Racial and Ethnic Inequities in the Receipt of Medications to Treat Opioid Use Disorder Among Pregnant People: A Meta-Analysis

Objectives: The aim of this meta-analysis is to examine inequities in the receipt of medications for opioid use disorder (MOUD) by race and ethnicity among pregnant people. Methods: PubMed and Embase were searched for studies examining the relationship between race and ethnicity and the receipt of MOUD during pregnancy. Studies were included if they were observational in nature and reported sufficient data to ascertain effect measures. Random-effects meta-analyses were conducted to estimate the pooled odds ratios (OR) with 95% CIs. Results: Fourteen studies were included with data on 157,208 individuals. Receipt of MOUD among Black (pooled OR: 0.35, 95% CI: 0.23, 0.55) and Hispanic (pooled OR: 0.60, 95% CI: 0.40, 0.89) pregnant people was significantly lower compared to their White counterparts. Among all other racial and ethnic categories, receipt of MOUD was nonsignificantly lower compared to White pregnant people (pooled OR: 0.79, 95% CI: 0.56, 1.12). Ten studies utilized self-reported race and ethnicity, and 3 studies reported data on well-defined racial and ethnic categories outside of White, Black, and Hispanic. Conclusions: There is strong evidence of racial and ethnic inequities in the receipt of MOUD during pregnancy. We hypothesize these inequities to be caused by structural and interpersonal racism impacting the quality of care for pregnant people with opioid use disorder. Increased use of self-identified race and ethnicity alongside improved reporting of racial and ethnic categories beyond Black, White, and Hispanic is needed in future research to better understand and measure constructs related to racism.