Pregnant women in Massachusetts have high rates of OUD. The year after delivery is a vulnerable period for women with OUD. Additional longitudinal supports and interventions tailored to women in the first year postpartum are needed to prevent and reduce overdose events.

Objective To compare the risks for adverse pregnancy and birth outcomes by diagnoses with and without ART treatment to non-ART pregnancies in fertile women. Design Historical cohort Setting Massachusetts vital records linked to ART clinic data from SART CORS Patients Diagnoses included male factor (ART only), endometriosis, ovulation disorders, tubal (ART only) and reproductive inflammatory disorders (non-ART only). Pregnancies resulting in singleton and twin live births from 2004–08 were linked to hospital discharges in women who had ART treatment (N=3,689), women with no ART treatment in the current pregnancy (N=4,098) and non-ART pregnancies to fertile women (N= 297,987). Interventions None Main Outcome Measures Risks of gestational diabetes, prenatal hospitalizations, prematurity, low birth weight, and small-for-gestation were modeled using multivariate logistic regression with fertile deliveries as the reference group adjusted for maternal age, race/ethnicity, education, chronic hypertension, diabetes mellitus, and plurality (adjusted odds ratios, AORs, and 95% confidence intervals, CI). Results Risk of prenatal hospital admissions was increased for endometriosis (ART 1.97, 1.38–2.80; non-ART 3.34, 2.59–4.31), ovulation disorders (ART 2.31, 1.81–2.96; non-ART 2.56, 2.05–3.21), tubal (ART 1.51, 1.14–2.01), and reproductive inflammation (non-ART 2.79, 2.47–3.15). Gestational diabetes was increased for women with ovulation disorders (ART 2.17, 1.72–2.73; non-ART 1.94, 1.52–2.48). Preterm delivery (AORs 1.24–1.93) and low birthweight (AORs 1.27–1.60) were increased in all groups except endometriosis with ART. Conclusions The findings indicate substantial excess perinatal morbidities associated with underlying infertility-related diagnoses in both ART-treated and non-ART-treated women.

Objective To compare on a population basis the birth outcomes of women treated with Assisted Reproductive Technologies (ART), women with indicators of subfertility but without ART, and fertile women. Design Longitudinal cohort study Setting Massachusetts Participants 334,628 births and fetal deaths to Massachusetts mothers giving birth in a Massachusetts hospital between July 1, 2004-December 31, 2008, subdivided into three subgroups for comparison: ART 11,271, subfertile 6,609, and fertile 316,748. Intervention None Main Outcome Measures Four outcomes: preterm birth, low birthweight, small for gestational age and perinatal death, were modeled separately for singletons and twins using logistic regression with the primary comparison between ART births and those to the newly created population based subgroup of births to women with indicators of subfertility but no ART. Results Singletons: The risks for both preterm birth and low birthweight were higher for the ART group (AOR 1.23 and 1.26, respectively) compared to the subfertile group and risks in both the ART and subfertile groups were higher than those among fertile births. Twins: the risk of perinatal death was significantly lower among ART births than fertile (AOR 0.55) or subfertile (AOR 0.15) births. Conclusions The use of a population based comparison group of subfertile births without ART demonstrated significantly higher rates of preterm birth and low birthweight in ART singleton births, but these differences are smaller than differences between ART and fertile births. Further refinement of the measurement of subfertile births and examination of the independent risks of subfertile births is warranted.

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...

Background Births to subfertile women, with and without infertility treatment, have been reported to have lower birthweights and shorter gestations, even when limited to singletons. It is unknown whether these decrements are due to parental characteristics or aspects of infertility treatment. Objective To evaluate the effect of maternal fertility status on the risk of pregnancy, birth, and infant complications. Study Design All singleton live births of ≥22 weeks’ gestation and ≥350 grams birthweight to Massachusetts resident women in 2004–10 were linked to hospital discharge and vital records. Women were categorized by their fertility status as in vitro fertilization (IVF), subfertile, or fertile. Women whose births linked to IVF cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System were classified as IVF. Women with indicators of subfertility but not treated with IVF were classified as subfertile. Women without indicators of subfertility or IVF treatment were classified as fertile. Risks of fifteen adverse outcomes (gestational diabetes, pregnancy hypertension, antenatal bleeding, placental complications (placenta abruptio and placenta previa), prenatal hospitalizations, primary cesarean, very low birthweight (<1,500g), low birthweight (<2,500g), small-for-gestation birthweight (Z-score ≤−1.28), large-for-gestation birthweight (Z-score ≥1.28), very preterm (<32 weeks), preterm (<37 weeks), birth defects, neonatal death (0–27 days), and infant death (0–364 days of life) were modeled by fertility status with the fertile group as reference, and the subfertile group as reference, using multivariate log binomial regression and reported as adjusted risk ratios (ARRs) and 95% confidence intervals. Results The study population included 459,623 women (441,420 fertile, 8,054 subfertile, and 10,149 IVF). Women in the subfertile and IVF groups were older than their fertile counterparts. Risks for six out of six pregnancy outcomes and six out of nine infant outcomes were increased for the subfertile group, and five out of six pregnancy outcomes and seven out of nine infant outcomes were increased for the IVF group. For four of the six pregnancy outcomes (uterine bleeding, placental complications, prenatal hospitalizations, and primary cesarean) and two of the infant outcomes (low birthweight and preterm) the risk was greater in the IVF group, with non-overlapping confidence intervals to the subfertile group, indicating a substantially higher risk among IVF-treated women. The highest risks for the IVF women were uterine bleeding (ARR 3.80, 95% CI 3.31, 4.36) and placental complications (ARR 2.81, 95% CI 2.57, 3.08), and for IVF infants, very preterm birth (ARR 2.13, 95% CI 1.80, 2.52) and very low birthweight (ARR 2.15, 95% CI 1.80, 2.56). With subfertile women as reference, risks for the IVF group were significantly increased for uterine bleeding, placental complications, prenatal hospitalizations, primary cesarean, low and very low birthweight, and preterm and very preterm bir...

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Background: Understanding the influence of perinatal stressors on the prevalence of postpartum depressive symptoms (PDS) and help-seeking for PDS using surveillance data can inform service provision and improve health outcomes. Methods: We used Massachusetts Pregnancy Risk Assessment Monitoring System (MA-PRAMS) 2007-2010 data to evaluate associations between selected perinatal stressors and PDS and with subsequent help-seeking behaviors. We categorized 12 stressors into 4 groups: partner, traumatic, financial, and emotional. We defined PDS as reporting ''always'' or ''often'' to any depressive symptoms on PRAMS Phase 5, or to a composite score ‡ 10 on PRAMS Phase 6 depression questions, compared with women reporting ''sometimes,'' ''rarely'' or ''never'' to all depressive symptoms. The median response time to MA-PRAMS survey was 3.2 months (interquartile range, 2.9-4.0 months). We estimated prevalence ratios (PRs) and 95% confidence intervals (95% CIs) using modified Poisson regression models, controlling for socioeconomic status indicators, pregnancy intention and prior mental health visits. Results: Among 5,395 participants, 58% reported ‡ 1 stressor (partner = 26%, traumatic = 16%, financial = 29% and emotional = 30%). Reporting of ‡ 1 stressor was associated with increased prevalence of PDS (PR = 1.68, 95% CI: 1.42-1.98). The strongest association was observed for partner stress (PR = 1.90, 95% CI: 1.51-2.38). Thirty-eight percent of mothers with PDS sought help. Mothers with partner-related stressors were less likely to seek help, compared with mothers with other grouped stressors. Conclusions: Women who reported perinatal common stressors-particularly partner-related stressors-had an increased prevalence of PDS. These data suggest that women should be routinely screened during pregnancy for a range of stressors and encouraged to seek help for PDS.

Background Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003–2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from one-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women’s perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Principal Findings 5.5% of Massachusetts’s deliveries between 2003–2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28–1.41) and low birthweight (LBW) (AOR 1.73, 95%CI 1.64–1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95%CI 0.55–0.68) and LBW (AOR 0.54, 95%CI 0.49–0.61). Conclusions SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don’t receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.