The Urban Institute, 500 L'Enfant Plaza, SW, Washington, DC 20024, USA.
The Urban Institute, 500 L'Enfant Plaza, SW, Washington, DC 20024, USA.
J Subst Abuse Treat. 2021 May;124:108265. doi: 10.1016/j.jsat.2020.108265. Epub 2020 Dec 26.
Substance use disorder (SUD) during pregnancy increases risks of adverse outcomes for mothers and children. Because Medicaid covers about half of all births and maternal SUD is a costly problem, describing the timing of enrollment and health care that Medicaid-enrolled pregnant women with SUDs receive is critical to understanding gaps in the timeliness and specificity of SUD diagnosis and treatment for pregnant women with SUDs. We used linked maternal and infant Medicaid claims and enrollment data and infant birth records from three states (n=72,086 mother-infant dyads) to estimate the share of sample women diagnosed with a specified SUD (e.g., opioid use disorder) before or during the birth month, with a specified SUD after the birth month, and with only an unspecified SUD diagnosed (e.g., drug use disorder complicating pregnancy). We also examined the timing of first observed Medicaid enrollment, SUD diagnosis and treatment, and maternal and infant costs. In the 24 months surrounding birth, 3.6% of women had a specified SUD diagnosis first observed before or during the birth month, 1.7% had a specified SUD diagnosis first observed after the birth month, and 6.0% had an SUD diagnosis that was not specified. Most women with a specified SUD diagnosis were enrolled in Medicaid before or early in pregnancy and initiated prenatal care in the first or second trimester, yet nearly one-third of these women received their specified SUD diagnosis after the birth month. Less than two-thirds of women with a specified SUD diagnosis received any SUD treatment during the study period (59.9% among those identified before or during the birth month and 63.1% among those observed after the birth month), and women with an unspecified SUD were about half as likely to get treatment (28.6%). Among treated women, more than two-thirds had the first observed treatment in the same month as their first observed SUD diagnosis. Findings point to a critical need for interventions as well as substantial opportunities to improve the identification of substance use-related needs and provision of treatment among women who birth in Medicaid. Changes in Medicaid and other public policy to reduce disincentives for pregnant and parenting women to report substance use during medical visits and to increase providers' abilities and motivation to equitably screen for as well as treat women with SUDs before, during, and after pregnancy could improve outcomes for mothers and their children. Improvements in SUD diagnosis would also improve prevalence estimates of specific types of SUD, which could contribute to better Medicaid policies aimed at prevention and treatment.
物质使用障碍（SUD）在怀孕期间会增加母婴不良结局的风险。由于医疗补助计划覆盖了大约一半的分娩，而产妇 SUD 是一个昂贵的问题，因此描述参加医疗补助计划的患有 SUD 的孕妇的入保时间和获得的医疗保健情况对于了解 SUD 诊断和治疗的及时性和针对性方面的差距至关重要。我们使用了来自三个州的产妇和婴儿医疗补助索赔和入保数据以及婴儿出生记录（n=72086 对母婴对），以估计在出生月份之前或期间被诊断出患有特定 SUD（例如，阿片类药物使用障碍）的样本女性的比例，在出生月份之后被诊断出患有特定 SUD 的女性比例，以及仅被诊断出未特指 SUD（例如，药物使用障碍合并妊娠）的女性比例。我们还检查了首次观察到的医疗补助入保、SUD 诊断和治疗以及母婴成本的时间。在出生前后的 24 个月中，有 3.6%的女性在出生月份之前或期间首次被诊断出患有特定 SUD，有 1.7%的女性在出生月份之后首次被诊断出患有特定 SUD，有 6.0%的女性被诊断出患有未特指的 SUD。大多数被诊断出患有特定 SUD 的女性在怀孕前或怀孕早期就加入了医疗补助计划，并在妊娠早期或中期开始接受产前护理，但近三分之一的女性在出生后才被诊断出患有特定 SUD。在研究期间，只有不到三分之二的患有特定 SUD 诊断的女性接受了任何 SUD 治疗（在出生前或期间被诊断出的女性中占 59.9%，在出生后被诊断出的女性中占 63.1%），而患有未特指 SUD 的女性接受治疗的可能性约为一半（28.6%）。在接受治疗的女性中，超过三分之二的人在首次观察到 SUD 诊断的当月接受了首次治疗。研究结果表明，迫切需要采取干预措施，以及为在医疗补助计划中分娩的女性提供更多机会，以确定与物质使用相关的需求并提供治疗。医疗补助计划和其他公共政策的改变，以减少怀孕和育儿的妇女在医疗访问期间报告物质使用的障碍，并提高提供者识别和公平对待患有 SUD 的妇女的能力和动机，这些都可以改善母婴的结局。SUD 诊断的改善也将提高特定类型 SUD 的患病率估计，这有助于制定更好的针对预防和治疗的医疗补助政策。
