Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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Biography
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.
Biography
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.
Biography
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.
Biography
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.
Article info
Publication history
Published online: September 15, 2022
Accepted:
August 15,
2022
Received in revised form:
July 7,
2022
Received:
July 30,
2021
Footnotes
Funding Statement: This work was supported by the Maternal and Child Health Training Grant through the Johns Hopkins Center of Excellence in Maternal and Child Health Education, Science, and Practice through Maternal and Child Health Bureau/Health Resources and Services Administration (fellows: B.O.B. and L.G.H.). The authors have no financial conflicts to disclose.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
