Maternal Health| Volume 33, ISSUE 1, P67-76, January 2023

Postpartum Care Visit Attendance Within 60 Days of Delivery Among Women With and Without Opioid Use During Pregnancy: An Analysis of Commercial Insurance Data

Published:September 15, 2022DOI:



      Postpartum care (PPC) is a key component of maternal health, particularly for people who use opioids during pregnancy. Little is known about the prevalence and correlates of PPC visit attendance among those using opioids compared with nonusers in a privately insured population.


      A retrospective cohort study was conducted using nationwide private insurance claims between 2011 and 2017 (N = 1,291,352 women) comparing the following opioid use groups: nonusers, nonchronic prescription users, chronic prescription users, and women with opioid use disorder (OUD). Multivariable logistic and linear regressions evaluated the odds of PPC attendance and the mean time to an initial PPC visit for each user group. Stratified models identified factors associated with PPC attendance by opioid use type.


      Overall, 45% of the cohort attended a PPC visit and nearly 10% had any opioid use during pregnancy. More women in the three opioid use categories attended PPC than nonusers (50–56% vs. 45%). Opioid use regardless of type was associated with higher odds and earlier PPC visitation than women with no opioid use; nonchronic and chronic users had 17% and 40% greater odds of PPC than nonusers (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [CI]: 1.16–1.19; aOR: 1.40, 95% CI: 1.34–1.46), whereas women with OUD had 7% higher odds (aOR: 1.07; 95% CI: 1.00–1.13). Antenatal care and psychiatric, hypertensive, and pain conditions were most strongly associated with higher odds of attending PPC; older maternal age was negatively associated with PPC. Stratified analysis showed opioid correlates varied similarly across user groups.


      PPC use was generally low in this study cohort of privately insured women. Women who used opioids and those with chronic conditions had greater odds of attending PPC. Improved efforts are needed to engage people in PPC, as well as service integration and coordination for people who use opioids during pregnancy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Admon L.K.
        • Winkelman T.N.A.
        • Heisler M.
        • Dalton V.K.
        Obstetric outcomes and delivery-related health care utilization and costs among pregnant women with multiple chronic conditions.
        Preventing Chronic Disease. 2018; 15: E21
        • Attanasio L.B.
        • Ranchoff B.L.
        • Cooper M.I.
        • Geissler K.H.
        Postpartum visit attendance in the United States: A systematic review.
        Womens Health Issues. 2022; 32: 369-375
        • Azeez O.
        • Kulkarni A.
        • Kuklina E.V.
        • Kim S.Y.
        • Cox S.
        Hypertension and diabetes in non-pregnant women of reproductive age in the United States.
        Preventing Chronic Disease. 2019; 16: E146
        • Bateman B.T.
        • Hernandez-Diaz S.
        • Rathmell J.P.
        • Seeger J.D.
        • Doherty M.
        • Fischer M.A.
        • Huybrechts K.F.
        Patterns of opioid utilization in pregnancy in a large cohort of commercial insurance beneficiaries in the United States.
        Anesthesiology. 2014; 120: 1216-1224
        • Bennett W.L.
        • Chang H.Y.
        • Levine D.M.
        • Wang L.
        • Neale D.
        • Werner E.F.
        • Clark J.M.
        Utilization of primary and obstetric care after medically complicated pregnancies: An analysis of medical claims data.
        Journal of General Internal Medicine. 2014; 29: 636-645
        • Callaghan W.M.
        • Creanga A.A.
        • Kuklina E.V.
        Severe maternal morbidity among delivery and postpartum hospitalizations in the United States.
        Obstetrics & Gynecology. 2012; 120: 1029-1036
        • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
        Opioid overdose: Data resources, analyzing prescription data and morphine milligram equivalents (MME).
        (Available:) (Accessed: September 21, 2022)
        • Chen J.
        • Cox S.
        • Kuklina E.V.
        • Ferre C.
        • Barfield W.
        • Li R.
        Assessment of incidence and factors associated with severe maternal morbidity after delivery discharge among women in the US.
        JAMA Network Open. 2021; 4: e2036148
        • Danilack V.A.
        • Brousseau E.C.
        • Paulo B.A.
        • Matteson K.A.
        • Clark M.A.
        Characteristics of women without a postpartum checkup among PRAMS participants, 2009–2011.
        Maternal and Child Health Journal. 2019; 23: 903-909
        • Daw J.R.
        • Hatfield L.A.
        • Swartz K.
        • Sommers B.D.
        Women in the United States experience high rates of coverage ‘churn’ in months before and after childbirth.
        Health Affairs. 2017; 36: 598-606
        • Desai R.J.
        • Hernandez-Diaz S.
        • Bateman B.T.
        • Huybrechts K.F.
        Increase in prescription opioid use during pregnancy among Medicaid-enrolled women.
        Obstetrics & Gynecology. 2014; 123: 997-1002
        • DeSisto C.L.
        • Rohan A.
        • Handler A.
        • Awadalla S.S.
        • Johnson T.
        • Rankin K.
        Comparing postpartum care utilization from Medicaid claims and the pregnancy risk assessment monitoring system in Wisconsin, 2011–2015.
        Maternal and Child Health Journal. 2021; 25: 428-438
        • DiBari J.N.
        • Yu S.M.
        • Chao S.M.
        • Lu M.C.
        Use of postpartum care: predictors and barriers.
        Journal of Pregnancy. 2014; 2014: 530769
        • Finkelstein N.
        Treatment programming for alcohol and drug-dependent pregnant women.
        International Journal of the Addictions. 1993; 28: 1275-1309
        • Grimes D.A.
        • Schulz K.F.
        False alarms and pseudo-epidemics: the limitations of observational epidemiology.
        Obstetrics and Gynecology. 2012; 120: 920-927
        • Haight S.C.
        • Ko J.Y.
        • Bohm M.K.
        • Callaghan W.M.
        Opioid use disorder documented at delivery hospitalization- United States, 1999-2014.
        Morbidity and Mortality Weekly Report. 2018; 67: 845-849
        • Heil S.H.
        • Jones H.E.
        • Arria A.
        • Kaltenbach K.
        • Coyle M.
        • Fischer G.
        • Martin P.R.
        Unintended pregnancy in opioid-abusing women.
        Journal of Substance Abuse Treatment. 2011; 40: 199-202
        • Himes K.P.
        • Donovan H.
        • Wang S.
        • Weaver C.
        • Grove J.R.
        • Facco F.L.
        Healthy beyond pregnancy, a web-based intervention to improve adherence to postpartum care: Randomized controlled feasibility trial.
        JMIR Human Factors. 2017; 4: e26
        • IBM Watson Health
        IBM MarketScan Research Databases for life sciences researchers.
        2018 (Available:)
        • Kellogg A.
        • Rose C.H.
        • Harms R.H.
        • Watson W.J.
        Current trends in narcotic use in pregnancy and neonatal outcomes.
        American Journal of Obstetrics & Gynecology. 2011; 204: 259.e1-259.e4
        • Kleppel L.
        • Suplee P.D.
        • Stuebe A.M.
        • Bingham D.
        National initiatives to improve systems for postpartum care.
        Maternal and Child Health Journal. 2016; 20: 66-70
        • Ko J.
        • D'Angelo D.
        • Haight S.
        • Morrow B.
        • Cox S.
        • Salveson von Essen B.
        • Barfield W.D.
        Prescription opioid pain reliever use during pregnancy- 34 U.S. Jurisdictions, 2019.
        MMWR Morbidity and Mortality Weekly Report. 2020; 2020: 897-903
        • Kotha A.
        • Chen B.A.
        • Lewis L.
        • Dunn S.
        • Himes K.P.
        • Krans E.E.
        Prenatal intent and postpartum receipt of long-acting reversible contraception among women receiving medication-assisted treatment for opioid use disorder.
        Contraception. 2019; 99: 36-41
        • Kozhimannil K.B.
        • Graves A.J.
        • Levy R.
        • Patrick S.W.
        Nonmedical use of prescription opioids among pregnant U.S. women.
        Womens Health Issues. 2017; 27: 308-315
        • Krans E.E.
        • Bobby S.
        • England M.
        • Gedekoh R.H.
        • Chang J.C.
        • Maguire B.
        • English D.H.
        The Pregnancy Recovery Center: A women-centered treatment program for pregnant and postpartum women with opioid use disorder.
        Addictive Behaviors. 2018; 86: 124-129
        • Krans E.E.
        • Cochran G.
        • Bogen D.L.
        Caring for opioid-dependent pregnant women: Prenatal and postpartum care considerations.
        Clinical Obstetrics and Gynecology. 2015; 58: 370-379
        • Kuklina E.V.
        • Whiteman M.K.
        • Hillis S.D.
        • Jamieson D.J.
        • Meikle S.F.
        • Posner S.F.
        • Marchbanks P.A.
        An enhanced method for identifying obstetric deliveries: Implications for estimating maternal morbidity.
        Maternal and Child Health Journal. 2008; 12: 469-477
        • Margulis A.V.
        • Setoguchi S.
        • Mittleman M.A.
        • Glynn R.J.
        • Dormuth C.R.
        • Hernandez-Diaz S.
        Algorithms to estimate the beginning of pregnancy in administrative databases.
        Pharmacoepidemiol Drug Safety. 2013; 22: 16-24
        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.J.K.
        • Driscoll A.K.
        • Drake P.
        Births: final data for 2016.
        National Vital Statistics Reports. 2018; 67: 1-55
        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.J.
        • Driscoll A.K.
        Births: Final data for 2019.
        National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2021; 70: 1-51
        • Masho S.W.
        • Cha S.
        • Karjane N.
        • McGee E.
        • Charles R.
        • Hines L.
        • Kornstein S.G.
        Correlates of postpartum visits among Medicaid recipients: An analysis using claims data from a managed care organization.
        Journal of Womens Health (Larchmt). 2018; 27: 836-843
        • Mogos M.F.
        • Liese K.L.
        • Thornton P.D.
        • Manuck T.A.
        • O'Brien Jr., W.D.
        • McFarlin B.L.
        Inpatient Maternal Mortality in the United States, 2002–2014.
        Nursing Research. 2020; 69: 42-50
        • Naeger S.
        • Ali M.M.
        • Mutter R.
        • Mark T.L.
        • Hughey L.
        Prescriptions filled following an opioid-related hospitalization.
        Psychiatric Services. 2016; 67: 1262-1264
        • Parlier A.B.
        • Fagan B.
        • Ramage M.
        • Galvin S.
        Prenatal care, pregnancy outcomes, and postpartum birth control plans among pregnant women with opiate addictions.
        Southern Medical Journal. 2014; 107: 676-683
        • Patton B.P.
        • Krans E.E.
        • Kim J.Y.
        • Jarlenski M.
        The impact of Medicaid expansion on postpartum health care utilization among pregnant women with opioid use disorder.
        Substance Abuse. 2019; 40: 371-377
        • Quinn P.D.
        • Hur K.
        • Chang Z.
        • Krebs E.E.
        • Bair M.J.
        • Scott E.L.
        • D’Onofrio B.M.
        Incident and long-term opioid therapy among patients with psychiatric conditions and medications: A national study of commercial healthcare claims.
        Pain. 2017; 158: 140-148
        • Rankin K.M.
        • Haider S.
        • Caskey R.
        • Chakraborty A.
        • Roesch P.
        • Handler A.
        Healthcare utilization in the postpartum period among Illinois women with Medicaid paid claims for delivery, 2009–2010.
        Maternal and Child Health Journal. 2016; 20: 144-153
        • Robbins C.L.
        • Deputy N.P.
        • Patel R.
        • Tong V.T.
        • Oakley L.P.
        • Yoon J.
        • Harvey S.M.
        Postpartum care utilization among women with Medicaid-funded live births in Oregon.
        Maternal and Child Health Journal. 2021; 25: 1164-1173
        • StataCorp
        Stata Statistical Software: Release 16.
        StataCorp LLC, College Station, TX2019
        • Strobino D.M.
        • Grason H.
        • Minkovitz C.
        Charting a course for the future of women's health in the United States: concepts, findings and recommendations.
        Social Science & Medicine. 2002; 54: 839-848
        • Substance Abuse and Mental Health Services Administration (SAMHSA)
        A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders (HHS Publication No. (SMA) 16–4978).
        • Terplan M.
        • Longinaker N.
        • Appel L.
        Women-centered drug treatment services and need in the United States, 2002–2009.
        American Journal of Public Health. 2015; 105: e50-e54
        • The American College of Obstetricians and Gynecologists
        Committee Opinion No. 666: Optimizing Postpartum Care.
        Obstetrics & Gynecology. 2016; 127: e187
        • The American College of Obstetricians and Gynecologists
        ACOG Committee Opinion No. 736: Optimizing Postpartum Care.
        Obstetrics & Gynecology. 2018; 131: e140-e150
        • Tsai P.J.
        • Nakashima L.
        • Yamamoto J.
        • Ngo L.
        • Kaneshiro B.
        Postpartum follow-up rates before and after the postpartum follow-up initiative at Queen Emma Clinic.
        Hawaii Medical Journal. 2011; 70: 56-59
        • Tully K.P.
        • Stuebe A.M.
        • Verbiest S.B.
        The fourth trimester: a critical transition period with unmet maternal health needs.
        American Journal of Obstetrics & Gynecology. 2017; 217: 37-41
        • U.S. Census Bureau
        2013–2017 American Community Survey 5-Year Estimates.
        2017 (Available:)
        • Weir S.
        • Posner H.E.
        • Zhang J.
        • Willis G.
        • Baxter J.D.
        • Clark R.E.
        Predictors of prenatal and postpartum care adequacy in a medicaid managed care population.
        Womens Health Issues. 2011; 21: 277-285
        • Wilcox A.
        • Levi E.E.
        • Garrett J.M.
        Predictors of non-attendance to the postpartum follow-up visit.
        Maternal and Child Health Journal. 2016; 20: 22-27
        • Yee L.M.
        • Martinez N.G.
        • Nguyen A.T.
        • Hajjar N.
        • Chen M.J.
        • Simon M.A.
        Using a patient navigator to improve postpartum care in an urban women's health clinic.
        Obstetrics & Gynecology. 2017; 129: 925-933


      Blair O. Berger, PhD, MSPH, is a postdoctoral research fellow at the Johns Hopkins Bloomberg School of Public Health. Her research focuses on measurement methods and applied epidemiology approaches to improve maternal morbidity, birth outcomes, and quality of care in maternity.


      Leah G. Horton, PhD, MSPH, researches maternal and reproductive health outcomes among traditionally marginalized populations in the US, with particular focus on postpartum contraceptive use dynamics among women who use opioids.


      Alison Gemmill, PhD, MPH, is an assistant professor at Johns Hopkins Bloomberg School of Public Health. Her research aims to improve the health of women and children using a population-health and life-course perspective.


      Donna M. Strobino, PhD, is a professor emeritus at the Johns Hopkins Bloomberg School of Public Health. Her research focuses on understanding the reasons disadvantaged women have higher rates of unfavorable pregnancy outcomes, interventions to improve their outcomes, and maternal morbidity and mental health.