The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts.
Objectives Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003-2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from 1-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women's perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Results 5.5% of Massachusetts's deliveries between 2003 and 2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28-1.41) and low birth weight (LBW) (AOR 1.73, 95% CI 1.64-1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95% CI 0.55-0.68) and LBW (AOR 0.54, 95% CI 0.49-0.61). Conclusions for Practice SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don't receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.
Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, MA, USA. mkotelchuck@mgh.harvard.edu.
Milton
M
Kotelchuck
Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Erika R
ER
Cheng
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
Candice
C
Belanoff
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
Howard J
HJ
Cabral
Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA.
Hermik
H
Babakhanlou-Chase
Center on Education and Human Services, Education Division, SRI International, Menlo ParkCA, USA.
Taletha M
TM
Derrington
Office of Data Translation, Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA.
Hafsatou
H
Diop
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
Stephen R
SR
Evans
Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
Judith
J
Bernstein
D000328:Adult; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D018743:Perinatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome; D015995:Prevalence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology
Linked health data systems; Perinatal health services utilization; Perinatal outcomes; Pregnancy; SUD treatment; Substance use disorder