High opioid use disorder and severe maternal morbidity rates reported among Medicaid patients

High opioid use disorder and severe maternal morbidity rates reported among Medicaid patients | Image Credit: © Svyatoslav Lypynskyy - © Svyatoslav Lypynskyy - stock.adobe.com.

Severe maternal morbidity (SMM) risk is significantly increased among pregnant patients with opioid use disorder (OUD) enrolled in Medicaid, according to a recent study published in JAMA Network Open.¹

Significant increases in rates of OUD have been observed among pregnant people in recent decades. Over 70% of pregnant patients with OUD are insured by Medicaid, which is required to provide coverage of prenatal care to individuals with incomes under 133% of the federal poverty level.²

Data has indicated associations between OUD and SMM.¹ However, rates of OUD among pregnant patients enrolled in Medicaid and associated adverse maternal health outcomes is lacking.

Investigators conducted a study to evaluate OUD and SMM rates among Medicaid patients. Data was obtained from the Transformed Medicaid Statistical Information System Analytic Files of the Centers for Medicare & Medicaid Services.

Inpatient files, Other Services files, and Demographic and Eligibility files were available in the data source. Maternal outcomes and obstetric services were identified based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes.

Participants included enrollees with live birth covered by Medicaid from March 1, 2016, to November 16, 2018. In participants with more than 1 delivery, both deliveries were included if they were separated by 180 days or longer. ICD-10 codes were used to identify OUD.

SMM comprised of 20 conditions selected by the Centers for Disease Control and Prevention. These conditions were linked to short- or long-term adverse health outcomes when treatment was not provided.

Hospital and emergency department claims in Other Services files and all claims in Inpatient files were used to measure SMM. Covariates included age, gestational age at delivery, mode of delivery, race and ethnicity, and health status.

There were 96,309 Medicaid enrollees with OUD diagnosed before live birth during the study period, encompassing 108,975 deliveries. An overall mean OUD rate of 324.8 per 10,000 live births was reported in this population.

Another substance use disorder was reported in 38.8% of pregnant patients with OUD. Participants were aged a mean 28.8 years, and 7.3% were Hispanic, 7.9% non-Hispanic Black, 69.6% non-Hispanic White, and 4% other race and ethnicity.

The mean SMM rate of Medicaid enrollments with OUD across states was 291.1 per 10,000 live births when excluding blood transfusions. Adult respiratory distress syndrome was the most common SMM, comprising 23.2% of cases. This was followed by sepsis at 14.1%, ventilation at 13.8%, acute heart failure at 13.4%, and eclampsia at 12.9%.

Significant variations in SMM rates were reported between states. Rates ranged from 101 per 10,000 in South Dakota to 682.2 in California and were not significantly altered by adjustments.

A mean enrollment in Medicaid of 17.4 months was reported among participants enrolling after January 1, 2017. An increase in SMM prevalence was reported among participants with reduced Medicaid enrollment, with rates of 335.7 per 10,000 live births for enrollment before pregnancy vs 423.8 per 10,000 for enrollment at delivery.

These results indicated high rates of OUD and a significant association with SMM among Medicaid enrollees. Investigators recommended strategies to address the SMM burden on OUD patients be implemented through state Medicaid programs.

References

1. Auty SG, Frakt AB, Shafer PR, Stein MD, Gordon SH. Severe maternal morbidity among pregnant people with opioid use disorder enrolled in Medicaid. JAMA Netw Open. 2025;8(1):e2453303. doi:10.1001/jamanetworkopen.2024.53303
2. Ranji U, Gomez I, Salganicoff A. Expanding postpartum Medicaid coverage. Kaiser Family Foundation. March 9, 2021. Accessed January 8, 2025. https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/