The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts

Abstract

Background Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003–2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from one-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women’s perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Principal Findings 5.5% of Massachusetts’s deliveries between 2003–2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28–1.41) and low birthweight (LBW) (AOR 1.73, 95%CI 1.64–1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95%CI 0.55–0.68) and LBW (AOR 0.54, 95%CI 0.49–0.61). Conclusions SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don’t receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.

A Novel 4D Ultrasound Parenting Intervention for Substance Using Pregnant Women in Finland: Participation in Obstetric Care, Fetal Drug Exposure, and Perinatal Outcomes in a Randomized Controlled Trial

“…The Medical Birth Register shows that around 5.9% of neonates are born preterm, 4.4% have a low in birth weight and perinatal mortality is four per thousand in Finland (Vuori and Gissler 2016). Our findings on the poor perinatal outcomes among substance using women are in line with previous studies (Forray and Foster 2015;Kotelchuck et al 2017;Ludlow et al 2004). The perinatal outcomes were similar in both groups.…”

“…Also, previous studies on prenatal psychosocial interventions have failed to display a difference in neonatal outcomes in comparison to comprehensive standard care among pregnant women with illicit drug use (Terplan et al 2015). Prenatal treatment for substance use disorders may improve neonatal outcomes, but many substance using pregnant women do not adhere to treatment (Kotelchuck et al 2017).…”

“…A few studies concerning brief interventions and integrated treatment approaches for pregnant women with substance use disorders have shown some promise in reducing fetal substance exposure (Farr et al 2014;Haug et al 2014;McLafferty et al 2016). However, the problem remains that substance using pregnant women rarely receive adequate prenatal care (Kotelchuck et al 2017).…”

“…Prenatal smoking, heavy drinking, and use of illicit drugs often lead to adverse neonatal outcomes, especially preterm birth and a small weight for gestational age (Forray and Foster 2015;Kotelchuck et al 2017;Ludlow et al 2004). Prescription opioid use in pregnancy is known to cause perinatal complications, of which the most significant one is neonatal abstinence syndrome (Behnke et al 2013;Forray and Foster 2015;Reddy et al 2017).…”

“…Substance use disorders have a strong association with inadequate prenatal care (Kotelchuck et al 2017;Roberts and Pies 2011). In addition, an increased number of emergency visits and hospitalizations but less participation in preventive care has been reported among substance using pregnant women (Kotelchuck et al 2017). One specific problem is the question of how to engage these high-risk patients in prenatal healthcare (Kotelchuck et al 2017;Roberts and Pies 2011).…”