Pregnant women with opioid use disorder and their infants in three state Medicaid programs in 2013–2016

Abstract

Background: Maternal opioid use disorder (OUD) has serious consequences for maternal and infant health. Analysis of Medicaid enrollee data is critical, since Medicaid bears a disproportionate share of costs. Methods: This study analyzes linked maternal and infant Medicaid claims data and infant birth records in three states in the year before and after a delivery in 2014-2015 (2013-2016) examining health, health care use, treatment, and neonatal outcomes. Diagnosis and procedure codes identify OUD and other substance use disorders (SUDs). Results: In the year before and after delivery, 2.2 percent of the sample had an OUD diagnosis, and 5.9 percent had a SUD diagnosis other than OUD. Of the women with OUD, 72.8% had treatment for a SUD in the year before and after delivery, but most had none in an average enrolled month, and only 8.8% received any methadone treatment in a given month. Pregnant women with OUD had delayed and lower rates of prenatal care compared to women with other substance use disorders (SUDs). Infants of mothers with OUD did not differ from infants of mothers with other SUDs in rate of preterm or low birth weight but had higher NICU admission rates and longer birth hospitalizations. Health care costs for women with an OUD were higher than those with other SUDs. Conclusions: There is an urgent need for comprehensive, evidence-based OUD treatment integrated with maternity care. To fill critical gaps in care, workforce and infrastructure innovations can facilitate delivery of preventive and treatment services coordinated across settings.

The Effect of Dioxin on Low Birth Weight in Southern West Virginia Between 1955 – 1969

“…The causes of low birth weight have been determined to be multifactorial and include exposures such as maternal alcohol use, smoking, infection during pregnancy, drug abuse, maternal age less than 17 years or greater than 35 years, and race (7,8, 9, 10). The mother’s health status can also play a significant role in the development process, as any related illnesses can alter the development process of the fetus (11).…”

Postpartum Treatment for Substance Use Disorder Among Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Substance Exposure

“…Several studies have documented the multiple barriers to care during the perinatal period for women with SUD, 8,28-30 including stigma, lack of treatment capacity, challenges with daily treatment attendance, and logistical hurdles such as childcare and transportation. 10,31 These more recent studies documenting multiple barriers suggest that the low rates documented in our study may very well continue to exist and highlight the continued need for programmatic and policy interventions to address barriers to engaging women with SUD in personcentered care during both the prenatal period as well as in the critical months following delivery, 32 (the ''fourth trimester''), 33 when relapse rates and overdose risk increase. 6,34 Overall, only one in five women with infants affected by substance exposure attended a postpartum visit within 60 days of delivery, which is consistent with a 2019 study of women with OUD in a single state.…”

“…7 Mothers with SUD whose infants are diagnosed with NAS or prenatal substance exposure (PSE) in the neonatal period are a readily identified high-risk population that should receive evidence-based postpartum SUD treatment, whether newly initiated or continuing from the prenatal period. While many SUD treatment barriers for pregnant women have been described 8,9 and a prior study has examined treatment receipt among women with SUD and OUD in the 24 months surrounding delivery, 10 little is known about rates of SUD treatment for women in dyads affected by substance use in the immediate postpartum period (i.e., the start of the so-called fourth trimester) 11 or the sociodemographic and clinical characteristics associated with treatment receipt. Therefore, using an innovative but infrequently used approach of linking mother-infant dyads in Medicaid data, 10,12 we sought to (1) identify sociodemographic, health insurance, utilization, and clinical characteristics of mothers of infants with NAS and PSE who did or did not receive SUD treatment in the first 60 days postpartum, and (2) for those receiving treatment, describe the timing of postpartum treatment receipt.…”

“…While many SUD treatment barriers for pregnant women have been described 8,9 and a prior study has examined treatment receipt among women with SUD and OUD in the 24 months surrounding delivery, 10 little is known about rates of SUD treatment for women in dyads affected by substance use in the immediate postpartum period (i.e., the start of the so-called fourth trimester) 11 or the sociodemographic and clinical characteristics associated with treatment receipt. Therefore, using an innovative but infrequently used approach of linking mother-infant dyads in Medicaid data, 10,12 we sought to (1) identify sociodemographic, health insurance, utilization, and clinical characteristics of mothers of infants with NAS and PSE who did or did not receive SUD treatment in the first 60 days postpartum, and (2) for those receiving treatment, describe the timing of postpartum treatment receipt. Building on literature describing factors associated with prenatal SUD treatment receipt, 13,14 we hypothesized that most mothers in substance-affected dyads would not receive timely postpartum treatment for SUD, and that race, urbanicity, duration of Medicaid enrollment, prenatal care attendance, and co-occurring mental health conditions would be associated with receipt of SUD treatment in the 60 days after delivery.…”

Leveraging Telehealth in the United States to Increase Access to Opioid Use Disorder Treatment in Pregnancy and Postpartum During the COVID-19 Pandemic

“…The rate of identification is very low, and the rate of treatment is even lower. Only about 25% of pregnant women with OUD receive treatment, and fewer receive medication for OUD, even though it is the goldstandard treatment for OUD (14). Even among women who initiate medication treatment for OUD, over half (56%) will discontinue their medication by 6 months postpartum (4).…”