(933) Substance Use Disorder and Adverse Pregnancy Outcomes: Analyses from the National Inpatient Sample

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 APO. SUD was defined as a composite between – alcohol, tobacco, cannabis, cocaine, sedatives, opioids, hallucinogens and stimulant use disorder. APO was defined as a composite to include hypertensive disorders of pregnancy (HDP), Antepartum hemorrhage (AH), postpartum hemorrhage (PPH) and fetal growth restriction (FGR). Multivariable logistic regression analyses were undertaken to predict the likelihood of APOs among pregnancy hospitalizations with / without SUD. Subgroup analyses were performed to predict the impact of each individual SUD subtype on APO as well as the likelihood of each type of APO among women with SUD.

Results:

From 2,967,969 hospitalizations, 184,766 (6.2%) were complicated by SUD and 129,906 (4.38%) had an APO. The prevalence of APOs was significantly higher among pregnancy hospitalizations with SUD (8,478 / 184,766 – 4.59%) vs. without SUD (121,428 / 2,783,203 – 4.36%, p < .001). Adjusting for relevant sociodemographic covariates, SUD was identified as an independent predictor of APOs (aOR 1.14; 95% CI 1.08-1.14). In subgroup analyses of all pregnancy hospitalizations with APO, SUD continued to remain a positive predictor of specific types of APO, including HDP (aOR 1.17; CI 95%, 1.04 to 1.33) and AH (aOR 1.35; CI 95%, 1.26 to 1.45). In subgroup analyses based on type of SUD, the risk for APO was significantly increased for alcohol, cannabis, cocaine, opioids, sedatives and stimulant use disorder as well as for polysubstance use (Figure 1).

Conclusion:

Patients with SUDs are at higher risk for APOs – particularly HDP and AH with greatest exposure risk seen with use of sedatives, stimulants, alcohol, opioids, or polysubstance use.