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      Biopsychosocial contexts of timely and adequate prenatal care utilization among women with criminal legal involvement and opioid use disorder

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          Abstract

          Objective

          Pregnant women with criminal legal involvement and opioid use disorder (CL-OUD) living in non-urban regions may be at risk for complex biomedical, psychological, and social barriers to prenatal care and healthy pregnancy. Yet, limited research has explored prenatal care utilization patterns among this subpopulation. This study describes the biopsychosocial factors of pregnant women with a history of criminal legal involvement and opioid use disorder (CL-OUD) associated with timely prenatal care initiation and adequate prenatal care utilization (APNCU).

          Methods

          Analyses were conducted on a subsample of medical record data from an observational comparative effectiveness study of medication treatment models for pregnant women with diagnosed opioid use disorder (OUD) who received prenatal care in Northern New England between 2015 and 2022. The subsample included women aged ≥ 16 years with documented criminal legal involvement. Analyses included χ 2, Fisher exact tests, and multiple logistic regression to assess differences in timely prenatal care and APNCU associated with biopsychosocial factors selected by backwards stepwise regression.

          Results

          Among 317 women with CL-OUD, 203 (64.0%) received timely prenatal care and 174 (54.9%) received adequate care. Timely prenatal care was associated with having two or three prior pregnancies (aOR 2.37, 95% CI 1.07–5.20), receiving buprenorphine at care initiation (aOR 1.85, 95% CI 1.01–3.41), having stable housing (aOR 2.49, 95% CI 1.41–4.41), and being mandated to court diversion (aOR 4.06, 95% CI 1.54–10.7) or community supervision (aOR 2.05, 95% CI 1.16–3.63). APNCU was associated with having a pregnancy-related medical condition (aOR 2.17, 95% CI 1.27–3.71), receiving MOUD throughout the entire prenatal care period (aOR 3.40, 95% CI 1.45–7.94), having a higher number of psychiatric diagnoses (aOR 1.35, 95% CI 1.07–1.70), attending a rurally-located prenatal care practice (aOR 2.14, 95% CI 1.22–3.76), having stable housing (aOR 1.94, 95% CI 1.06–3.54), and being mandated to court diversion (aOR 3.11, 95% CI 1.19–8.15).

          Conclusion

          While not causal, results suggest that timely and adequate prenatal care among women with CL-OUD may be supported by OUD treatment, comorbid indications for care, stable access to social resources, and maintained residence in the community (i.e., community-based alternatives to incarceration).

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          Most cited references24

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          Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

          Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
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            An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index.

            The assessment of the adequacy of prenatal care utilization is heavily shaped by the way in which utilization is measured. Although it is widely used, the current major index of utilization, the Kessner/Institute of Medicine Index, has not been subjected to systematic examination. This paper provides such an examination. Data from the 1980 National Natality Survey are used to disaggregate the components of the Kessner Index for detailed analysis. An alternative two-part index, the Adequacy of Prenatal Care Utilization Index, is proposed that combines independent assessments of the timing of prenatal care initiation and the frequency of visits received after initiation. The Kessner Index is seriously flawed. It is heavily weighted toward timing of prenatal care initiation does not distinguish timing of initiation from poor subsequent utilization, inaccurately measures utilization for full- or post-term pregnancies, and lacks sufficient documentation for consistent computer programming. The Adequacy of Prenatal Care Utilization Index offers a more accurate and comprehensive set of measures of prenatal care utilization than the Kessner Index.
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              Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women's Legal Status and Public Health

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                Author and article information

                Contributors
                Milan.F.Satcher@dartmouth.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                21 April 2023
                21 April 2023
                2023
                : 23
                : 729
                Affiliations
                [1 ]GRID grid.254880.3, ISNI 0000 0001 2179 2404, Department of Community and Family Medicine, , Dartmouth Health, ; Lebanon, NH USA
                [2 ]GRID grid.254880.3, ISNI 0000 0001 2179 2404, Center for Technology and Behavioral Health, Geisel School of Medicine, , Dartmouth College, ; Lebanon, NH USA
                [3 ]Department of Psychiatry, Dartmouth Health, Lebanon, NH USA
                [4 ]GRID grid.254880.3, ISNI 0000 0001 2179 2404, The Dartmouth Institute, Geisel School of Medicine, , Dartmouth College, ; Hanover, NH USA
                [5 ]Department of Obstetrics-Gynecology, Dartmouth Health, Lebanon, NH USA
                [6 ]Department of Pediatrics, Dartmouth Health, Lebanon, NH USA
                [7 ]GRID grid.254880.3, ISNI 0000 0001 2179 2404, Department of Biomedical Data Sciences, , Geisel School of Medicine, Dartmouth College, ; Hanover, NH USA
                Article
                15627
                10.1186/s12889-023-15627-6
                10119004
                37085842
                6284cec5-65c2-4d1f-a9bc-5e19c3046272
                © The Author(s) 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 28 November 2022
                : 7 April 2023
                Categories
                Research
                Custom metadata
                © The Author(s) 2023

                Public health
                social determinants,prenatal care,criminal legal system,criminal justice,opioid use disorder,northern new england

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