BACKGROUND:The postpartum period-when supports often wane and stressors intensify-is a time of heightened risk for individuals with substance use disorder (SUD), including a markedly elevated likelihood of overdose. In this context, contraception is considered vital to supporting recovery, stability, and reproductive health and autonomy. However, individuals with SUD encounter persistent barriers to postpartum contraceptive care, resulting in lower rates of usage and higher unintended pregnancy rates than those without SUD. PURPOSE:This scoping review maps impediments to postpartum contraception for individuals with SUD, identifies potential avenues for clinical and community-based practice improvements, and highlights literature gaps to inform future research. METHODS:We conducted a search of seven databases for studies that examined access to postpartum contraception for individuals with SUD as a core research aim. Eligible articles were peer reviewed and based in the United States. Each of the databases were searched independently on July 15, 16, 18, and 22, 2024. An updated search was conducted on May 17, 2025. RESULTS:Twenty studies ultimately met the criteria for inclusion and were analyzed using a qualitative descriptive methodology. Common barriers included limited availability of immediate postpartum contraception, low postpartum visit attendance, care discontinuity, stigma, coercion, criminalization, and broader structural hindrances. Author-identified suggestions included co-locating contraceptive and SUD services, strengthening provider training in patient-centered care modalities, implementing prenatal contraceptive planning, and expanding immediate postpartum contraception availability. CONCLUSIONS:Few studies assessed patient autonomy or satisfaction with postpartum contraceptive care, underscoring the necessity for research that goes beyond measuring uptake rates to define intervention success. Qualitative inquiry is particularly warranted. Additionally, other avenues of co-location and service integration should be explored in greater depth.
OBJECTIVE:We estimated postpartum hospital readmissions trends among women with gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PDM; i.e., diabetes present before pregnancy), and neither. METHODS:Using the National Readmissions Database, we identified women aged 15-44 years who had a live birth or stillbirth between January 1 and June 30 annually, from 2016 through 2022. Births by diabetes status (GDM, PDM, and no diabetes diagnosis) were grouped to obtain the 1) rates of postpartum rehospitalization for all causes, severe maternal morbidity (SMM), diabetes-related diagnoses, and mental health-related diagnoses, 2) repeated admissions, and 3) the leading causes of readmission. Joinpoint regression was used to assess trends in outcomes for 30, 60, and 180 days postpartum. RESULTS:From 2016 to 2022, rates of all-cause postpartum readmissions increased significantly among women with GDM and women without diabetes by 30 days (annual percent change [APC], 2.78 for both), whereas rates of SMM postpartum readmissions decreased significantly among women with GDM by 30 days (APC, -7.44), 60 days (APC, -7.12), and 180 days (APC, -6.37), among women with PDM by 60 days (APC, -7.05), and among women with no diabetes by 30 days (APC, -5.83), 60 days (APC, -5.68), and 180 days (APC, -4.45). Postpartum diabetes-related readmission rates decreased for all periods among women with GDM and without diabetes (APC p values < .05) and by 180 days among women with PDM (APC, -7.03). Repeated diabetes-related admissions decreased at 60 and 180 days postpartum (APC p values < .05) among women with PDM. Hypertensive disorders were among the top three reasons for readmissions, regardless of diabetes status. CONCLUSION:Although all-cause readmissions increased by 30 days among women with GDM and without diabetes, postpartum SMM and diabetes-related readmissions decreased overall among women with GDM, PDM, and neither. Hypertensive disorders as a top reason for readmission suggests the need to monitor these disorders among women with GDM and PDM at birth.
