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

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).