Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012.

OBJECTIVES This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity. METHODS We used 2007-2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects. RESULTS Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44-0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45-0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45-1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64-0.72]; aOR, 0.86 [95% CI, 0.80-0.92]; aOR, 0.71 [95% CI, 0.64-0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80-0.91]; aOR, 0.86 [95% CI, 0.80-0.93]; aOR, 0.83 [95% CI, 0.73-0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05-1.20]; aOR, 1.12 [95% CI, 1.00-1.26]). CONCLUSIONS Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy.

[1]  Natasia S. Courchesne-Krak,et al.  Differences in outpatient, emergency, and inpatient use among pregnant women with a substance-related diagnosis , 2022, American Journal of Obstetrics & Gynecology MFM.

[2]  Shari M. Lawson,et al.  Bridging the Postpartum Gap: A Randomized Controlled Trial to Improve Postpartum Visit Attendance Among Low-Income Women with Limited English Proficiency , 2021, Women's health reports.

[3]  D. Feaster,et al.  Disparities in Opioid Overdose Death Trends by Race/Ethnicity, 2018-2019, From the HEALing Communities Study. , 2021, American journal of public health.

[4]  B. Stein,et al.  Postpartum Treatment for Substance Use Disorder Among Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Substance Exposure , 2021, Women's health reports.

[5]  K. Bowers,et al.  Substance Use and Utilization of Prenatal and Postpartum Care , 2021, Journal of addiction medicine.

[6]  T. Musa,et al.  Depression during pregnancy and the risk of low birth weight, preterm birth and intrauterine growth restriction- an updated meta-analysis. , 2020, Early human development.

[7]  Mary B. Johnson.  Prenatal Care for American Indian Women. , 2020, MCN. The American journal of maternal child nursing.

[8]  Maria I. Rodriguez,et al.  Coverage of immediate postpartum long acting reversible contraception has improved birth intervals for at risk populations. , 2019, American journal of obstetrics and gynecology.

[9]  B. Zierler,et al.  Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010 , 2019, BMC Pregnancy and Childbirth.

[10]  Kathi L H Harp,et al.  The Racialized Nature of Child Welfare Policies and the Social Control of Black Bodies , 2019, Social politics.

[11]  M. Tonelli,et al.  Association of Mental Health Disorders With Health Care Utilization and Costs Among Adults With Chronic Disease , 2019, JAMA network open.

[12]  C. Vladutiu,et al.  Emergency Care Utilization Among Pregnant Medicaid Recipients in North Carolina: An Analysis Using Linked Claims and Birth Records , 2019, Maternal and Child Health Journal.

[13]  Sandra L. Momper,et al.  Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives. , 2018, Addictive behaviors.

[14]  W. Callaghan,et al.  Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999–2014 , 2018, MMWR. Morbidity and mortality weekly report.

[15]  Natasha Parekh,et al.  Prenatal and Postpartum Care Disparities in a Large Medicaid Program , 2018, Maternal and Child Health Journal.

[16]  Y. Paradies,et al.  Racism and health service utilisation: A systematic review and meta-analysis , 2017, PloS one.

[17]  C. Kothari,et al.  Emergency Department Use in the Perinatal Period: An Opportunity for Early Intervention , 2017, Annals of emergency medicine.

[18]  Matthew M Davis,et al.  Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005-2014. , 2017, Obstetrics and gynecology.

[19]  F. Shebl,et al.  Association Between Maternal Comorbidities and Emergency Department Use Among a National Sample of Commercially Insured Pregnant Women , 2017, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[20]  Committee Opinion No. 667: Hospital-Based Triage of Obstetric Patients , 2016, Obstetrics and gynecology.

[21]  S. Till,et al.  Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes. , 2015, The Cochrane database of systematic reviews.

[22]  L. Sharp,et al.  Traveling Towards Disease: Transportation Barriers to Health Care Access , 2013, Journal of Community Health.

[23]  Karen Donelan,et al.  Barriers to specialty care and specialty referral completion in the community health center setting. , 2013, The Journal of pediatrics.

[24]  Yvonne W. Cheng,et al.  The impact of chronic hypertension and pregestational diabetes on pregnancy outcomes. , 2012, American journal of obstetrics and gynecology.

[25]  Thomas S Inui,et al.  The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. , 2012, American journal of public health.

[26]  Alisa B. Busch,et al.  Racial and ethnic disparities in postpartum depression care among low-income women. , 2011, Psychiatric services.

[27]  C. D’Angio,et al.  Infant Race Affects Application of Clinical Guidelines When Screening for Drugs of Abuse in Newborns , 2010, Pediatrics.

[28]  Aaron B Caughey,et al.  Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. , 2010, American journal of obstetrics and gynecology.

[29]  Samuel F. Posner,et al.  An Enhanced Method for Identifying Obstetric Deliveries: Implications for Estimating Maternal Morbidity , 2008, Maternal and Child Health Journal.

[30]  M. Taualii,et al.  A nationwide population-based study identifying health disparities between American Indians/Alaska Natives and the general populations living in select urban counties. , 2006, American journal of public health.

[31]  P. Plunkett,et al.  Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. , 2003, Annals of emergency medicine.

[32]  J. Ager,et al.  Punishing pregnant drug users: enhancing the flight from care. , 1993, Drug and alcohol dependence.

[33]  ACOG Committee Opinion No. 736: Optimizing Postpartum Care. , 2018, Obstetrics and gynecology.

[34]  Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy. , 2017, Obstetrics and gynecology.

[35]  ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. , 2012, Obstetrics and gynecology.

[36]  J. Ickovics,et al.  Prenatal health care beyond the obstetrics service: utilization and predictors of unscheduled care. , 2008, American journal of obstetrics and gynecology.