Elsevier

Women's Health Issues

Volume 33, Issue 1, January–February 2023, Pages 67-76
Women's Health Issues

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

https://doi.org/10.1016/j.whi.2022.08.005Get rights and content

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.

Section snippets

Data Source and Study Sample

Data for this retrospective cohort study were obtained from the MarketScan Commercial Claims and Encounters Database, which contains paid health and pharmaceutical insurance claims for people with employer-sponsored, private health insurance in the United States. MarketScan includes paid claims for inpatient admissions, outpatient encounters, and outpatient pharmaceutical prescriptions and insurance enrollment information for an estimated 100 million enrollees (IBM Watson Health, 2018). Women

Results

Table 1 shows the distribution of demographic, opioid use, and clinical characteristics in the study cohort overall and by PPC status. Approximately 45% of women in the sample had a PPC visit within 60 days of delivery. A higher percentage of women in any opioid use category attended a PPC visit (50.1% among nonchronic users, 50.6% among women with OUD, and 55.6% among chronic users) than women who did not use opioids (44.5%). A higher percentage of women who attended any ANC also attended a

Discussion

Our study used nationwide claims data to assess differences in PPC visit attendance among women who did not use opioids during pregnancy and different types of opioid users in a privately insured population. Fewer than half (45%) of women in our study had a PPC visit, despite the high prevalence of some clinical risk factors in this cohort. Women with no opioid use had particularly low PPC attendance whereas just over half of women with any form of opioid use attended PPC, with the highest

Acknowledgments

The authors thank the Johns Hopkins Center for Drug Safety and Effectiveness for providing access to the MarketScan database.

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.

References (50)

  • O. Azeez et al.

    Hypertension and diabetes in non-pregnant women of reproductive age in the United States

    Preventing Chronic Disease

    (2019)
  • B.T. Bateman et al.

    Patterns of opioid utilization in pregnancy in a large cohort of commercial insurance beneficiaries in the United States

    Anesthesiology

    (2014)
  • W.L. Bennett et al.

    Utilization of primary and obstetric care after medically complicated pregnancies: An analysis of medical claims data

    Journal of General Internal Medicine

    (2014)
  • W.M. Callaghan et al.

    Severe maternal morbidity among delivery and postpartum hospitalizations in the United States

    Obstetrics & Gynecology

    (2012)

  • Opioid overdose: Data resources, analyzing prescription data and morphine milligram equivalents (MME)

  • J. Chen et al.

    Assessment of incidence and factors associated with severe maternal morbidity after delivery discharge among women in the US

    JAMA Network Open

    (2021)
  • V.A. Danilack et al.

    Characteristics of women without a postpartum checkup among PRAMS participants, 2009–2011

    Maternal and Child Health Journal

    (2019)
  • J.R. Daw et al.

    Women in the United States experience high rates of coverage ‘churn’ in months before and after childbirth

    Health Affairs

    (2017)
  • R.J. Desai et al.

    Increase in prescription opioid use during pregnancy among Medicaid-enrolled women

    Obstetrics & Gynecology

    (2014)
  • C.L. DeSisto et al.

    Comparing postpartum care utilization from Medicaid claims and the pregnancy risk assessment monitoring system in Wisconsin, 2011–2015

    Maternal and Child Health Journal

    (2021)
  • J.N. DiBari et al.

    Use of postpartum care: predictors and barriers

    Journal of Pregnancy

    (2014)
  • N. Finkelstein

    Treatment programming for alcohol and drug-dependent pregnant women

    International Journal of the Addictions

    (1993)
  • D.A. Grimes et al.

    False alarms and pseudo-epidemics: the limitations of observational epidemiology

    Obstetrics and Gynecology

    (2012)
  • S.C. Haight et al.

    Opioid use disorder documented at delivery hospitalization- United States, 1999-2014

    Morbidity and Mortality Weekly Report

    (2018)
  • K.P. Himes et al.

    Healthy beyond pregnancy, a web-based intervention to improve adherence to postpartum care: Randomized controlled feasibility trial

    JMIR Human Factors

    (2017)

    • Cited by (0)

    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.

    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.

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