(566) Co-occurring Opioid and Stimulant Use Disorders: Is there an Incremental Impact on Adverse Pregnancy Outcomes?

To assess the impact of co-occurring opioid and stimulant use disorder on adverse pregnancy outcomes (APO) among inpatient delivery admissions.

Study Design:

We conducted a cross-sectional analysis of delivery admissions from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2016 to 2019. ICD-10 codes were used to identify admissions with opioid and stimulant use disorder and APOs. Diagnosis Related Group codes were used to identify delivery admissions. APO was defined as a composite to include hypertensive disorders, antepartum hemorrhage, postpartum hemorrhage, preterm birth, and fetal growth restriction. Multivariable logistic regression analyses were undertaken to predict the likelihood of APOs among admissions with opioid use, stimulant use, or co-occurring (opioid + stimulant) use disorders while adjusting for sociodemographic characteristics including age, race and/or ethnicity, insurance payer and income level.

Results:

25,243 delivery hospitalizations including 16,526 (65.5%) with opioid use disorder, 7,241 (28.7%) with stimulant use disorder and 1,476 (5.8%) with co-occurring (opioid + stimulant) use disorder were identified. The prevalence of APOs was highest among delivery hospitalizations with co-occurring use disorder (767/1,476, 52.0%, p< .001), as compared with opioid use disorder (6,772/16,526, 41.0%) or stimulant use disorder alone (3,424/7,241, 47.3%). Rates of APO increased significantly in consequent years for all cohorts (Figure 1) (p < .001). Adjusting for relevant sociodemographic covariates, co-occurring use disorder was identified as the strongest predictor of APOs [aOR 3.495 (CI 95%, 3.14-3.89)] as compared to opioid [aOR 2.34 (CI 95%, 2.17-2.31)] or stimulant use disorder [aOR 2.87 (CI 95%, 2.73-3.01)] alone.

Conclusion:

Co-occurring opioid and stimulant use disorders represent the highest magnitude of risk for APOs, beyond the risk attributable to stimulants or opioids alone. This underscores the need for bolstering substance use recovery services in pregnancy given the recent increases in stimulant use and co-occurring use disorders.