Association of Obstetric Comorbidity Index Score with Postpartum Contraception Use among Medicaid Recipients in the United States.

Objective: Little is known about postpartum contraceptive use among people at high risk for severe maternal morbidity (SMM). Our objective was to evaluate the association between risk for severe maternal morbidity (SMM) and postpartum contraceptive use.

Study design: We conducted a retrospective cohort study of live births to Medicaid recipients from 2016 to 2020 across 44 US states. We evaluated risk for SMM by calculating the Obstetric Comorbidity Index (OCI) scores for each enrollee into lowest risk (OCI = 0) and highest risk (top quartile) groups. We determined the association between the highest quartile OCI score with use of most or moderately effective postpartum contraception and attendance at outpatient postpartum visits within 60 days. Models adjusted for maternal age, mode of delivery, and comorbidities.

Results: Of 3,342,568 deliveries, 2,474,020 deliveries were associated with an OCI score of 0 (Q0; no risk factors for SMM), while the highest quartile of non-zero OCI scores (Q4) ranged from 13 to 96 (mean risk of SMM 19.7%, SD 7.1) and encompassed 868,548 deliveries. Individuals with the highest risk for SMM were more likely to use postpartum contraception (40.0% vs. 32.6%), although after removing sterilization, the difference was modest (32.6% vs. 30.1%). There was no meaningful difference in rates of outpatient postpartum visit among people with the highest and lowest OCI scores (46.1% vs. 45.6%).

Conclusion: Medicaid recipients with high OCI scores are only slightly more likely to use postpartum contraception as their low-risk peers, and over half will not have outpatient postpartum visit by 60 days.

Implications: Medicaid recipients at high risk for maternal morbidity are only slightly more likely to use postpartum contraception.