Abstract
This cross-sectional study explores the association between mothers’ receipt of opioid use disorder treatment during pregnancy and their infants’ health services use in the first year of life.
Opioid use during pregnancy has greatly increased in the past 3 decades.1 Medications for opioid use disorder (MOUD) are an effective treatment, but use of MOUD remains low.1 Little is known about the association between MOUD use in pregnancy and improved outcomes for children of pregnant people with opioid use disorder (OUD).2,3,4,5 This omission from the literature is important, as treatment during the prenatal period may have long-term implications for infant health by ameliorating the harm caused by untreated OUD. Using a multistate Medicaid claims database on mother-infant dyads, we examined the association between receipt of prenatal MOUD and health services use (recommended number of well-child visits, emergency department [ED] visits, and rehospitalization) during the first year of life.
Methods
In accordance with the Common Rule, this cross-sectional study was exempt from ethics review and informed consent because it was not human participant research. We followed the STROBE reporting guideline.
Data for this analysis were drawn from the 2012 to 2019 Merative MarketScan multistate Medicaid database (6-10 participating states each year). The cohort comprised mothers with OUD and 9 months of continuous enrollment before childbirth and their infants with 1 year of continuous enrollment after birth. Variable of interest was the receipt of MOUD (buprenorphine or methadone) in the prenatal period. Infant-level outcomes of interest were at least 6 well-child visits, any ED visits, and any readmission (ie, any inpatient care after childbirth) in the first year after birth.
Logistic regression models with year, state fixed effects, and clustered SEs were estimated. Model covariates included infant sex, maternal race and ethnicity (collected because of known race-based disparities in receipt of MOUD during pregnancy), maternal age at childbirth, plan type (managed care or fee-for-service), and urban or rural residence. Data analysis was performed with R, version 4.2 (R Core Team).
Results
Table 1 presents characteristics of the sample (n = 10 352; 5362 boys [51.8%] and 4990 girls [48.2%]) by prenatal MOUD use. Overall, 55.3% of mothers received no MOUD. Prenatal MOUD use was associated with 20% higher odds of infants receiving 6 well-child visits (adjusted odds ratio [AOR], 1.20; 95% CI, 1.11-1.31), 4% lower odds of ED visits (AOR, 0.96; 95% CI, 0.88-1.04), and 20% lower odds of readmissions (AOR, 0.80; 95% CI, 0.70-0.91) during the first year of life (Table 2). Although prenatal MOUD was inversely associated with any ED visit, the result was not significant.
Table 1. Demographic Characteristics and Outcomes for Medicaid-Covered Mother-Infant Dyads.
| Characteristic | No. (%) | ||
|---|---|---|---|
| All | Received no MOUD | Received MOUD | |
| No. of mother-infant dyads | 10 352 (100.0) | 5720 (55.3) | 4632 (44.7) |
| Maternal age at birth, y | |||
| 18-24 | 2565 (24.8) | 1679 (29.3) | 889 (19.2) |
| 25-29 | 4100 (39.6) | 2159 (37.7) | 1967 (41.9) |
| 30-34 | 2651 (25.6) | 1350 (23.6) | 1302 (28.1) |
| 35-39 | 901 (8.7) | 458 (8.0) | 414 (9.5) |
| 40-45 | 135 (1.3) | 74 (1.3) | 60 (1.3) |
| Maternal race and ethnicitya | |||
| Hispanic | 93 (0.9) | 63 (1.1) | 37 (0.8) |
| Non-Hispanic Black | 957 (9.2) | 775 (13.6) | 176 (3.8) |
| Non-Hispanic White | 8628 (83.3) | 4516 (79.0) | 4109 (88.7) |
| Non-Hispanic otherb | 93 (0.9) | 63 (1.1) | 32 (0.7) |
| Missing data | 580 (5.6) | 303 (5.3) | 278 (6.0) |
| Urban (vs rural)c | 7402 (71.5) | 4073 (71.2) | 3330 (71.9) |
| Enrolled in Medicaid managed care (vs Medicaid fee for service) | 9482 (91.6) | 5131 (89.7) | 4349 (93.9) |
| Infant male sex | 5362 (51.8) | 2974 (52.0) | 2389 (51.5) |
| Infant female sex | 4990 (48.2) | 2746 (48.0) | 2243 (48.5) |
| Presumed OUD in pregnancy (not mutually exclusive) | |||
| OUD diagnosis during pregnancy | 8944 (86.4) | 4393 (76.8) | 4553 (98.3) |
| NAS birth | 4938 (47.7) | 2231 (39.0) | 2705 (58.4) |
| Prenatal opioid exposure | 311 (3.0) | 114 (2.0) | 199 (4.3) |
| Type of MOUD treatment during prenatal period (not mutually exclusive) | |||
| Buprenorphine | 4048 (39.1) | NA | 4553 (87.4) |
| Methadone | 725 (7.0) | NA | 723 (15.6) |
| No. of months with any MOUD, median (IQR) | 5 (7) | NA | 5 (7) |
| Outcomes: infant health care use in first 12 mo after birth | |||
| Well-child visits: ≥6 | 3747 (36.2) | 2128 (37.2) | 1627 (34.9) |
| ED visits: any, excluding birth | 6387 (61.7) | 3529 (61.7) | 2863 (61.8) |
| Readmissions: any, excluding birth | 1066 (10.3) | 353 (9.5) | 519 (11.2) |
Abbreviations: ED, emergency department; MOUD, medications for opioid use disorder; NA, not applicable; NAS, neonatal abstinence syndrome; OUD, opioid use disorder.
Race and ethnicity data were obtained from MarketScan database.
Other included American Indian or Alaska Native, Asian, Native Hawaiian, and Pacific Islander.
Urban is defined as the mother residing in a Metropolitan Statistical Area.
Table 2. Association of Prenatal MOUD With Health Care Use in the First Year of Lifea.
| Characteristic | Health care use, AOR (95% CI) | ||
|---|---|---|---|
| ≥6 Well-child visits | ED visit | Readmission | |
| Total No. of infants | 10 352 | 10 352 | 10 352 |
| Independent variable | |||
| Prenatal MOUD | 1.20 (1.11-1.31) | 0.96 (0.88-1.04) | 0.80 (0.70-0.91) |
| Covariates | |||
| Infant male sex | 1.03 (0.95-1.11) | 0.88 (0.81-0.95) | 0.92 (0.81-1.04) |
| Maternal race and ethnicity: Hispanic | 1.10 (0.72-1.68) | 0.88 (0.58-1.34) | 1.08 (0.56-2.10) |
| Maternal race and ethnicity: non-Hispanic Black | 1.41 (1.22-1.64) | 0.79 (0.68-0.91) | 0.97 (0.77-1.21) |
| Maternal race and ethnicity: non-Hispanic White | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Maternal race and ethnicity: other/missing data | 1.06 (0.90-1.25) | 0.85 (0.72-1.00) | 1.01 (0.78-1.32) |
| Maternal age at childbirth | 1.00 (0.99-1.01) | 1.04 (1.03-1.05) | 1.01 (1.00-1.03) |
| Maternal plan type at childbirth: managed care | 0.92 (0.79-1.07) | 0.86 (0.74-0.99) | 1.07 (0.85-1.34) |
| Rural or urban residence: urban | 0.82 (0.75-0.90) | 0.85 (0.78-0.93) | 0.92 (0.80-1.06) |
Abbreviations: AOR, adjusted odds ratio; ED, emergency department; MOUD, medication for opioid use disorder.
Models included state and year fixed effects.
Discussion
Among a cohort of Medicaid-covered mother-infant dyads, prenatal MOUD use was associated with infants receiving the recommended number of well-child visits and reduced likelihood of readmissions. This finding is consistent with the hypothesis that when pregnant individuals are engaged in OUD treatment, their infants are also likely to receive the appropriate levels of care. Additionally, we found that prenatal MOUD use was associated with lower odds of hospital readmissions after birth, a costly and potentially avoidable health service use that is common among infants with neonatal abstinence syndrome and signifies exacerbation of symptoms.6
The prenatal period is a unique opportunity for identifying and providing needed care to pregnant individuals with OUD. Although MOUD is the standard of care for pregnant individuals with OUD, a large portion of these individuals do not receive this treatment.1 The findings indicate that policies aimed toward increasing access to MOUD during the prenatal period will be beneficial not only for mothers but also for their infants.
Study limitations included the observational design, which did not allow us to account for unobserved confounders that could influence both MOUD uptake and infant outcomes (eg, home life stability, social supports, transportation access); thus, these results should be interpreted with caution. Another limitation was that the Medicaid-covered mother-infant dyads were from a select group of states. Consequently, the findings might not be generalizable to a national Medicaid sample.
Data Sharing Statement
References
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Supplementary Materials
Data Sharing Statement