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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:https://doi.org/10.1016/j.whi.2022.08.005

      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.