Opioid use disorder and medication for opioid use disorder among pregnant women with commercial insurance in the United States, 2016-2020.

Abstract

To examine the prevalence of opioid use disorder (OUD) diagnosis and medications for OUD (MOUD), which includes methadone, buprenorphine, and naltrexone, during pregnancy, and examine pre-pregnancy clinical factors associated with MOUD receipt in a nationwide commercial insurance database. We utilized data from Marketscan to identify pregnancies among women aged 15-54 years from 2016 to 2020. Individuals were included if they had consecutive enrollment from 90 days before the estimated last menstrual period (LMP) through 90 days postpartum. OUD and MOUD were identified using International Classification of Diseases (ICD) codes and pharmaceutical claims or Healthcare Common Procedure Coding System (HCPCS) codes. Multivariable Poisson regression was used to examine demographic and pre-pregnancy clinical factors associated with MOUD. We identified 909,241 total pregnancies, among which 2926 (0.3%) individuals had an OUD diagnosis during pregnancy or postpartum. Among women diagnosed pre- or during pregnancy with OUD (n = 2346), 1014 (40.2%) received MOUD. Demographic and clinical factors positively associated with an OUD diagnosis included younger age and non-metropolitan statistical area (MSA) residence. Factors negatively associated with MOUD receipt during pregnancy included co-occurring chronic pain or concurrent substance use disorder diagnosis other than OUD. Having two or more mental health disorders was positively associated with MOUD receipt. Less than half of pregnant women with OUD received MOUD, the gold standard for treatment. Our results demonstrate substantial missed opportunities for MOUD treatment during pregnancy, highlighting the need for targeted interventions to improve evidence-based perinatal OUD care.