Postpartum Treatment for Substance Use Disorder Among Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Substance Exposure

Abstract

Background: Little is known about rates of substance use disorder (SUD) treatment for women in dyads affected by substance use in the immediate postpartum period. This study's objectives were to (1) identify characteristics of mothers of infants with neonatal abstinence syndrome (NAS) and/or prenatal substance exposure (PSE) who did or did not receive SUD treatment in the first 60 days postpartum and (2) describe timing of treatment receipt. Methods: This descriptive study examined linked mother-infant dyads using Medicaid data from Louisiana, Massachusetts, and Wisconsin for 2006-2009. Dyads were included if the infant had NAS and/or PSE. Descriptive statistics on sociodemographic characteristics, prenatal SUD, mental health conditions, Medicaid enrollment, and health care utilization were reported for women who did and did not receive SUD treatment in the first 60 days postpartum. The distribution of each variable was compared using chi-square tests. The timing of first postpartum treatment in weeks since delivery was examined. Results: Among Medicaid-insured women whose infants had in utero substance exposure, 15% received any postpartum SUD treatment. Fewer than half were diagnosed with SUD prenatally. Of those who received postpartum SUD treatment, 68% had received prenatal treatment. No association was observed between postpartum SUD treatment receipt and months of Medicaid enrollment in the year before delivery, prenatal visits, or postpartum visit attendance. Conclusions: Most women who likely need postpartum SUD treatment did not receive it and multipronged solutions are needed. These findings provide a useful baseline for evaluations of policies aimed at improving maternal health.

Sociodemographic Differences in Quality of Treatment to Medicaid Enrollees Receiving Buprenorphine

“…Using the MAX eligibility files, we determined an individual's sex; age (14–25 years, 26–35, 36–45, 46–54, and 55–64); and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, or other/unknown race/ethnicity). Using the MAX outpatient and inpatient services files, we determined whether an individual had a concurrent mental health or chronic condition comorbidity (see Appendix Table A6 for the diagnosis codes included, based on the International Classifications of Disease, Version 9 (ICD-9) codes) 48 , 49 . We defined the buprenorphine episode year as the calendar year in which the first buprenorphine fill of the treatment episode occurred.…”

“…Using the MAX outpatient and inpatient services files, we determined whether an individual had a concurrent mental health or chronic condition comorbidity (see Appendix Table A6 for the diagnosis codes included, based on the International Classifications of Disease, Version 9 (ICD-9) codes). 48,49 We defined the buprenorphine episode year as the calendar year in which the first buprenorphine fill of the treatment episode occurred.…”

Development and Implementation of State and Federal Child Welfare Laws Related to Drug Use in Pregnancy

“…Similar to nonpregnant individuals, both pharmacological and non‐pharmacological therapies may be helpful for pregnant individuals with SUD, however, pregnant individuals often face additional barriers to treatment. Although a larger share of pregnant people with SUD get treatment relative to nonpregnant people with SUD, less than half of pregnant people with SUD receive treatment, 31 including methadone or buprenorphine, as appropriate, for OUD, the standard of care during pregnancy 32,33 . When pregnant individuals with OUD or another SUD are not able to access treatment—as a result of structural barriers or fears of criminal or civil consequences—the likelihood of a substance‐exposed newborn or other adverse outcome, including maternal death, increases 34 …”

Response to Reddy and Schiff

“…We agree that in both research and clinical practice, focusing on the maternal-infant dyad is preferable to focusing on either in isolation. In recent work, we have linked mothers and infants in Medicaid MAX data to examine postpartum treatment receipt among women whose infants were identified as being exposed to substances in utero or diagnosed with NAS [3].…”