Integrated Perinatal Addiction Care and Postpartum Hospitalization and Emergency Room Visits ID 3533

INTRODUCTION: Postpartum individuals with substance use disorder (SUD) are at high risk for overdose and suicide in the late postpartum period (43–365 days), often preceded by emergency department (ED) or hospital visits. These encounters may be opportunities to intervene. We compared late postpartum acute care use between individuals receiving integrated perinatal addiction care (SUPeRAD) and non-integrated care. METHODS: This was a retrospective cohort study of deliveries (August 2017 to October 2025) at a single urban academic medical center among patients with SUD (opioids, methamphetamine, alcohol, or cocaine). Integrated care was defined as one or more visit in SUPeRAD. Acute care included hospitalizations and ED visits more than 42 days postpartum. Inverse probability weighted logistic regression adjusted for maternal age, race/ethnicity, prenatal visits, postpartum visit within 42 days, and insurance; propensity scores accounted for SUD type and insurance. RESULTS: Among 1,091 patients (integrated n=810; non-integrated n=280), integrated care patients were more likely to have public insurance (84% versus 65%), methamphetamine use disorder (77% versus 48%), and opioid use disorder with medication (59% versus 16%) (all P <.001). Acute care rates were similar: hospitalizations (30 versus 58, P =.08), mental health/SUD hospitalizations (1 versus 7, P =.65), ED visits (123 versus 325, P =.43), and mental health/SUD ED visits (11 versus 25, P =.66). Integrated care was not associated with odds of acute care (adjusted odds ratio aOR 0.93; 95% CI, 0.70–1.23). A postpartum visit within 8 weeks lowered odds (aOR 0.56; 95% CI, 0.43–0.74). CONCLUSIONS/IMPLICATIONS: Early postpartum visits were protective for acute care encounters, suggesting that this is an important intervention in this high-risk population.