Objective
This study aimed to examine the trends and outcomes associated with substance use disorders.
Study Design
For this repeated cross-sectional analysis of the 2000 to 2018 National Inpatient Sample, deliveries to women aged 15 to 54 years with substance use disorder diagnoses were identified. Substance use disorders included (1) cannabis use disorder, (2) opioid use disorder, (3) alcohol use disorder, and (4) other drug use disorder. Temporal trends in substance use disorders were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% confidence intervals (CIs). The relationships among substance use disorders, demographic factors, and several adverse maternal outcomes were analyzed with unadjusted and adjusted log linear regression models with unadjusted and adjusted risk ratios (aRRs) as measures of the effects. Adjusted models included demographic factors, hospital characteristics, and clinical characteristics. To evaluate which hospital and patient characteristics were associated with substance use disorder diagnoses, we calculated the standardized mean difference (SMD) with ≥0.1 (10%) considered a meaningful difference.
Results
Of an estimated 73,109,791 delivery hospitalizations, 1,071,558 (1.5%) had ≥1 substance use disorder diagnosis. The proportion of delivery hospitalizations with ≥1 substance use disorder diagnosis increased from 0.8% in 2000 to 2.6% in 2018—a 230% increase (AAPC, 7.4%; 95% CI, 4.9–10.0). The proportion of delivery hospitalizations with cannabis use disorder increased from 0.3% to 1.5% (AAPC, 9.9%; 95% CI, 8.2–11.5) and those with opioid use disorder increased from 0.10% to 0.73% (AAPC, 12.0%; 95% CI, 8.8–15.3). The proportion of delivery hospitalizations with alcohol use disorder remained relatively stable, whereas the proportion with other drug use disorders increased slightly ( Figure ). Substance use disorder diagnoses were more common among younger women (SMD, 35.1% for maternal age category), women of non-Hispanic Black and non-Hispanic White race (SMD, 40.2% for maternal race and ethnicity), women with Medicaid insurance (SMD, 86.9% for payer), and women in the lowest income quartile based on ZIP code (SMD, 47.4% for ZIP code-based income quartile). Deliveries occurring at rural hospitals were more likely to be associated with substance use disorder diagnoses. Deliveries associated with any substance use disorder diagnosis were more likely to be associated with ≥1 mental health condition than those without (SMD, 50.4%). Deliveries with a substance use disorder diagnosis were also more likely to be associated with obesity (SMD, 10.4%), asthma (SMD, 23.0%), and tobacco use (SMD, 101.3%). Increases in substance use disorder diagnoses were highest for non-Hispanic White women (AAPC, 9.0%; 95% CI, 8.1–9.8). In adjusted analyses accounting for demographic, hospital, and clinical factors, substance use disorder diagnoses retained the association with an increased risk for nontransfusion severe maternal morbidity (aRR, 1.51; 95% CI, 1.48–1.54), hypertensive disorders of pregnancy (aRR, 1.09; 95% CI, 1.08–1.09), preterm delivery (aRR, 1.78; 95% CI, 1.77–1.79), and abruption and antepartum hemorrhage (aRR, 2.32; 95% CI, 2.29–2.34).
