The U.S. carceral health care system presents a unique opportunity to expand reproductive health services. Evidence suggests that women incarcerated in jails want to initiate contraception, but access varies across facilities and is limited by concerns about cost, reproductive coercion, and a lack of consistent policies. To better understand the reproductive health needs of rural incarcerated women, a cross-sectional study of women incarcerated in four rural Maine jails was conducted using a 59-question survey on contraceptive history, needs, and preferences. Seventy-three women with complex histories of trauma, substance use, and poor reproductive health outcomes completed the survey. There were low rates of contraceptive use prior to incarceration. Thirty-nine percent plan to use contraception following release despite only 15% desiring pregnancy. Most respondents felt that women incarcerated in jails should have access to permanent sterilization but were concerned about coercion.

AbstractIn June 2022, the U.S. Supreme Court ruling in Dobbs v. Jackson Women's Health Organization ended the federal constitutional right to abortion in the United States. As a result, 12 states now ban abortion in nearly all circumstances and several states restrict abortion access to early gestational limits. This article considers how abortion bans and restrictions have influenced maternal morbidity and mortality, sentinel indicators of our nation's health. This article discusses the availability of routinely collected U.S. data for studying abortion bans and restrictions on maternal morbidity and mortality, study design and context considerations for estimating consequences of abortion bans and restrictions, and recommendations about how to improve data collection and dissemination.

To examine whether the effect of a paid family leave program on acute care encounters for respiratory tract infections among young infants differed by subgroups. We examined 52 943 hospitalizations and emergency department visits between October 2015 and February 2020 among infants aged <= 8 weeks in New York, which introduced paid family leave in January 2018, and four New England control states (Massachusetts, New Hampshire, Vermont, and Maine). We conducted a controlled time series analysis that compared observed counts in New York during the putative respiratory virus season (October to March) in each population subgroup to those predicted in the absence of the policy. Absolute reductions in respiratory tract infection-related acute care encounters among young infants were greater for Hispanic as compared to non-Hispanic White infants (5.60 fewer cases per 1000 infants [95% CI, -8.74 to -2.51]) and for encounters paid for by Medicaid as compared to private payer (4.22 fewer cases per 1000 [95% CI, -6.45 to -2.18]). Findings by Child Opportunity Index 2.0 quintiles showed no clear pattern. Our findings suggest the program may have larger benefits for infants from less advantaged groups. What's Known on This Subject: The introduction of paid family leave in New York state reduced hospital and emergency department visits for respiratory tract infection by 18% among young infants. What This Study Adds: Reductions in hospital and emergency department visits for respiratory tract infection among young infants were greater for Hispanic infants as compared to non-Hispanic White infants and were greater for encounters paid for by Medicaid as compared to private payer.

Abstract Introduction While the strong association of prenatal depression with an increased risk of new cardiovascular disease (CVD) within 24 months postpartum has been demonstrated in two distinct cohorts, it is unclear if treatment of prenatal depression may mitigate this risk. We aimed to estimate the cumulative risk of new CVD and new chronic hypertension in the first 24 months postpartum among pregnant individuals with prenatal depression treated with antidepressant medications or psychotherapy compared with those with untreated prenatal depression. We hypothesized that treatment for prenatal depression may be associated with a lower risk of CVD postpartum among those with prenatal depression. Methods Our longitudinal population‐based study included pregnant individuals with deliveries in the Maine Health Data Organization's All Payer Claims Data during 2007–2020. We excluded those individuals with any diagnosis before pregnancy of the cardiovascular conditions being examined postpartum, multifetal gestations, or no continuous health insurance during pregnancy. Prenatal depression, psychotherapy, and antidepressant medications were identified with ICD9/10 diagnosis codes, CPT codes, and pharmacy dispensing data, respectively. Primary outcomes were a dichotomous CVD composite (heart failure, ischemic heart disease, cerebrovascular disease, arrhythmia/cardiac arrest, cardiomyopathy) and chronic hypertension within 24 months postpartum. Adjusted Cox models were used to estimate hazard ratios. Results Among the 17,100 pregnant individuals with depression included in our analysis (13.5% of 126,333 total eligible pregnancies), 50.0% (n = 8556) had treatment with antidepressants and/or psychotherapy visits. Among the 16,953 pregnant individuals with depression included in the composite CVD outcome analysis, treatment with antidepressant medication use and/or psychotherapy was associated with a 25% lower risk of CVD (adjusted hazard ratio [aHR],, 0.75; 95% confidence interval [CI], 0.57–0.98). However, among the 15,240 pregnant individuals with depression included in the new chronic hypertension outcome analysis, no association was observed (aHR, 1.05; 95% CI, 0.84–1.32). Conclusion The cumulative risk of new CVD within 24 months postpartum was significantly lower in patients with antidepressant and/or psychotherapy use during pregnancy compared to those with untreated prenatal depression. This suggests that treatment of prenatal depression may mitigate CVD risk; however, given the limitations of observational research, further study is warranted to elucidate the pathophysiologic mechanisms that underlie this association.

Importance:There are large racial and ethnic differences in the use of medications for opioid use disorder (MOUD). Whether differences in geographic availability of MOUD providers (defined in this study as buprenorphine prescribers, methadone dispensing opioid treatment programs, and naltrexone prescribers) contribute to these differences in Medicaid is unknown. Objective:To examine differential geographic availability of MOUD in Medicaid and whether it is associated with MOUD use. Design, Setting, and Participants:This cross-sectional study analyzed the geographic availability of Medicaid prescribers of MOUD in 2021, spanning 10 states (Delaware, Kentucky, Maryland, Maine, Michigan, North Carolina, Pennsylvania, Tennessee, Virginia, and West Virginia) in the Medicaid Outcomes Distributed Research Network. The study population included Medicaid enrollees aged 18 to 64 not enrolled in Medicare and their MOUD providers. The data analysis was conducted from December 2022 to April 2026. Exposures:Geographic availability was measured at the zip code level (number of MOUD providers available in Medicaid within a 15-minute drive time per 100 Medicaid enrollees). Main Outcomes and Measures:Main outcomes included the probability of buprenorphine, methadone, and naltrexone use as a function of enrollee race and ethnicity, whether they had above-median geographic availability, and interactions between above-median geographic availability and race and ethnicity. Results:The sample included 8 081 899 Medicaid enrollees; 472 409 (5.8%) had an OUD diagnosis. The population was 58.7% female and 41.3% male. Among the study population, 11.7% were aged 18 to 20 years, 39.5% were aged 21 to 34 years, 21.4% were aged 35 to 44 years, 14.5% were aged 45 to 54 years, and 12.9% were aged 55 to 64 years. Overall, 7.3% of the sample were Hispanic enrollees, 27.4% were non-Hispanic Black enrollees, 56.2% were non-Hispanic White enrollees, and 7.2% were enrollees from other racial and ethnic groups. Overall, 13 575 buprenorphine prescribers, 516 methadone dispensers, and 4801 naltrexone prescribers billed Medicaid. Median Medicaid MOUD providers available within a 15-minute drive were 0.89 per 100 enrollees for buprenorphine, 0.03 for methadone, and 0.32 for naltrexone. Above-median geographic availability of methadone was associated with a 0.99 (95% CI, 0.54-1.42)-percentage point increase in methadone use for non-Hispanic White enrollees; there was no such increase for non-Hispanic Black or Hispanic enrollees. Evidence of similar differences was limited for naltrexone. Above-median availability of buprenorphine was not associated with increased use of MOUD for any racial or ethnic group. Conclusions and Relevance:In this cross-sectional study of 10 state Medicaid programs, greater geographic availability of MOUD was associated with increased use only for methadone and, to a lesser extent, naltrexone. No racial and ethnic groups experienced gains in use associated with improved access. Additional strategies beyond addressing geographic access may be needed to close racial and ethnic gaps in MOUD.

OBJECTIVE:To estimate the characteristics and describe the incidence of lactational mastitis among postpartum people. METHODS:We used Maine Health Data Organization's All Payer Claims Data for people who delivered during 2016-2022 with insurance coverage throughout pregnancy and 12 months postpartum and had a breast pump claim (as a proxy for breastfeeding) (N = 22520). We estimated the incidence of lactational mastitis within one year postpartum using International Classification of Diseases-Clinical Modification 10 diagnosis codes. We examined mastitis incidence by rurality of residence, delivery year, maternal age, parity (using a proxy measure), insurance type, pregnancy condition, and history of mastitis. We also assessed the timing and setting of the first mastitis diagnosis. RESULTS:The incidence of lactational mastitis was 4.4% (95% CI: 4.1, 4.7). Persons with a higher incidence of mastitis included those living in metro areas (4.9%), 25-29 years old (4.6%), having commercial insurance coverage at delivery (5.0%), with their first or second delivery in the dataset (4.5%), and with a history of mastitis (13.9%). Overall, 15% of lactational mastitis was first diagnosed during an acute care encounter; however, this was higher among those living in isolated rural areas (22%), 20-24 years old (32%), having Medicaid insurance (24%), with three or more deliveries in the dataset (21%), and without a history of mastitis (18.5%). CONCLUSION:The incidence of diagnosed lactational mastitis varies by several maternal and pregnancy characteristics. Persons who are younger, live in rural areas, have Medicaid or have higher parity may face barriers to care in the primary care setting and ultimately be diagnosed with lactational mastitis during acute care encounters.

PURPOSE:To estimate the rate of ambulatory care use among postpartum persons by rurality of residence and pregnancy-related conditions. METHODS:We used Maine Health Data Organization's All Payer Claims Data for persons who delivered between 2007 and 2019 (N = 121,905). We estimated rates of ambulatory care (nonemergency department outpatient health care) utilization during the first 24 months' postpartum by level of rurality (urban, large rural, small rural, and isolated rural) and by pregnancy-related conditions (prenatal depression, hypertensive disorders of pregnancy, and gestational diabetes). To estimate rate ratios (RR), we used Poisson regression with an offset for population at risk, adjusting for potential confounders and restricting the analysis to those with continuous insurance (n = 70,431). FINDINGS:The mean monthly rate per 100 deliveries of ambulatory care visits was 86.1; the median number of visits was 12 (interquartile range = 6, 25). Persons living in rural areas had lower monthly rates of visits than persons living in urban areas (adjusted RR ranged from 0.87 [95% CI: 0.85, 0.89] in isolated rural areas to 0.91 [95% CI: 0.90, 0.93] in large rural areas). Persons with prenatal depression (aRR = 2.07; 95% CI: 2.04, 2.11), hypertensive disorders of pregnancy (aRR = 1.07; 95% CI: 1.05, 1.10), and gestational diabetes (aRR = 1.11; 95% CI: 1.08, 1.14) had higher rates of visits than those without these conditions. CONCLUSIONS:New practices and policies may be needed to improve postpartum ambulatory care access and utilization in rural areas. Postpartum persons with pregnancy-related conditions are accessing ambulatory care at higher rates after delivery, which may reduce their need for acute health care use.

PURPOSE:To compare trends in inpatient postpartum (IPP) long-acting reversible contraception (LARC) and permanent contraception provision among women with and without opioid use disorder (OUD) in Maine, which has recently seen a decrease in prevalence of maternal OUD. MATERIALS AND METHODS:We used diagnosis codes recorded in hospital discharge data to identify deliveries with and without OUD in Maine during 2016-2023. We calculated trends in annual rates per 1000 deliveries of IPP LARC or permanent methods of contraception (LAPM), permanent contraception, and LARC. We ran tests of coincidence to compare trends between deliveries with and without OUD. RESULTS:Among the 87,339 delivery hospitalisations identified, 2604 (3.0%) had an OUD diagnosis code. Women with OUD had higher IPP contraception provision (LAPM: 12.1%, permanent contraception: 9.0% LARC: 3.1%) than those without OUD (LAPM: 6.2%, permanent contraception: 5.4%, LARC: 0.9%). Annual rate increases per 1000 deliveries were larger over the study period for women with OUD (LAPM: 11.8 [p = 0.02], permanent contraception: 3.96 [p = 0.20], LARC: 6.48 [p = 0.04]) as compared to those for women without OUD (LAPM: 0.46 [p = 0.25], permanent contraception: -0.91 [p = 0.05], LARC: 1.48 [p < 0.01]); all tests of coincidence were significant (p < 0.05). CONCLUSIONS:Among deliveries in Maine during 2016-2023, provision of IPP LAPM, permanent contraception, and LARC were higher and increased at a greater rate over time among deliveries with OUD compared to those without OUD. Our findings suggest that IPP contraceptive use could be one of many factors in the recent decrease in maternal OUD and NAS rates in Maine.

BACKGROUND:Approximately 20% of pregnancies end in spontaneous loss, an outcome associated with adverse health consequences. Statistically stable estimates of the risk of pregnancy loss are limited for nonmetropolitan populations due to small sample sizes. OBJECTIVES:This study evaluated the utility of the enhanced Modified Kalman Filter (eMKF) in producing estimates of the risk of pregnancy loss for subgroups of US women with small sample sizes to examine recent trends. METHODS:Data from the National Survey of Family Growth (NSFG; 2006-2019) were used to estimate trends in the risk of self-reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15-44 years) who reported at least one completed pregnancy (excluding induced abortions) conceived during 2000-2018 (n = 17,314 women, 35,988 pregnancies) by metropolitan status and maternal age. The eMKF was used to smooth estimates over groups and time. We compared the relative 95% confidence intervals (95% CIs) of model-based estimates to direct estimates to assess improvements in precision. RESULTS:Among completed pregnancies conceived during 2000-2018, 21.6% ended in pregnancy loss. Relative 95% CIs for model-based estimates were 33.0% and 53.0% smaller for metropolitan and nonmetropolitan groups, respectively, than direct estimates. After adjustment, the risk of pregnancy loss for women ages 15-44 increased by a relative 1% annually for both metropolitan (risk ratio [RR] 1.01, 95% CI 1.01, 1.02) and nonmetropolitan (RR 1.01, 95% CI 1.00, 1.01) women. The risk of pregnancy loss increased for metropolitan women ages 15-19 (RR 1.01, 95% CI 1.00, 1.01), 20-24 (RR 1.01, 95% CI 1.00, 1.01), 25-29 (RR 1.02, 95% CI 1.01, 1.02), and 30-34 (RR 1.02, 95% CI 1.01, 1.03). CONCLUSIONS:Risk of pregnancy loss increased by a relative 1% annually for women overall, and by 1%-2% annually among subgroups of women ages 15-34 in metropolitan areas. The eMKF provided improvements in estimate precision relative to direct estimates.

RATIONALE:Death data available in Medicaid enrolment files may be incomplete and lack cause of death information. We sought to compare Medicaid enrolment death data to state-wide death records in Maine. AIMS AND OBJECTIVES:(1) To compare the date of death of Medicaid enrollees in Maine according to the Medicaid enrolment data to the date of death obtained through an ongoing quarterly death certificate-Medicaid linkage for 2016-2023; and (2) using the death certificate-Medicaid linkage data, to perform an analysis of the risk of drug overdose death in 2023 by opioid use disorder (OUD) status in 2023, as part of monitoring activities required for one of Maine's new approaches to delivering Medicaid services. METHODS:We used Maine Medicaid enrolment data 2010 through 2023 and claims data 2016 through 2023, and Maine final death certificate data 2016 through 2023 (plus Q1-Q2 2024 provisional data). We estimated the risk of drug overdose death in 2023 by OUD diagnosis among non-elderly adults in 2023 using underlying cause of death information from the death certificate-Medicaid linkage data file. RESULTS:There were 124,510 deaths in Maine among Maine residents from 2016 to 2023. Among Medicaid enrollees each year, there was a slightly higher number of deaths when using the death certificate-Medicaid linkage data than when using current enrolment data (e.g. 12% vs. 11% among 2016 enrollees), but generally, death counts were consistent (90% found in both data sources). In our analysis of death certificate-Medicaid linkage data, we found the risk of drug overdose death in 2023 was 0.68% among those with OUD and 0.11% among those without OUD (risk ratio = 6.1). CONCLUSION:Generally, there was good agreement between the two sources on the date of death. However, only ongoing death certificate-Medicaid linkage allows for examination of the cause of death, which is required for monitoring a new approach to delivering Medicaid services in Maine.

Objective To estimate trends in maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in Maine using the most recent data available. Study design We used hospital discharge data to estimate the annual prevalence of maternal OUD and NAS between 2016 and 2022. In addition, we used birth certificate-linked Medicaid data to estimate related trends among Medicaid enrollees. Result From 2016 to 2022, the prevalence of maternal OUD decreased from 35.3 to 18.8 per 1000 deliveries and the prevalence of NAS decreased from 33.2 to 14.0 per 1000 newborns (linear trend p values <0.01). Decreasing trends were also found among Medicaid enrollees. Conclusion In Maine between 2016 and 2022, there was a decrease in maternal OUD and NAS diagnoses recorded in administrative datasets. These findings should be interpreted with caution due to changes in how OUD and NAS diagnoses are recorded and COVID-related changes in healthcare utilization.

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2024 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal

PURPOSE:To estimate the effect of reversible postpartum contraception use on the risk of recurrent pregnancy condition in the subsequent pregnancy and if this effect was mediated through lengthening the interpregnancy interval (IPI). METHODS:We used data from the Maine Health Data Organization's Maine All Payer Claims dataset. Our study population was Maine women with a livebirth index pregnancy between 2007 and 2019 that was followed by a subsequent pregnancy starting within 60 months of index pregnancy delivery. We examined recurrence of three pregnancy conditions, separately, in groups that were not mutually exclusive: prenatal depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes (GDM). Effective reversible postpartum contraception use was defined as any intrauterine device, implant, or moderately effective method (pills, patch, ring, injectable) initiated within 60 days of delivery. Short IPI was defined as ≤ 12 months. We used log-binomial regression models to estimate risk ratios and 95 % confidence intervals, adjusting for potential confounders. RESULTS:Approximately 41 % (11,448/28,056) of women initiated reversible contraception within 60 days of delivery, the prevalence of short IPI was 26 %, and the risk of pregnancy condition recurrence ranged from 38 % for HDP to 55 % for prenatal depression. Reversible contraception initiation within 60 days of delivery was not associated with recurrence of the pregnancy condition in the subsequent pregnancy (aRR ranged from 0.97 to 1.00); however, it was associated with lower risk of short IPI (aRR ranged from 0.67 to 0.74). CONCLUSION(S):Although initiation of postpartum reversible contraception within 60 days of delivery lengthens the IPI, our findings suggest that it does not reduce the risk of prenatal depression, HDP, or GDM recurrence. This indicates a missed opportunity for providing evidence-based healthcare and health interventions in the intrapartum period to reduce the risk of recurrence.

BACKGROUND:Cardiovascular disease is the leading cause of death among women in the United States. It is well established that gestational diabetes mellitus is associated with an overall lifetime increased risk of cardiometabolic disease, even among those without intercurrent type 2 diabetes. However, the association between gestational diabetes mellitus and short-term risk of cardiovascular disease is unclear. Establishing short-term risks of cardiovascular disease for patients with gestational diabetes mellitus has significant potential to inform early screening and targeted intervention strategies to reduce premature cardiovascular morbidity among women. OBJECTIVE:This study aimed to compare the risk of cardiovascular disease diagnosis in the first 24 months postpartum between patients with and without gestational diabetes mellitus. STUDY DESIGN:Our longitudinal population-based study included pregnant individuals with deliveries from 2007 to 2019 in the Maine Health Data Organization's All Payer Claims Database. We excluded records with gestational age <20 weeks, non-Maine residence, multifetal gestation, no insurance in the month of delivery or the 3 months before pregnancy, an implausibly short interval until next pregnancy (<60 days), pregestational diabetes mellitus, and any prepregnancy diagnosis of the cardiovascular conditions being examined postpartum. Gestational diabetes mellitus and cardiovascular disease (heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease/stroke, and new chronic hypertension) were identified by International Classification of Diseases 9/10 diagnosis codes. Cox proportional hazards models were used to estimate hazard ratios, adjusting for potential confounding factors. We assessed whether the association between gestational diabetes mellitus and chronic hypertension was mediated by intercurrent diabetes mellitus. RESULTS:Among the 84,746 pregnancies examined, the cumulative risk of cardiovascular disease within 24 months postpartum for those with vs without gestational diabetes mellitus was 0.13% vs 0.20% for heart failure, 0.16% vs 0.14% for ischemic heart disease, 0.60% vs 0.44% for cerebrovascular disease/stroke, 0.22% vs 0.16% for arrhythmia/cardiac arrest, 0.20% vs 0.20% for cardiomyopathy, and 4.19% vs 1.83% for new chronic hypertension. After adjusting for potential confounders, those with gestational diabetes had an increased risk of new chronic hypertension (adjusted hazard ratio, 1.56; 95% confidence interval, 1.32-1.86) within the first 24 months postpartum compared with those without gestational diabetes. There was no association between gestational diabetes and ischemic heart disease (adjusted hazard ratio, 0.75; 95% confidence interval, 0.34-1.65), cerebrovascular disease/stroke (adjusted hazard ratio, 1.13; 95% confidence interval, 0.78-1.66), arrhythmia/cardiac arrest (adjusted hazard ratio, 1.16; 95% confidence interval, 0.59-2.29), or cardiomyopathy (adjusted hazard ratio, 0.75; 95% confidence interval, 0.40-1.41) within the first 24 months postpartum. Those with gestational diabetes appeared to have a decreased risk of heart failure within 24 months postpartum (adjusted hazard ratio, 0.45; 95% confidence interval, 0.21-0.98). Our mediation analyses estimated that 28% of the effect of gestational diabetes on new chronic hypertension was mediated through intercurrent diabetes mellitus. CONCLUSION:Patients with gestational diabetes mellitus have a significantly increased risk of new chronic hypertension as early as 24 months postpartum. Most of this effect was not due to the development of diabetes mellitus. Our findings suggest that all women with gestational diabetes need careful monitoring and screening for new chronic hypertension in the first 2 years postpartum.

Abstract Background The aim of our study was to evaluate the post-release outcomes of incarcerated individuals with opioid use disorder (OUD) treated with extended-release buprenorphine (XRB) in a rural county jail. Administrative data were collected from a pilot program within a jail in Maine that introduced XRB treatment in 2022 and a comparable jail utilizing sublingual buprenorphine (SLB) during the same period to compare post-release outcomes. Log-binomial regression models were used to estimate the risk ratio (RR) and 95% confidence interval (CI) for jail use of XRB vs. SLB on post-release community buprenorphine continuation. Results From September 2022 to September 2023, 70 individuals who received XRB were released from the pilot jail and 130 individuals who received SLB were released from the comparison jail. After adjusting for age, sex, and buprenorphine use at entry to jail, individuals released from the pilot jail were almost 3 times (adjusted RR = 2.67, 95% CI 1.84, 3.88) as likely to continue community buprenorphine treatment post-release relative to the comparison jail. In addition, utilization of XRB allowed for expanded access to OUD treatment, was well tolerated, and reduced medication diversion. Conclusions In this pilot program in Maine, XRB treatment during incarceration was associated with higher post-release community buprenorphine continuation when compared to individuals treated with SLB. These findings provide strong evidence for the superiority of XRB vs. SLB for the treatment of OUD in jail settings.