A Substance Related Diagnosis Impacts Healthcare Service Utilization among Pregnant Women

Introduction: As a vulnerable population, pregnant women with a substance-related diagnosis (SRD; e.g., use, misuse, abuse, or dependence of substances) may be experiencing disproportionate rates of outpatient visits, emergency visits, and inpatient hospitalizations [1-3]. The primary goal of this study was to evaluate the healthcare service utilization of pregnant women with and without an SRD who presented for delivery in a large tertiary healthcare system.

Methods: This retrospective study retrieved electronic health record data on women (ages ≥ 18 and ≤ 44 years) who delivered a single live or stillbirth at ≥ 20 weeks of gestation from November 1st, 2012-September 30th, 2019. Imbalance in measured maternal sociodemographic and obstetrical characteristics between those with and without an SRD was attenuated using propensity score matching on key demographic characteristics (e.g., age, body mass index), yielding a matched 1:1 sample. Unadjusted and adjusted logistic regression was used to determine the association between having an SRD and outpatient visits, emergency visits, and inpatient hospitalizations.

Results: From the total sample (n=16,770), the matched cohort consisted of 1,986 deliveries. Most of the sample were Non-Hispanic/Latina White (45.8%) or of other race/ethnicity (37.7%; i.e., American Indian/Alaskan Native (n=10), Asian/Pacific Islander (n=139), and other race or mixed race/ethnicity (n=600) with a mean age of 29.8 ([SD] =5.6, range 18-44 years of age). An SRD was identified in 993 (50% due to matching). When grouped by SRD type, the most common SRDs included cannabis (16%), nicotine (16%), stimulants (14%), opioids (10%), and alcohol (5%; these were not mutually exclusive). Pregnant women with an SRD were more likely to have < 10 outpatient clinical visits compared to pregnant women without an SRD (AOR = 1.75 [95% CI, 1.39-2.21], p-value = < 0.0001). Pregnant women with an SRD were more likely to have ≥ 1 emergency department visit compared to pregnant women without an SRD (AOR = 1.39 [95% CI, 1.02-1.89], p-value = 0.0367). Pregnant women with an SRD were more likely to have ≥ 3 inpatient days in the hospital compared to pregnant women without an SRD (AOR = 1.69 [95% CI, 1.07-2.67], p-value = 0.0256).

Conclusion: Pregnant women with an SRD are experiencing disproportionately higher odds of emergency room visits and hospitalizations and lower odds of outpatient visits compared to pregnant women without an SRD in a large matched pregnancy cohort at a tertiary care center from 2012-2019. The results from this study reinforce the need to identify SRDs in pregnant women early to minimize disproportionate utilization of outpatient visits, emergency visits, and hospitalizations through intervention and treatment.

References: 1. Staton-Tindall, M., Duvall, J. L., Leukefeld, C., & Oser, C. B. (2007). Health, mental health, substance use, and service utilization among rural and urban incarcerated women. Women's Health Issues, 17(4), 183-192.
2. Goler, N. C., Armstrong, M. A., Taillac, C. J., & Osejo, V. M. (2008). Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard. Journal of Perinatology, 28(9), 597-603.