OUD Rates in Pregnant Medicaid Enrollees Higher Than Previously Thought

Medicaid programs provide insurance for a large portion of pregnant people living with opioid use disorder (OUD), which places them at an increased risk for severe maternal morbidity (SMM) that could otherwise likely be avoided. To date, however, researchers are not wholly aware of the burden of SMM for this subpopulation.

A new investigation, published today in JAMA Network Open, revealed that, among pregnant Medicaid beneficiaries, OUD prevalence was more than double earlier approximations.¹

Severe maternal morbidity data has been hard to gather because it is not very reproducible and still occurs relatively rarely. | image credit: Gajus - stock.adobe.com

SMM can refer to a broad set of childbirth-related complications and consequences, typically indicating events that were life threatening or could have lasting health impacts. For every maternal death in the US an estimated 70 cases of SMM occur; these metrics are often used to track system-wide faults and identify areas for improving patient outcomes. SMM remains largely understudied due to “the absence of reliable and reproducible means of collecting data and the rarity of many complications.”²

This gap in knowledge motivated the current authors to evaluate the burden of adverse maternal outcomes for individuals with OUD and prevalence of this condition in Medicaid enrollees. To accomplish this, 2016-2018 data on live births, including Inpatient, Other Services and Demographic and Eligibility files were gathered from CMS databases, specifically for claims tied to various codes related to maternal health, obstetric-related services, and the prenatal, delivery, and postpartum periods.¹

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes, among others, were used to identify SMM in the 6 weeks leading up to delivery. There were 20 conditions indicative of SMM, including sepsis, acute myocardial infarction, shock and more.

A total of 96,309 Medicaid enrollees were identified with an OUD diagnosis preceded their live birth (n = 108,975 deliveries). On average throughout the states, the prevalence of OUD during pregnancy for Medicaid enrollees was 324.8 cases per every 10,000 live births. When blood tranfusions were excluded, this average totaled to 292.1 cases of OUD for every 10,000 live births. In 38% of deliveries (n = 42,265), the researchers saw additional substance use disorders (SUD) accompanying OUD, including alcohol (9.6%, n = 8097), cocaine (10.4%, n = 11,300), other stimulants (10.9%, n = 11,977), sedatives (15.1%, = 16,423), and cannabis (18%, n = 19,640).

The most prevalent conditions of SMM were adult respiratory disease (23.2%, n = 845), followed by sepsis (14.1%, n = 514), then ventilation (13.8%, n = 502), acute heart failure/pulmonary edema (13.4%, n = 489), and eclampsia (12.9%, n = 471).

The authors noted how SMM rates typically grew as Medicaid enrollment duration shrank. Those who enrolled after January 1, 2017, were enrolled for an average of 17.4 months prior to delivery. If an individual enrolled in Medicaid before they were pregnant, SMM prevalence was 335.7 per 10,000 live births vs 423.8 in those who enrolled at the time of delivery (n = 1970 vs 32).

“State Medicaid programs are uniquely positioned to implement strategies that address the burden of SMM among pregnant people with OUD. Doing so will require early identification of pregnant Medicaid enrollees with OUD and implementation of targeted strategies to increase engagement with perinatal care and SUD treatment,” the authors concluded.

References

1. Auty SG, Frakt AB, Shafer PR, Stein MD, Gordon SH. Severe maternal morbidity among pregnant people with opioid use disorder in Medicaid. JAMA Netw Open. 2025;8(1):e2453303. doi:10.1001/jamanetworkopen.2024.53303

2. Severe maternal morbidity. UpToDate. Updated January 6, 2025. Accessed January 7, 2025. https://www.uptodate.com/contents/severe-maternal-morbidity#:~:text=Severe%20maternal%20morbidity%20(SMM)%20is,approximately%20seven%20million%20hospitalizations%20annually