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Independent risk factors for chronic illicit substance use during pregnancy

Manuel C. Vallejo, MD, DMD, Robert E. Shapiro, MD, Mitchell W. Lippy, BS, Christa L. Lilly, PhD, Leo R. Brancazio, MD

Abstract


Objective: We aimed to determine the incidence of chronic illicit substance use during pregnancy and to identify associated risk factors.

Design: A 2-year time-matched retrospective maternal quality control database (n = 4,470) analysis of parturients with chronic illicit substance use compared to controls.

Setting: A tertiary academic medical center located in a rural setting.

Results: The rate of chronic illicit substance use was 1.95 percent. Demographic factors associated with chronic illicit substance use in pregnancy-included lower body mass index (BMI; OR: 0.93; 95 percent CI: 0.89-0.96, p < 0.0001), higher gravidity (OR: 1.24; 95 percent CI: 1.13-1.36, p < 0.0001), higher parity (OR: 1.38; 95 percent CI: 1.22-1.57, p < 0.0001), and more live births (OR: 1.30; 95 percent CI: 1.16-1.46, p < 0.0001). A history of smoking (OR: 10.51; 95 percent CI: 5.69-19.42, p < 0.0001), alcohol use (OR: 48.98; 95 percent CI: 17.33-138.40, p < 0.0001), anxiety (OR: 1.88; 95 percent CI: 1.16-3.05, p = 0.01), depression (OR: 2.44; 95 percent CI: 1.55-3.85, p = 0.0001), transfer on admission (OR: 2.12; 95 percent CI: 1.16-3.87, p = 0.01), payor insurance (OR: 2.12, 95 percent CI: 2.10-5.04, p < 0.0001), and Apgar scores < 7 at 1 minute (OR: 0.50; 95 percent CI: 0.25-1.00, p = 0.049) were significant. Multiple variable logistic regression-revealed BMI, smoking, alcohol use, and Apgar score < 7 at 1 minute as significant factors.

Conclusions: Awareness of these factors can assist in identifying and treating parturients with chronic illicit substance use.


Keywords


pregnancy, maternal outcomes, chronic illicit drug use, risk factors

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References


Committee on Obstetric Practice: Committee Opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstet Gynecol. 2017; 130(2): e81-e94. doi:10.1097/AOG.0000000000002235.

Lamvu G, Feranec J, Blanton E: Perioperative pain management: An update for obstetrician-gynecologists. Am J Obstet Gynecol. 2018; 218(2): 193-199. doi:10.1016/j.ajog.2017.06.021.

The White House: Council of Economic Advisers report: The underestimated cost of the opioid crisis. 2017. Available at https://www.whitehouse.gov/briefings-statements/cea-reportunderestimated-cost-opioid-crisis/. Accessed March 14, 2020.

World Health Organization: Health topics: Substance abuse. Available at https://www.who.int/topics/substance_abuse/en/. Accessed March 14, 2020.

Bailey NA, Diaz-Barbosa M: Effect of maternal substance abuse on the fetus, neonate, and child. Pediatr Rev. 2018; 39(11): 550-559. doi:10.1542/pir.2017-0201.

NIH National Institute on Drug Abuse: Advancing addiction science. West Virginia opioid summary. Available at https://www.drugabuse.gov/opioid-summaries-by-state/west-virginiaopioid-summary. Accessed March 14, 2020.

United States Department of Health and Human Services: Substance Abuse and Mental Health Services Administration. Center for Behavioral Health. National Survey on Drug Use and Health, 2013 (ICPSR 35509). Available at https://www.icpsr.umich.edu/icpsrweb/NAHDAP/studies/35509. https://doi.org/10.3886/ICPSR35509.v3. Accessed March 14, 2020.

Badreldin N, Grobman WA, Yee LM: Inpatient opioid use after vaginal delivery. Am J Obstet Gynecol. 2018; 219(6): 608. e1-608.e7. doi:10.1016/j.ajog.2018.08.039.

Chou R, Gordon DB, de Leon-Casasola OA, et al.: Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologist' Committee on Regional Anesthesia, executive committee, and administrative council. J Pain. 2016; 17(2): 131-157. doi:10.1016/j.jpain.2015.12.008.

Oga EA, Mark K, Coleman-Cowger VH: Cigarette smoking status and substance use in pregnancy. Matern Child Health J. 2018; 22(10): 1477-1483. doi:10.1007/s10995-018-2543-9.

Biaggi A, Conroy S, Pawlby S, et al.: Identifying the women at risk of anxiety and depression: A systematic review. J Affect Disord. 2016; 191: 62-77. doi:10.1016/j.jad.2015.11.014.

Wendell AD: Overview and epidemiology of substance abuse in pregnancy. Clin Obstet Gynecol. 2013; 56(1): 91-96. doi:10.1097/GRF.0b013e31827feeb9.

Kirby T, Barry AE: Alcohol as a gateway drug: A study of US 12th graders. J Sch Health. 2012; 82(8): 371-379. doi:10.1111/j.1746-1561.2012.00712.x.

Hudak ML, Tan RC: Neonatal drug withdrawal. Drugs, Committee on drugs, Committee on Fetus and Newborn, American Academy of Pediatrics. Pediatrics. 2012; 129(2): e540-e560. doi:10.1542/peds.2011-3212.

Maeda A, Bateman BT, Clancy CR, et al.: Opioid abuse and dependence during pregnancy: Temporal trends and obstetrical outcomes. Anesthesiology. 2014; 121(6): 1158-1165. doi:10.1097/ALN.0000000000000472.

Levels of maternal care: Obstetric care consensus no. 9. Obstet Gynecol. 2019; 134(2): e41-e55. doi:10.1097/AOG.0000000000003383.




DOI: https://doi.org/10.5055/jom.2020.0590

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