(830) How does social vulnerability influence substance use patterns in pregnant persons with substance use disorder?

This study was undertaken to evaluate the impact of extremes of social vulnerability on substance use patterns in pregnant persons with substance use disorder (SUD).

Study Design:

We conducted a retrospective cohort analysis of mother-neonate dyads who received prenatal care through a specialized perinatal SUD program at a tertiary academic center from December 2019 to March 2023. Overall as well as subcomponent Social Vulnerability Index (SVI) scores were assigned based on zip code, as defined by the CDC. Information pertaining to demographic characteristics, prenatal care utilization and substance use patterns during pregnancy, were abstracted from electronic records and compared across 2 subgroups – the lowest and highest overall SVI quartiles. Student’s t test and chi2 / Fisher’s exact tests were used to compare continuous and categorical data, respectively. Statistical significance was set at p</span>≤.05.

Results:

Of 491 pregnant persons, 124 (25%) were in the lowest SVI and 106 (22%) in the highest SVI quartile. Mean SVI scores were 0.131 ± 0.099 vs 0.849 ± 0.012 (mean ± SD) in the lowest and highest quartile categories, respectively. Patients in the high SVI category had higher parity (p< .01), were more likely to be non-hispanic Black (p< .01) and have lower median income (p< .01). The high social vulnerability subgroup also notably had higher rates of any current substance use (p=< .01), specifically opioid (p=.03) and cocaine (p< .01) use as well as DSM-V defined cocaine use disorder (p=.03). Patients in the high SVI group had limited prenatal care utilization as evidenced by - later presentation to prenatal care (p=.02), with fewer prenatal care visits (p=.04) which translated into higher rates of positive urine drug screens (UDS) for illicit substances upon admission to L&D (p=.05).

Conclusion:

Pregnant persons with SUD exposed to high SVI environments are at increased risk for continued use, relapse and limited healthcare utilization. Addressing determinants of social vulnerability is a critical need for achieving perinatal health equity and addressing disparities in care.