Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (MJ, JYK, JMD); Muskie School of Public Service, University of Southern Maine, Portland, ME (KAA); Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, WV (LA); Department of Maternal and Child Health, University of North Carolina-Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC (AA); Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA (AJB); Ohio Colleges of Medicine Government Resource Center, Columbus, OH (DC, RM); School of Social Work, University of North Carolina-Chapel Hill, Chapel Hill, NC (PL); The Hilltop Institute, University of Maryland Baltimore County, Baltimore, MD (SM); Office of Health Affairs, West Virginia University Health Sciences Center, Morgantown, WV (NP); Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY (JT); Departments of Psychiatry and Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI (KZ); Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (KZ).
J Addict Med. 2021;15(5):406-413. doi: 10.1097/ADM.0000000000000780.
State Medicaid programs are the largest single provider of healthcare for pregnant persons with opioid use disorder (OUD). Our objective was to provide comparable, multistate measures estimating the burden of OUD in pregnancy, medication for OUD (MOUD) in pregnancy, and related neonatal and child outcomes.
Drawing on the Medicaid Outcomes Distributed Research Network (MODRN), we accessed administrative healthcare data for 1.6 million pregnancies and 1.3 million live births in 9 state Medicaid populations from 2014 to 2017. We analyzed within- and between-state prevalences and time trends in the following outcomes: diagnosis of OUD in pregnancy, initiation, and continuity of MOUD in pregnancy, Neonatal Opioid Withdrawal Syndrome (NOWS), and well-child visit utilization among children with NOWS.
OUD diagnosis increased from 49.6 per 1000 to 54.1 per 1000 pregnancies, and the percentage of those with any MOUD in pregnancy increased from 53.4% to 57.9%, during our study time period. State-specific percentages of 180-day continuity of MOUD ranged from 41.2% to 84.5%. The rate of neonates diagnosed with NOWS increased from 32.7 to 37.0 per 1000 live births. State-specific percentages of children diagnosed with NOWS who had the recommended well-child visits in the first 15 months ranged from 39.3% to 62.5%.
Medicaid data, which allow for longitudinal surveillance of care across different settings, can be used to monitor OUD and related pregnancy and child health outcomes. Findings highlight the need for public health efforts to improve care for pregnant persons and children affected by OUD.
州医疗补助计划是为患有阿片类药物使用障碍（OUD）的孕妇提供医疗保健的最大单一提供者。我们的目的是提供可比的多州措施，估计妊娠期间 OUD 的负担、妊娠期间的 OUD 药物治疗（MOUD）以及相关的新生儿和儿童结局。
利用医疗补助结果分布式研究网络（MODRN），我们获取了 9 个州医疗补助人群中 160 万例妊娠和 130 万例活产的行政医疗保健数据，时间范围为 2014 年至 2017 年。我们分析了以下结局在州内和州间的流行率和时间趋势：妊娠期间 OUD 的诊断、妊娠期间 MOUD 的起始和连续性、新生儿阿片类戒断综合征（NOWS）以及患有 NOWS 的儿童的常规健康检查利用率。
在我们的研究期间，OUD 诊断率从每 1000 例妊娠 49.6 例增加到每 1000 例妊娠 54.1 例，妊娠期间接受任何 MOUD 的比例从 53.4%增加到 57.9%。180 天 MOUD 连续性的州特异性百分比范围为 41.2%至 84.5%。被诊断为 NOWS 的新生儿人数从每 1000 例活产 32.7 例增加到每 1000 例活产 37.0 例。被诊断为 NOWS 且在头 15 个月内接受推荐常规健康检查的儿童的州特异性百分比范围为 39.3%至 62.5%。
医疗补助数据允许对不同环境下的护理进行纵向监测，可用于监测 OUD 及相关妊娠和儿童健康结局。研究结果强调需要开展公共卫生工作，改善对患有 OUD 的孕妇和儿童的护理。
