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Clinical Obstetrics

Poster Session 4

(1051) The Burden of Substance Use Associated Stigma in Pregnancy

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Alison M. Kimura, MD, MPH

    MFM Fellow
    Prisma Health
    Greenville, SC, United States

    • Coauthor(s)

  • MF

    Melissa L. Fair, PhD

    Furman University Institute for the Advancement of Community Health
    Greenville, SC, United States

  • KD

    Kara Davis, PhD

    University of South Carolina Upstate
    Spartanburg, SC, United States

  • HM

    Hannah McKinnon, BS

    Furman University Institute for the Advancement of Community Health
    Greenville, SC, United States

  • Kacey Eichelberger, MD

    Chair, Department of Obstetrics & Gynecology
    USC School of Medicine Greenville
    Greenville, SC, United States

Objective:

Stigma is a predictor of the quality and quantity of prenatal care among patients with substance use disorder (SUD).  The Substance Use Stigma Mechanism Scale (SU-SMS), a previously validated scale, measures 3 domains of substance use related stigma: enacted, anticipated, and internalized stigma.  Our objective was to quantify the burden of stigma among a cohort of patients at a perinatal addiction medicine collaborative care clinic, evaluating differences by age, SUD type, and trimester of prenatal care initiation. Our hypothesis was that older patients, patients with stimulant use disorders, and those who delayed prenatal care will report higher levels of stigma.

Study Design:

This is a prospective cohort study of all patients who received prenatal care at our addiction medicine collaborative care clinic, were at least 18 years old, and completed the SU-SMS tool.  ANOVAs were used to compare domain-specific stigma scores by age (> 25 years, 25-29.99, 30-34.99, equal or > 35), SUD type (opioid only, stimulant only, combined opioid/stimulant, all other SUD diagnoses), and trimester of prenatal care initiation.

Results:

166 patients completed the SU-SMS tool and are included in this analysis.  Patients reported highest levels of internalized stigma, (M =3.14, SD=1.06), followed by enacted (M=2.31, SD=1.0) and anticipated stigma (M=1.81, SD=0.90). Those who initiated prenatal care in the third trimester had significantly higher internalized stigma scores compared to those who initiated in the first trimester (3.76 vs 2.90, p<0.01).  Patients with stimulant or combined opioid/stimulant use disorders reported significantly higher anticipated (F=3.48, p=0.02) and enacted (F=6.21, p<0.001) stigma when compared to patients with other SUD diagnoses.

Conclusion:

This study supports previous research on the association between stigma and delayed entry to prenatal care and enhances understanding of differences in stigma by SUD type among pregnant individuals with SUD. Future research should explore ways to reduce community level stigma and incorporate patient care models that address different domains of stigma.