Marcela C. Smid, MD explains early postpartum care and reduced acute visits in perinatal SUD

Early postpartum follow-up—rather than participation in an integrated perinatal addiction clinic—was associated with reduced acute care utilization among postpartum individuals with substance use disorder (SUD), according to findings presented by Marcela C. Smid, MD, of the University of Utah Health (UUH) in Salt Lake City, at the 2026 American College of Obstetricians & Gynecologists (ACOG) Annual Clinical & Scientific Meeting.

The retrospective cohort study evaluated 1091 patients with SUD who delivered between August 2017 and October 2025 at a single urban academic center. Of these, 810 received integrated perinatal addiction care through UUH’s Substance Use & Pregnancy—Recovery, Addiction, and Dependence clinic, while 280 received nonintegrated care. Integrated care patients were more likely to have public insurance (84% vs 65%), methamphetamine use disorder (77% vs 48%), and opioid use disorder with medication (59% vs 16%) (all P < .001).

How does earlier postpartum care impact acute visits for SUD?

Despite these differences, acute care utilization in the late postpartum period (beyond 42 days) was similar between groups, including hospitalizations (30 vs 58, P = .08), mental health/SUD hospitalizations (1 vs 7, P = .65), emergency department visits (123 vs 325, P = .43), and mental health/SUD emergency department visits (11 vs 25, P = .66). Integrated care was not associated with reduced odds of acute care use (adjusted OR [AOR] 0.93; 95% CI, 0.70–1.23). However, a postpartum visit within 8 weeks was associated with significantly lower odds of acute care utilization (AOR 0.56; 95% CI, 0.43–0.74).

“What we wanted to look at is what is the effect of receiving care in our integrated perinatal addiction clinic, which extends out to a year postpartum, vs people with a substance use disorder who did not get integrated care within our own health system, and how that affected postpartum acute hospitalizations in that year postpartum,” Smid said.

“We didn’t actually see a difference in the integrated vs the nonintegrated model, but we wanted to look at early postpartum care. So one of the things that has changed over time is the importance of postpartum care for any condition, and particularly, postpartum care because of that year postpartum. And that actually did reduce the odds of that acute hospitalization and [emergency department] care by 44%,” she added.

Postpartum care is not a “one-stop shop”

Smid emphasized that evolving care patterns and patient complexity are likely to have influenced the findings. “The people that we take care of in our integrated clinic have the most severe substance use disorder. So, they're actively using substances, they a lot of times have major barriers to care, they're unhoused, they have really complex mental health,” she said.

She also highlighted broader system-level changes that may contribute to similar outcomes across care models. “Our hospital system and our [emergency department] over this time period are much more able to absorb addiction care,” Smid said.

Importantly, Smid underscored that postpartum care should extend beyond a single visit.

“Postpartum care is not a one-stop; it's not a one-time event. It is a continuity of care, which is where our integrated model is able to continue that and do that in a way that not all places are yet set up to do,” she said.

Reference

Smid MC, Charles JE, Rose Jurtz T, et al. Integrated perinatal addiction care and postpartum hospitalization and emergency room visits. Presented at: 2026 American College of Obstetricians & Gynecologists Annual Clinical & Scientific Meeting; May 1-3, 2026; Washington, DC.