RECENT NATIONAL STUDY indicated that illicit drug use is 16.2% among pregnant teens and 7.4% among pregnant women aged 18 to 25 years. 1 Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome in newborns following birth. The syndrome most commonly occurs in the context of antepartum opiate use, although other drugs have also been implicated. [2][3][4][5] In addition to NAS, illicit drug use (specifically opioid dependence) during pregnancy is associated with a significantly increased risk of adverse neonatal outcomes such as low birthweight (Ͻ2500 g) and mortality. [6][7][8][9] Neonatal abstinence syndrome is characterized by a wide array of signs and symptoms including increased irritability, hypertonia, tremors, feeding intolerance, emesis, watery stools, seizures, and respiratory distress. 10 Symptoms of withdrawal associated with NAS have been described in 60% to 80% of newborns exposed to heroin or methadone in utero. 11 Recently, analyses from Australia 12 and the Florida Medicaid program (D. Aronberg, JD, written communication, November 30, 2011) found that the incidence of NAS has been increasing. To date, there are no national es-Author Affiliations are listed at the end of this article.

Objective Randomized controlled trials document the safety and efficacy of reduced frequency prenatal visit schedules and virtual visits, but real-world data are lacking. Our institution created a prenatal care delivery model incorporating these alternative approaches to continue safely providing prenatal care during the COVID-19 pandemic. Our objective was to evaluate institutional-level adoption and patient and provider experiences with the COVID-19 prenatal care model. Study Design We conducted a single-site evaluation of a COVID-19 prenatal care model incorporating a reduced frequency visit schedule and virtual visits deployed at a suburban academic institution on March 20, 2020. We used Electronic Health Record data to evaluate institution-level model adoption, defined as changes in overall visit frequency and proportion of virtual visits in the three months before and after implementation. To evaluate the patient and provider experience with the COVID-19 model, we conducted an online survey of all pregnant patients (>20 weeks gestation) and providers in May 2020. Three domains of care experience were evaluated: 1) access, 2) quality and safety, and 3) satisfaction. Quantitative data were analyzed with basic descriptive statistics. Free-text responses coded by the three survey domains elucidated drivers of positive and negative care experiences. Results Following COVID-19 model adoption, average weekly prenatal visit volume fell by 16.1%, from 898 to 761 weekly visits, the average weekly proportion of prenatal visits conducted virtually increased from 10.8% (97/898) to 43.3% (330/761), and the average visit no-show rate remained stable (4.3% pre-implementation; 4.2%, post-implementation). Of those eligible, 74.8% (77/103) of providers and 15.0% (253/1690) of patients participated in the surveys. Patient respondents were largely white (180/253, 71.1%) and privately insured (199/253, 78.7%), reflecting the study site population. Rates of chronic conditions and pregnancy complications also differed from national prevalence. Provider respondents were predominantly white (44/66, 66.7%) and female (50/66, 75.8%). Most patients and almost all providers reported that virtual visits improved access to care (patients: 68.8%, 174/253; providers: 74/77, 96.1%). Over half of respondents (patients: 124/253, 53.3%; providers: 41/77, 62.1%) believed virtual visits were safe. Nearly all believed home blood pressure cuffs were important for virtual visits (patients: 213/231, 92.2%; providers: 63/66, 95.5%). Most reported satisfaction with the COVID-19 model (patients: 196/253, 77.5%; providers: 64/77, 83.1%). In free-text responses, drivers of positive care experiences were similar for patients and providers, and included perceived improved access to care through decreased barriers (e.g. transportation, childcare); perceived high quality of virtual visits for low-risk patients and increased ...

IMPORTANCE Racial and ethnic disparities persist across key health and substance use treatment outcomes for mothers and infants. The use of medications, such as methadone or buprenorphine, for the treatment of opioid use disorder (OUD) has been associated with improvements in the outcomes of mothers and infants; however, only half of all pregnant women with OUD receive these medications. The extent to which maternal race or ethnicity is associated with the use of medication to treat OUD, the duration of the use of medication to treat OUD, and the type of medication used to treat OUD during pregnancy are unknown.OBJECTIVE To examine the extent to which maternal race and ethnicity is associated with the use of medications for the treatment of OUD in the year before delivery among pregnant women with OUD. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used a linked populationlevel statewide data set of pregnant women with OUD who delivered a live infant in Massachusetts between October 1, 2011, and December 31, 2015. Of 274 234 total deliveries identified, 5247 deliveries among women with indicators of having OUD were included in the analysis. Maternal race and ethnicity were defined as white non-Hispanic, black non-Hispanic, or Hispanic based on selfreported data on birth certificates. MAIN OUTCOMES AND MEASURESMain outcomes were the receipt of any medication for OUD, the consistency of the use of medication (at least 6 continuous months of use before delivery, inconsistent use, or no use) for the treatment of OUD, and the type of medication (methadone or buprenorphine) used to treat OUD. Multivariable models were adjusted for maternal sociodemographic characteristics, comorbidities, and any significant interactions between the covariates and race and ethnicity. RESULTSThe sample included 5247 pregnant women with OUD who delivered a live infant in Massachusetts during the study period. The mean (SD) maternal age at delivery was 28.7 (5.0) years; 4551 women (86.7%) were white non-Hispanic, 462 women (8.8%) were Hispanic, and 234 women (4.5%) were black non-Hispanic. A total of 3181 white non-Hispanic women (69.9%) received any type of medication for the treatment of OUD in the year before delivery compared with 228 Hispanic women (49.4%) and 108 black non-Hispanic women (46.2%). Compared with white non-Hispanic women, black non-Hispanic and Hispanic women had a substantially lower likelihood (adjusted odds ratio [aOR], 0.37; 95% CI, 0.28-0.49 and aOR, 0.42; 95% CI, 0.35-0.52, respectively) of receiving any medication for the treatment of OUD. Stratification by maternal age identified greater disparities among younger women. Black non-Hispanic and Hispanic women also had a lower likelihood (aOR, 0.24; 95% CI, 0.17-0.35 and aOR, 0.34; 95% CI, 0.27-0.44, respectively) of consistent use of medication for the treatment of OUD compared with white non-Hispanic women. With respect to (continued) Key Points Question Do differences by maternal race and ethnicity exist in the use of methadone or buprenorphine...