coupled with recent guidelines recommending buprenorphine as first‐line therapy during pregnancy, highlights the need for ongoing monitoring and targeted support to improve retention among women who are at higher risk of discontinuation. [ABSTRACT FROM AUTHOR]
Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Retention in opioid agonist treatment during pregnancy and variations according to treatment and maternal characteristics.
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  Data: <searchLink fieldCode="AR" term="%22Varney%2C+Bianca%22">Varney, Bianca</searchLink><br /><searchLink fieldCode="AR" term="%22Jones%2C+Nicola%22">Jones, Nicola</searchLink><br /><searchLink fieldCode="AR" term="%22Bharat%2C+Chrianna%22">Bharat, Chrianna</searchLink><br /><searchLink fieldCode="AR" term="%22Brett%2C+Jonathan%22">Brett, Jonathan</searchLink><br /><searchLink fieldCode="AR" term="%22Degenhardt%2C+Louisa%22">Degenhardt, Louisa</searchLink><br /><searchLink fieldCode="AR" term="%22Oei%2C+Ju‐Lee%22">Oei, Ju‐Lee</searchLink><br /><searchLink fieldCode="AR" term="%22Pearson%2C+Sallie‐Anne%22">Pearson, Sallie‐Anne</searchLink><br /><searchLink fieldCode="AR" term="%22Havard%2C+Alys%22">Havard, Alys</searchLink><br /><searchLink fieldCode="AR" term="%22Tran%2C+Duong+T%2E%22">Tran, Duong T.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Addiction%22">Addiction</searchLink>. Jun2026, Vol. 121 Issue 6, p1520-1529. 10p.
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  Data: <searchLink fieldCode="DE" term="%22Methadone+treatment+programs%22">Methadone treatment programs</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Population-based+case+control%22">Population-based case control</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+addiction%22">Drug addiction</searchLink><br /><searchLink fieldCode="DE" term="%22Substance+abuse+treatment%22">Substance abuse treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Scientific+observation%22">Scientific observation</searchLink><br /><searchLink fieldCode="DE" term="%22Logistic+regression+analysis%22">Logistic regression analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Psychology+of+women%22">Psychology of women</searchLink><br /><searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br /><searchLink fieldCode="DE" term="%22Multivariate+analysis%22">Multivariate analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Opioid+analgesics%22">Opioid analgesics</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+records%22">Medical records</searchLink><br /><searchLink fieldCode="DE" term="%22Acquisition+of+data%22">Acquisition of data</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+programs%22">Treatment programs</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Buprenorphine%22">Buprenorphine</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22New+South+Wales%22">New South Wales</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Background and aims: To measure the proportion of women in New South Wales, Australia, retained in opioid agonist treatment (OAT) for opioid dependence (OD) during pregnancy and examine how this varies according to treatment and maternal characteristics. Design: Retrospective cohort study using linked population‐based data, including OAT records, perinatal, hospital admissions, mental health outpatient services and criminal justice data. Setting: New South Wales, Australia, January 2004–December 2021. Participants: Pregnancies resulting in childbirth among women receiving OAT during pregnancy. The cohort included 4472 pregnancies among 2821 women receiving OAT during pregnancy. Measurements We defined retention as continuous receipt of OAT from the date of OAT initiation during pregnancy or date of conception (whichever came last) until childbirth. We calculated the proportion of women retained in treatment and 95% confidence intervals (CI) overall, by timing of initiation (pre‐conception, first, second and third trimester) and medication type (methadone, buprenorphine) at initiation. We used logistic regression to assess retention variation according to maternal socio‐demographic and clinical factors, including morbidities commonly co‐occurring with OD, stratified by timing of initiation. Data on dosing, other substance use and psychopharmacological medications were unavailable. Findings OAT was initiated pre‐conception in 74.8% (3346) of pregnancies, during the first trimester in 11.1% (n = 497), second trimester in 8.8% (n = 394) and third trimester in 5.3% (n = 237). Overall, women were retained in OAT for 84.3% (3771) of all pregnancies. Retention was 87.4% (95% CI = 86.3–88.6) with pre‐conception initiation; 65.8% (95% CI = 61.6–70.0) in the first trimester; 80.5% (95% CI = 76.5–84.4) second trimester; and 85.2% (95% CI = 80.8–89.7) third trimester. Retention was 72.4% (95% CI = 69.5–75.3) with buprenorphine and 87.7% (95% CI = 86.6–88.9) with methadone. Pregnancies delivered during 2019–2021 were less likely to be retained in treatment compared with those delivered during 2004–2006, regardless of the timing of initiation [pre‐conception initiation odds ratio (OR) = 0.49, 95% CI = 0.30–0.79; first trimester initiation OR = 0.29, 95% CI = 0.08–1.07; second/third trimester initiation OR = 0.29, 95% CI = 0.10–0.91). Among women who initiated OAT pre‐conception, retention was lower among those whose first antenatal visit occurred after 20 gestational weeks (OR = 0.68, 95% CI = 0.53–0.86), those in their first (OR = 0.72, 95% CI = 0.54–0.97) or second pregnancy (OR = 0.73, 95% CI = 0.56–0.96) and those who initiated on buprenorphine (OR = 0.31, 95% CI = 0.24–0.40) or in a custodial setting (OR = 0.66, 95% CI = 0.44–1.01). Conclusions: In New South Wales, Australia, from 2004 to 2021, over 84% of women receiving opioid agonist treatment during pregnancy were retained in treatment until childbirth; however, lower retention in later study years and among women initiating buprenorphine, coupled with recent guidelines recommending buprenorphine as first‐line therapy during pregnancy, highlights the need for ongoing monitoring and targeted support to improve retention among women who are at higher risk of discontinuation. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/add.70325
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        Text: English
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      – SubjectFull: Methadone treatment programs
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      – SubjectFull: Population-based case control
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      – SubjectFull: Drug addiction
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Longitudinal method
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      – SubjectFull: Odds ratio
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      – SubjectFull: Opioid analgesics
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      – SubjectFull: New South Wales
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