(1041) Are pregnant women with substance use disorders likely to experience a specific SMM event?

This study was undertaken to evaluate the differential impact of substance use disorders (SUD) on various Severe Maternal Morbidity (SMM) events among inpatient pregnancy hospitalizations.

Study Design:

We conducted a cross-sectional analysis of inpatient pregnancy hospitalizations from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2016 to 2019. ICD-10 codes were used to identify patients with a SUD and/or SMM. SUD was defined as a composite, including alcohol, tobacco, cannabis, cocaine, sedative, opioid, hallucinogen and stimulant use disorders. Likewise, SMM was defined as a composite of individual maternal morbidity diagnoses, as characterized by the CDC. Rates of each individual SMM event were compared across pregnancy hospitalizations with and without SUD. Multivariable logistic regression analyses were undertaken to predict the likelihood of SMM as a composite among pregnancy hospitalizations with and without SUD as well as to predict the likelihood of each type of SMM in a subgroup of all inpatient hospitalizations with SMM.

Results:

Of the 2,967,969 inpatient pregnancy hospitalizations included in the analyses, 184,766 (6.22%) had SUD diagnosis and 61,294 (2.07%) had a SMM diagnosis. Rates of SMM events were significantly higher among pregnancy hospitalizations with SUD for a majority of the SMM events (Figure 1).  Adjusting for relevant sociodemographic covariates, SUD was identified as an independent predictor of SMM (aOR 3.51; 95% CI 1.46-1.55). In subgroup analyses of all pregnancy hospitalizations with SMM, SUD was a strong positive predictor of several key types of SMM events – acute MI (aOR 2.41; 95% CI 1.79-3.25), aneurysm (aOR 2.24; 95% CI 0.79-6.34), need for ventilation (aOR 1.80; 95% CI 1.59-2.05), and pulmonary embolism/acute heart failure (aOR 1.82; 95% CI 1.66-2.00) (Figure 2).

Conclusion:

Pregnant women with SUD are at a significantly increased risk for various SMM events, particularly cardiovascular complications including acute MI, aneurysmal rupture and pulmonary embolism / acute heart failure.