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35th AM (2025) - Poster Session
Gaps in Prescribing Methadone in Prenatal and Post ...
Gaps in Prescribing Methadone in Prenatal and Postpartum Woman With Opioid Use Disorder_A Systemic Review
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Pdf Summary
This systematic review examines disparities in methadone prescribing for prenatal and postpartum women with Opioid Use Disorder (OUD), focusing on racial and ethnic differences. Methadone is the primary and evidence-supported treatment during pregnancy; however, significant gaps exist in dosing equity. The review analyzed 10 cohort studies from 2010 to 2023, using data from electronic medical records and state datasets, focusing on White, Black, and Hispanic women with OUD.<br /><br />Findings reveal that women of color receive substantially less methadone at delivery compared to White women—67% less on average. Treatment rates were higher among White women (50%) than Black (32%) or Hispanic (28%) women. Women of color also faced systemic barriers such as mistrust of healthcare providers, fear of judgment, and delayed initiation of methadone, contributing to increased maternal morbidity and delivery complications.<br /><br />Quantitatively, average methadone doses at delivery were 144.9 mg for White women versus 105.8 mg for women of color, with race independently associated with dosing disparities even after adjusting for confounders like age, gestational age, BMI, opioid type, and parity. These dosing inequities suggest underlying provider bias and historical healthcare gaps.<br /><br />The study calls for individualized methadone dosing, universal OUD screening, and improved postpartum follow-up to address these disparities. Recommendations include provider training on implicit bias and cultural competence, alongside educational outreach in underserved communities, aiming to reduce racial disparities and ensure equitable care for all prenatal and postpartum women with OUD. Addressing such biases is critical to improve treatment outcomes and maternal health equity.
Keywords
methadone prescribing
prenatal women
postpartum women
Opioid Use Disorder
racial disparities
ethnic differences
treatment equity
maternal morbidity
provider bias
cultural competence
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