476 - Relationship Between Perceived Stigma and Health Care Delays Among Pregnant Women With Opioid Use Disorder

Poster Number: 476
Publication Number: 476.129

Carla Bann, RTI International, Research Triangle Park, NC, United States; Jamie E. Newman, RTI International, Carrboro, NC, United States; Brenda Poindexter, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, United States; Sara B. DeMauro, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Scott A. Lorch, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Myriam Peralta-Carcelen, The University of Alabama at Birmingham, Birmingham, AL, United States; Deanne Wilson-Costello, Rainbow Babies and Children's Hospital, Cleveland, OH, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States; Catherine Limperopoulos, Children's National Health System, Washington, DC, United States; Leslie A. Clarke, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Stephanie L. Merhar, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Stigma around substance use can prevent individuals with substance use disorder from disclosing their conditions to health care professionals and serve as a barrier to seeking needed treatment and medical care. Pregnant women may be particularly vulnerable to this type of stigma because their substance use could impact not only their own health, but that of their unborn child. Given current rates of neonatal opioid withdrawal syndrome, more information is needed regarding stigma experienced by pregnant women with opioid use disorder (OUD).

Objective: To examine perceptions and experiences of stigma in health care settings during pregnancy among mothers with opioid use disorder and whether stigma prevents them from receiving prenatal care.

Design/Methods: Analyses included 79 mothers of infants with antenatal opioid exposure enrolled in the ACT NOW Outcomes of Babies with Opioid Exposure study. Following delivery, new mothers were asked about their experiences with stigma in health care settings during pregnancy. Frequencies and percentages of responses to the 8 stigma items were computed. Chi-square tests were used to compare demographics and receipt of adequate prenatal care among women by reported stigma. Mothers were also asked an open-ended item about their experiences and concerns with how others would react to finding out about their opioid use during pregnancy.

Results: Mothers frequently delayed health care during pregnancy due to concerns about how they would be treated if providers discovered their opioid use (35%) and having to take a drug test (25%) (Table 1). Twenty-nine percent of mothers felt they could not talk to providers about their opioid use and 38% tried to avoid talking with providers about their opioid use to avoid being judged. Mothers with public insurance were more likely to delay getting care due to concerns about providers discovering their opioid use (p=0.019). Mothers who reported delaying care due to concerns about a drug test were less likely to have received adequate prenatal care (p=0.003) (Figure 1). Those who felt they could not talk to providers about their opioid use were less likely to have received adequate prenatal care (p < 0.001) as were those who avoided talking to providers due to worries about being judged (p=0.030). Illustrative verbatim responses to the open-ended question are presented (Table 2).Conclusion(s): Among mothers with OUD, stigma about their condition presented barriers to communication with health care providers regarding their opioid use and delays in seeking health care during pregnancy.
Table 1. Anticipated and Experienced Stigma in Health Care Settings among Mothers of Opioid-Exposed Infants (Nf79)
Table 2. Example Verbatim Responses to Open-Ended Stigma Question