Submission Type

Original Research


Introduction: The accuracy of the drug-dependency checkbox on Maine birth certificates is unknown. Our objective was to compare the drug-dependency checkbox with information on substance use disorders (SUDs) documented in Medicaid claims.

Methods: Using rule-based deterministic matching, we linked Medicaid enrollment information to Maine birth-record data between 2016 and 2020 (N = 58 584). Among the linked records (n = 27 448), we identified maternal SUD diagnoses during the 280 days before through 7 days after delivery using ICD-CM-9/10 diagnosis codes. We used the following hierarchy to create mutually exclusive SUD categories: opioid use disorder (OUD), cannabis use disorder without cocaine use disorder, and other SUD disorders (alcohol, cocaine, nicotine, or other).

Results: Among women enrolled in Medicaid at the time of delivery, 12% had drug dependency indicated on their birth record and 34% had at least one SUD diagnosis recorded in their Medicaid claims. Among birth records with drug dependency indicated, 56% indicated OUD, 26% indicated cannabis use disorder without cocaine use disorder, 8% indicated other SUD, and 10% indicated no SUD. Among those without drug dependency indicated, the corresponding percentages were 4% for OUD, 9% for cannabis use disorder, 14% for other SUD, and 74% for no SUD.

Discussion: Although diagnoses of OUD and cannabis use disorder were more common among birth records with a checked drug-dependency checkbox, reporting of drug dependency on birth records does not appear to accurately indicate SUD during pregnancy.

Conclusions: Our findings suggest that the drug-dependency checkbox on Maine birth certificates may have limited value in identifying SUD during pregnancy.



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