(99) Comparing Postpartum MOUD Monitoring Across Integrated vs Separate Prenatal Care Models

Background & Introduction: Medication for opioid use disorder (MOUD) significantly improves maternal and neonatal outcomes. Patients frequently engage in treatment antenatally, however postpartum remains a highly vulnerable time with increased risk of MOUD interruption, return to use, and overdose. Despite this risk, there is limited evidence exploring the unique postpartum factors that contribute and the best prevention strategies to support postpartum patients in continued treatment.

Clinical models for perinatal patients with OUD include integrated care, in which prenatal care and MOUD management are supported by a single provider, or separate care, in which MOUD is provided externally from prenatal care. Evaluating the long term treatment outcomes of each model remains challenging due to multiple systemic gaps. Well intentioned confidentiality protections result in MOUD data being siloed, data sharing and electronic health record (EHR) visibility between providers being limited, and prescription drug monitoring having restricted use. These gaps prevent reliable evaluation of postpartum MOUD care transitions and treatment retention, limiting understanding of how to best support ongoing recovery after delivery.

This study aims to evaluate how integrated versus separate prenatal care models impact postpartum data visibility, the ability to determine MOUD continuation, and clinical touch points in the first year following delivery.

Methods: We conducted a retrospective chart review of 175 deliveries at University of Vermont Medical Center, between 2021-2023, among patients receiving MOUD during the third trimester of their pregnancy. Patients were categorized as either receiving integrated care or separate care. Integrated care included structured postpartum MOUD management with 7-14 day refills, biweekly phone check ins, and coordination of transition to a community prescriber within the first year following delivery. Patients receiving separate care relied on routine postpartum follow up without a standardized MOUD monitoring system.

Primary outcomes were 1) ability to determine continuation of MOUD at one year postpartum via EHR, and 2) postpartum healthcare touch points, including the number and type of visits. Secondary outcomes assessed antepartum factors including number of prenatal visits, duration of MOUD use, and illicit opioid use in pregnancy.

Descriptive statistics were used to summarize the results and chi-squared and Fischer exact tests were used to compare integrated and separate care. Analyses emphasized EHR visibility and care continuity rather than true treatment retention due to fragmented cross system reporting.

Results: Among the 175 deliveries to patients receiving MOUD, 41 (23%) received integrated care and 134 (77%) received separate care. Antepartum engagement was high across both models, though mean prenatal visits were higher among integrated care patients (9.1 ± 3.0 vs 7.4 ± 3.2; p=0.01). Most patients were on MOUD prior to pregnancy (78% integrated vs 87% separate, p=0.21), and nearly all continued MOUD through delivery (90% overall). Illicit opioid use in the antepartum period was similar between groups (24% integrated vs 26% separate, p=1.00).

Postpartum healthcare engagement was limited across the cohort. Of the 175 deliveries, 42 patients (24%) had no documented follow-up within the first year postpartum, which was less common among integrated care patients compared with separate care patients (4/41 [10%] vs 38/134 [28%]; p=0.02). Additionally, 37 patients (21%) had a postpartum visit as their only documented follow-up, more frequently in integrated care than separate care (14/41 [34%] vs 23/134 [17%]; p=0.02). Another 21 patients (12%) had only emergency department visits, with similar rates between groups (6/41 [15%] vs 15/134 [11%]; p=0.59).

Overall, MOUD status was captured in the EHR in 89 of all patients at 1 year postpartum (89/175 [51%]). Documentation occurred across all engagement types: 19/42 (45%) of patients with no visits, 18/37 (49%) with only a postpartum visit, 10/21 (48%) with only an ED visit, and 42/75 (56%) with multiple visits. A chi-square test confirmed that the type or amount of visits with the healthcare system did not significantly impact the likelihood of knowing MOUD status (p=0.69). In contrast, integrated care patients were significantly more likely to have MOUD status documented in the 12 months following delivery compared with separate care patients (28/41 [68%] vs 61/134 [46%]; p=0.01).

Conclusion & Discussion: Care trajectories for patients with OUD often become invisible to the healthcare system in the postpartum period. In this cohort, only 51% of patients had determinable MOUD status at one year postpartum and 1 in 4 had no documented healthcare visits during this time. While integrated care did not ensure improved rates of MOUD continuation, it significantly increased the ability to monitor postpartum outcomes at 1 year following delivery, even among patients with limited or no healthcare visits. This suggests that the care model itself, rather than the amount of postpartum engagement, was the primary factor associated with capturing outcomes. Integrated care significantly increased data visibility, documented care transitions, and reliable monitoring even with limited patient contact, while separate care lacked a standardized postpartum transition, making outcomes unmeasurable even if treatment continued elsewhere.

Despite high antepartum care engagement across both models, continuity during the postpartum transition was limited. These findings highlight the need for structured postpartum follow up, cross system data integration, and interventions targeting care fragmentation to improve assessment of treatment retention and support maternal recovery through the postpartum period.

References: Ellis LP, Parlier‑Ahmad AB, Scheikl M, Martin CE. An integrated care model for pregnant and postpartum individuals receiving medication for opioid use disorder. J Addict Med. 2023;17(2):131‑139. doi:10.1097/ADM.0000000000001052.

Frankeberger J, Jarlenski M, Krans EE, Coulter RWS, Mair C. Opioid use disorder and overdose in the first year postpartum: a rapid scoping review and implications for future research. Matern Child Health J. 2023;27(7):1140‑1155. doi:10.1007/s10995‑023‑03614‑7. PMID:36840785.

Mburu M, Masese R, Knippler ET, et al. Factors associated with medications for opioid use disorder (MOUD) treatment success during the pregnancy and postpartum periods: a scoping review. Drug Alcohol Depend. 2024;264:112454. doi:10.1016/j.drugalcdep.2024.112454. PMID:39366154.

Ray‑Griffith S, Tharp E, Coker JL, Catlin D, Knight B, Stowe ZN. Buprenorphine medication for opioid use disorder: a study of factors associated with postpartum treatment retention. Am J Addict. 2021;30(1):43‑48. doi:10.1111/ajad.13084.

Zhou J, Varney B, Jones N, Bharat C, Degenhardt L, Havard A, Tran DT. Postpartum retention in opioid agonist treatment for opioid dependence: a population‑based cohort study. Arch Womens Ment Health. 2026;29(1):6. doi:10.1007/s00737‑025‑01640‑8.