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An Examination of Opioid Use Disorder Outcomes among Pregnant Women in Medicaid from 2007-2012: Trends, Disparities and Association with Punitive Child Welfare Policies

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This study examined trends and disparities in opioid use disorder (OUD) outcomes among pregnant women and analyzed the association of these outcomes with punitive child welfare policies. We examined the association between sociodemographic and clinical characteristics and receipt of any OUD treatment, medication for OUD (MOUD), and counseling alone among pregnant women with an OUD diagnosis. We also examined the association between OUD status and perinatal and emergency care utilization, and between sociodemographic and clinical characteristics and perinatal and emergency care utilization among pregnant women with OUD. We also examined the association between child welfare policies and changes in the probability of OUD diagnosis, any OUD treatment, MOUD and adequate prenatal care. Compared to White women, Black and American Indian/Alaskan Native (AI/AN) women were less likely to receive any OUD treatment and MOUD. Pregnant women with OUD were less likely to receive adequate prenatal care and attend the postpartum visit and more likely to have perinatal emergency visits than pregnant women without OUD. Among pregnant women with OUD, Black, Hispanic and AI/AN women were less likely to receive adequate prenatal care and attend the postpartum visit relative to White women. Black and AI/AN women were also more likely to receive emergency care. Child welfare policies were associated with a decrease in the probability of OUD diagnosis but an increase in the probability of MOUD given OUD diagnosis. Our results have public health and policy implications, especially in the context of state-level efforts to reduce maternal opioid use.

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