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

TLDR: There is an urgent need for comprehensive, evidence-based OUD treatment integrated with maternity care and to fill critical gaps in care, workforce and infrastructure innovations can facilitate delivery of preventive and treatment services coordinated across settings.

About: This article is published in Drug and Alcohol Dependence.The article was published on 2019-02-01 and is currently open access. It has received 37 citations till now. The article focuses on the topics: Prenatal care & Medicaid.

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Table 2 Percent with SUD-related treatment among women with a diagnosed SUD who delivered an infant in 2014 or 2015 by type of SUD, type of treatment, and consecutive months of treatment before and after delivery, in three state Medicaid programs. Source: Birth certificates and claims and enrollment data for women and their infants, three state Medicaid programs covering the 24 months surrounding the deliveries (2013–2016). SUD-related treatment estimates are derived from the claims data.

Table 3 Maternal health care utilization rates during the 12 months before delivery month among women with a diagnosed substance use disorder (SUD) who delivered infants in 2014 or 2015 by SUD status and type for three state Medicaid programs. Source: Birth certificates and claims and enrollment data for women and their infants, three state Medicaid programs covering the 24 months surrounding the deliveries (2013–2016). Prenatal care estimates derived from birth certificate data except in cases where there was no report in which case we looked for a Medicaid claim. Numbers of hospital stays and ED visits are from the claims data.

Table 1 Sociodemographic and health characteristics of women who delivered infants in 2014 or 2015 by substance use disorder (SUD) status and type, three state Medicaid programs. Source: Birth certificates and claims and enrollment data for women and their infants, three state Medicaid programs covering the 24 months surrounding the deliveries (2013–2016). Characteristic estimates are derived from birth certificate data except Strong Start participant, number of unique diagnoses before delivery, and psychiatric diagnosis.

Table 4 Infant health care utilization and infant outcomes for infants with women with a diagnosed substance use disorder (SUD) who delivered infants in 2014 or 2015 by SUD status and type for three state Medicaid programs. Source: Birth certificates and claims and enrollment data for women and their infants, three state Medicaid programs covering the 24 months surrounding the deliveries (2013–2016). NICU, number of hospital days, and drug/alcohol related diagnoses are from the claims data. Other estimates are from the birth certificate data.

Table 5 Maternal and infant health care expenditures among women with a diagnosed substance use disorder (SUD) who delivered infants in 2014 or 2015 by SUD status and type for three state Medicaid programs. Source: Birth certificates and claims and enrollment data for women and their infants, three state Medicaid programs covering the 24 months surrounding the deliveries (2013–2016). Expenditure estimates were derived from the claims data.

Frequently asked questions

Q1. What are the contributions mentioned in the paper "Pregnant women with opioid use disorder and their infants in three state medicaid programs in 2013–2016" ?

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. 

Q2. What are the future works mentioned in the paper "Pregnant women with opioid use disorder and their infants in three state medicaid programs in 2013–2016" ?

This is an important an area for future research. The data reveal that many women engaged in some form of treatment at some point in the year before and/ or the year after birth, suggesting that many pregnant and parenting women want treatment. The low monthly rates of maternal treatment suggest an urgent need for comprehensive, high-quality, evidencebased OUD treatment, development of targeted workforce ( e. g., prenatal care providers who have training in addiction medicine and are waivered to prescribe buprenorphine ) and infrastructure ( e. g., co-location of MAT and prenatal care, optimal use of technology to improve care and to facilitate and track care coordination ), and coordinated efforts to facilitate delivery of preventive and treatment services to maternity care patients across multiple settings. Efforts to train physicians and other providers to prescribe medications as part of MAT are underway ( Substance Abuse and Mental Health Services Administration ( SAMHSA, 2018b ) but may need to be expanded further among those with expertise in maternity care. 

Q3. What is the key element for initiation and continuation of treatment for pregnant and postpartum women?

Ensuring that seeking treatment is not a cause for women to be separated from their infants may also be a key element for initiation and continuation of OUD treatment for pregnant and postpartum women. 

Q4. What is the important factor in understanding treatment gaps?

Because Medicaid bears a disproportionate share of costs related to women and infants affected by OUD, analysis for Medicaid participants is particularly critical to understanding treatment gaps. 

Q5. How many women with OUD had at least some treatment related to substance use?

Over the course of 24 months, nearly three in four women with OUD in their sample had at least some treatment related to substance use. 

Q6. What is the importance of improving access to treatment?

Improving access to treatment involves ensuring sufficient resources, including trained providers, to offer care for all eligible pregnant and postpartum women. 

Q7. What is the importance of addressing stigma and misinformation among women?

Addressing stigma and misinformation among women, their family and peers, maternity care and neonatal providers, and the general population is also essential to provision and uptake of appropriate treatment. 

Q8. What was the analysis of the women who received methadone treatment prior to delivery?

Only 39 of the 216 sample women who received methadone treatment prior to delivery had a treatment duration of 6 months or more prior to delivery, so only an analysis of women who received any methadone was done and not an analysis of people who obtained the recommended treatment throughout their pregnancy. 

Q9. What were the common types of treatment for OUD?

SUD treatments were classified as: any inpatient treatment, any outpatient therapy, any residential, any partial hospitalization/intensive outpatient, any SUD medication (including unspecified medications with a primary diagnosis of SUD), any methadone, and any indicator of buprenorphine. 

Q10. What is the key to understanding the barriers to maternal OUD treatment?

Identifying patterns of maternal and infant care, costs, and outcomes related to maternal OUD is critical for designing effective policies to address maternal OUD treatment in multiple settings. 

Q11. What is the main reason for the high cost of health care use among women with OUD?

The high cost of health care use among women with OUD and their infants compared to other groups is likely driven in part by differences in NICU use. 

Q12. What was the average number of consecutive months with methadone treatment before the birth month?

Among women who got methadone treatment before the birth month, that treatment was generally not sustained throughout pregnancy—the average number ofconsecutive months with methadone treatment before the birth month was only 2.8 months. 

Q13. What was the average number of consecutive months with methadone treatment for women with an OUD?

In the 12 months before delivery, sample women with an OUD also had over three times the rate of hospital stays and over twice the rate of ED visits of women without a SUD. 

Q14. How many women with OUDs had claims indicating some form of SUD treatment?

Over three-quarters (72.8%) of sample women with an OUD had claims indicating some form of SUD treatment during the year before and after delivery compared to 52.3% of women with other SUDs (Table 2). 

Q15. What was the average number of consecutive months with methadone treatment before birth?

OUD who obtained any methadone treatment, the monthly rate of methadone treatment was only 30 percent, and the average number of consecutive months with methadone treatment before birth was 2.8. 

Q16. What is the reason why the results of the study were not better than those of women without met?

The authors suspect that lack of recommended standard of methadone care is one reason why outcomes for mothers with methadone treatment were no better than outcomes for women with no OUD treatment. 

Q17. What are the barriers to accessing treatment?

Misinformation and stigma surrounding medications to treat OUD may also impede access to treatment, as may the barriers associated with making daily clinic visits if methadone is used. 

Q18. What was the NAS used to identify a woman with a SUD?

Identificationof infant NAS was not used as a criterion to identify maternal OUD, since NAS diagnosis in the claims was not specific to opioid exposure. 

Q19. What is the difference between rooming in and NICU care?

NICU care, as opposed to rooming-in with the mother, has been shown to correlate withsubstantial increases in the length of pharmaceutical treatment for NAS, such as morphine, rather than evidence-based non-pharmacological techniques, such as skin-to-skin contact and breastfeeding, which have been shown to reduce length of stay and costs (Grossman et al., 2017; Holmes et al., 2016; MacMillan et al., 2018). 

Q20. What are the barriers to treatment for pregnant women?

Despite steep increases over the past two decades in both prevalence of opioid use disorder (OUD) among pregnant women and incidence of NAS (Brown et al., 2016; Haight, 2018; Jones et al., 2015; Ko, 2016; Tolia et al., 2015), many pregnant women have barriers to OUD treatment.