Project Overview

The COVID-19 pandemic in the United States (US) is likely to have a severe and disproportionate impact on persons with substance use disorders (SUDs), including pregnant and postpartum women with opioid use disorder (OUD). Pregnant women with OUD may be at greater risk for COVID-19-related complications because they have a greater risk of complications from respiratory infections, such as influenza and SARS-CoV, and have higher rates of tobacco (54% vs 12%) and marijuana (12% vs 2%) use compared to non-OUD pregnant women.

Further, because analyses from our current R01 demonstrate that OUD during pregnancy is independently associated with a 50% increase in the risk of severe maternal morbidity (SMM), COVID-19 infection may further exacerbate high rates of adverse maternal (i.e. overdose, SMM) and perinatal (i.e. preterm birth, low birthweight) health outcomes among pregnant women with OUD.

Medications for OUD (MOUD) markedly reduce the risk of relapse and overdose mortality and are associated with significant reductions in the risk of preterm birth and low birthweight among pregnant women with OUD. Despite this, analyses from our current R01 demonstrate that 44% of pregnant women with OUD do not use MOUD, less than half utilize any behavioral health services and 3% experience an overdose event during pregnancy or the postpartum period.

Modifications to the substance use treatment process due to COVID-19, such as changes in the type (telemedicine vs in-person), frequency (monthly vs biweekly) and quality (lack of urine drug screening) of treatment services may create additional barriers to MOUD use during pregnancy. Thus, there is a critical need to understand how COVID-19 infection influences health outcomes among pregnant women with OUD and how the broad impacts of COVID-19 (i.e. healthcare system changes) affect access to and quality of substance use treatment for pregnant and postpartum women with OUD.

This project will:

1) evaluate how COVID-19 infection influences the rate of adverse maternal and perinatal health outcomes among pregnant and postpartum women with OUD and

2) understand how the broad impacts of COVID-19 (i.e. healthcare system changes) affect access to and quality of addiction treatment for pregnant and postpartum women with OUD.

Grant Number

3R01DA045675-03S1

Principal Investigator(s)

Research Aims

These analyses are complementary to our current R01, which uses administrative healthcare data to examine how changes in the availability, accessibility and quality of OUD treatment services differentially impact maternal (i.e. opioid overdose) and perinatal (i.e. preterm birth, low birthweight) health outcomes.

For this research, we will continue to utilize administrative healthcare data from the Pennsylvania Medicaid program and the University of Pittsburgh Medical Center (UPMC), one of the largest health systems in Pennsylvania. UPMC electronic medical record (EMR) data are available with approximately a 1-month lag and will allow us to rapidly describe temporal changes in testing for and treatment of COVID-19 and subsequent health outcomes among pregnant women with OUD.

In Year 2, we will utilize administrative healthcare data from the Pennsylvania Medicaid program including claims, encounters, and pharmacy data for all Medicaid beneficiaries in Pennsylvania to evaluate the effect of COVID-19 infection on health outcomes among >12,000 pregnant women with OUD and their infants, from 2019 and 2020, after approximately a 9-month lag.

Specifically, we aim to:

AIM 1. Quantify the effect of COVID-19 infection on the risk of adverse maternal (i.e. overdose, SMM) and perinatal (i.e. preterm birth, low birthweight) health outcomes among pregnant women with OUD.

  • We will create a cohort of pregnant women with OUD and COVID-19 infection and conduct a matched cohort analysis using propensity score matching techniques to determine the extent to which COVID-19 infection increases the risk of adverse maternal and perinatal health outcomes among pregnant women with OUD.

AIM 2. Determine how healthcare system changes due to COVID-19 affect access to and quality of substance use treatment for pregnant and postpartum women with OUD.

  • We will use a pre-post interrupted time series design to assess whether COVID-19-related changes in the delivery of substance use treatment affects OUD treatment outcomes (i.e. overdose, MOUD utilization).
  • We will quantify temporal trends in the delivery of OUD treatment services including dispensed quantities of MOUD, frequency of urine drug screening, use of telemedicine and the frequency of OUD treatment, behavioral health and prenatal visits.

Changes to substance use treatment due to COVID-19 are extraordinary and the unique effects of COVID-19 on outcomes among pregnant and postpartum women with OUD are unknown. Therefore, the research supplement is significant because it will use existing healthcare data to quantify the effects of healthcare system responses to COVID-19 on outcomes among pregnant and postpartum women with OUD and innovative by allowing us to describe how COVID-19 infection influences morbidity (i.e. overdose) among pregnant women with OUD. Research findings generated from this research will directly inform the future provision of substance use treatment services for pregnant women and postpartum with OUD.