Relationship between opioid use disorder during pregnancy, delivery-related outcomes, and healthcare utilization in Michigan Medicaid, 2012-2021.

Shuman CJ, Zhang X, Hall SV, Tilea A, Clark SJ, Vance AJ, Courant A, Zivin K. Relationship between opioid use disorder during pregnancy, delivery-related outcomes, and healthcare utilization in Michigan Medicaid, 2012-2021. Journal of substance use and addiction treatment. 2025 Aug 1; 175:209720, DOI: 10.1016/j.josat.2025.209720.

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• RCS 21-138 – Research Career Scientist Award

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Abstract:

INTRODUCTION: Pregnant individuals with opioid use disorder (OUD) deliver > 20,000 infants annually in the United States, with serious health consequences for perinatal individuals and their infants. This study compares delivery-related outcomes and healthcare utilization among Michigan Medicaid-enrolled perinatal individuals with and without an OUD diagnosis. METHODS: We conducted a retrospective cohort study among Michigan Medicaid enrollees aged 15-44 who delivered a live infant between 2012 and 2021. RESULTS: The cohort included 218,890 deliveries among 170,002 individuals enrolled continuously in Michigan Medicaid for nine months before delivery and up to three months postpartum. Of those, 3.26 % had an OUD diagnosis during this analytic period. Perinatal individuals with OUD identified primarily as White (82.9 %), lived in urban areas (77.2 %), and had a lower income (68.6 %). Among individuals with OUD, 31 % had another behavioral health diagnosis and 55.1 % received a prescription for a psychotropic medication. Of those with OUD, 47.4 % received a prescription for medication for OUD. Deliveries with OUD versus without OUD had a lower probability of cesarean delivery (aOR  =  0.89) but higher odds of preterm delivery (aOR  =  1.31). Those with OUD had higher likelihood of ambulatory (aOR  =  1.99), ED/observational (aOR  =  1.19), psychotherapy (aOR  =  5.48), and substance use disorder care (aOR  =  27.05) visits than those without OUD. CONCLUSIONS: Medicaid-enrolled perinatal individuals in Michigan with OUD had higher rates of preterm birth and healthcare utilization compared to those without OUD. Clinicians and policymakers should target early detection and tailored, coordinated treatment to better address the needs of these individuals.