(879) Perinatal outcomes of methamphetamine use in pregnancy in California, 2008-2019

Objective: While methamphetamine use has been rising in recent years, occurring amongst a wider demographic and in broader geographical areas, there is limited research on its use in pregnancy. The objective of this study is to examine the association between prenatal methamphetamine use and perinatal outcomes in a large, recent birth cohort.

Study Design: This is a retrospective cohort study using California linked vital statistics and hospital discharge data from 2008-2019. We included singletons with gestational age 23-42 weeks. We further excluded cocaine, opioid, or other substance use. Methamphetamine use was identified using ICD-9 and ICD-10 codes. Chi-square tests and multivariable logistic regression models were used to evaluate associations of methamphetamine use with perinatal outcomes.

Results: A total of 5,148,972 births were included, of which 6,056 (0.12%) had prenatal methamphetamine use. Compared with no use, individuals with methamphetamine use had higher proportions of severe maternal morbidity (3.1% vs. 1.2%; p< 0.001), preterm delivery < 37 weeks (16.0% vs. 6.7%; p< 0.001), and neonatal intensive care unit (NICU) admission (21.6% vs. 10.2%; p< 0.001). Individuals with methamphetamine use had increased odds of gestational hypertension (aOR=1.63, (1.44, 1.83)), preeclampsia (aOR=1.65, (1.48, 1.85)), placental abruption (aOR=2.09, (1.76, 2.48)), cardiovascular morbidity (aOR=2.11, (1.61, 2.77)), and severe maternal morbidity (aOR=2.11, (1.81, 2.47)). Hispanic patients and those with public insurance had higher odds of adverse maternal outcomes. With regards to neonatal outcomes, methamphetamine use was associated with increased odds of preterm birth < 37 weeks (aOR=2.10, (1.95, 2.26)), NICU admission (aOR=1.99, (1.87, 2.12)), small for gestational (aOR=1.30, (1.20, 1.41)), and infant death (aOR=3.29, (2.56, 4.23)).

Conclusion: Methamphetamine use in pregnancy is associated with increased odds of both adverse maternal and neonatal outcomes. The results of this study can inform care in pregnancy and postpartum for this high-risk, socioeconomically vulnerable population.