(216) Perinatal Substance Use Programming: Impact on Maternal and Neonatal Outcomes Among Women with Psychiatric Comorbidities

The objective of this study was to evaluate the impact of participation in a comprehensive perinatal substance use disorder (SUD) program on maternal and neonatal outcomes among women with SUD and co-occurring psychiatric diagnoses.

Study Design:

We conducted a retrospective cohort study of women receiving prenatal care through a specialized perinatal SUD program at an academic tertiary center from December 2019 to March 2023. Demographic characteristics, substance use patterns, maternal and neonatal outcomes were abstracted from electronic records and compared across 2 groups – women with SUD with and without co-occurring psychiatric disorders. Our study outcomes were – an adverse maternal composite, including antepartum and postpartum – relapse, overdose and severe maternal morbidity (SMM), and an adverse neonatal composite including Neonatal Abstinence Syndrome (NAS) requiring pharmacologic treatment, NICU stay >7 days, SGA at birth and neonatal demise. 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 ≤.05. 

Results:

Of the 466 pregnant women with a DSM-V defined SUD, 410 (88%) had co-occurring psychiatric disorder(s) and 56 (12%) did not. Those with co-occurring psychiatric disorders were more likely to be white (P< .01), married (p=.02), had higher rates of history of IV drug use (p< .01), participation in inpatient rehabilitation (p< .01), prior overdose (p< .01), history of sexual trauma (p=0.04) and prior arrest/incarceration (p=.02). While Opioid use disorder (OUD) was the predominant SUD in 85% (n=396) of the overall cohort, the subset with psychiatric comorbidities had higher rates of benzodiazepine (p=.04) and amphetamine use disorder (p< .01). Gestational age at care initiation, number of prenatal visits as well as rates of adverse maternal and neonatal composite outcomes were similar across both groups.

Conclusion:

Participation in a comprehensive prenatal substance use recovery program can potentially improve clinical outcomes for women with SUD and co-occurring psychiatric diagnoses.