Prenatal care utilization among pregnant women with substance use disorder: A drug-free moms and babies program study.

BACKGROUND: Prenatal stimulant and opioid use continue to rise, with disproportionately higher rates observed in rural and socioeconomically disadvantaged populations. OBJECTIVE: To examine the association between opioid and stimulant use patterns and prenatal care adequacy among women with substance use disorder (SUD) enrolled in the Drug-Free Moms and Babies (DFMB) program in West Virginia. METHODS: Secondary data analysis of DFMB participants (2018-2022; N = 1264). Opioid and stimulant use were categorized into four mutually exclusive groups. Adequacy of prenatal care was measured using the Kessner Index, categorized as inadequate, intermediate, and adequate. RESULTS: Pregnant women with SUD who used opioids only [AOR = 2.21 (1.38, 3.57)], stimulants only [AOR = 4.25 (2.01, 8.99)], or both [AOR = 5.42 (2.77, 10.62)] had higher odds of receiving inadequate prenatal care compared with women who did not use these substances. Similarly, women using opioids only [AOR = 2.10 (1.50, 2.94)], stimulants only [AOR = 2.27 (1.18, 4.39)], or both substances [AOR = 2.31 (1.24, 4.33)] were more likely to receive intermediate care. DISCUSSION: While all substance-use groups demonstrated increased odds of inadequate or intermediate prenatal care, the risk was highest among women using both opioids and stimulants, followed by stimulant use alone. CONCLUSIONS: The study highlights the need to identify and address upstream factors that influence prenatal care engagement among rural pregnant women with SUD, particularly those using opioids and/or stimulants. SCIENTIFIC SIGNIFICANCE: The study identifies the intersection between opioid and stimulant use, prenatal care utilization, and social determinants of health. ARTICLE SUMMARY: Opioid and stimulant use during pregnancy was associated with a higher risk of both inadequate and intermediate prenatal care utilization, with the greatest risk observed among those using both substances. Social factors, including social disadvantage, unplanned pregnancy, and larger family size, further contributed to inadequate prenatal care. Together, these findings highlight the need to address upstream social, structural, and substance-related barriers to improve prenatal care engagement and, ultimately, maternal and child health in rural populations.