OBJECTIVES: To evaluate regional variations in the prevalence of opioid use disorder (OUD), treatment among pregnant women, and the prevalence of adverse outcomes among newborns, in a commercially US insured population.

METHODS: The study was a retrospective cohort analysis using the IMS Lifelink database with electronic records from 2007-2015. Pregnant women (ICD-9 V22.2) were identified and classified as having an OUD (ICD9 304.00) if they had that diagnosis before or during their pregnancy. Receipt of treatment was recorded if an NDC code for the following medications was present during pregnancy: methadone, buprenorphine, or a combination of buprenorphine/naloxone. Newborns with diagnoses codes for fetal alcohol syndrome, presence of hallucinogenic agents or narcotics, suspected infectious conditions, withdrawal symptoms or neonatal abstinence syndrome were classified as having an adverse outcome. Based on the state of residence, women and newborns were placed into 4 different regions: South, Midwest, West, and Northeast.

RESULTS: Of 310,861 pregnant women, 1247 (0.41%) had OUD, 329 (0.11%) received treatment, and 1369 (0.39%) of newborns had an adverse outcome. In the North, there was a higher prevalence of OUD (0.57%) among pregnant women and adverse outcomes (0.75%) among newborns, but a lower prevalence of treatment (0.14%). In contrast, the South had a lower prevalence of OUD (0.34%) among pregnant women, similar prevalence of treatment (0.13%) and lower prevalence of adverse outcomes (0.18%) among newborns. The prevalences West and Midwest were in between the North and South values. The different prevalences were all statistically significant (p<. 0001).

CONCLUSIONS: The magnitude of the prevalence of OUD and adverse outcomes in newborns is highest in the North and lowest in the South. These results show significant regional variations in the patterns of OUD diagnosis, treatment, and newborn adverse outcomes, and suggests a need to further explore the source of these variations.