Use of Amphetamine and Opioid During Pregnancy Rising

National Inpatient Sample (NIS), a nationally representative sample of hospital discharges in the United States, in order to estimate trends in incidence, outcomes, and overall cost among hospital deliveries related to amphetamines and opioids use between 2004 and 2015. During the decade-long study period, about 47million deliveries were reported in U.S. hospitals.

The results revealed that 82,254 delivery hospitalizations reported one (or more) amphetamine use diagnoses, and 170,164 included opioid use diagnoses. By 2014-15, amphetamine use complicated roughly one percent of all deliveries in the rural West (11.2 per 1,000 hospital deliveries); the highest incidence of maternal opioid use was found in the rural Northeast, complicating nearly three percent of all deliveries (28.7 per 1,000 hospital deliveries). A majority of patients in both substance use groups were non-Hispanic white, from lower-income communities, and had public insurance.

Overall, the incidence of amphetamine-affected births doubled during the study period, from 1.2 per 1,000 hospitalizations in 2008-2009 to 2.4 per 1,000 delivery hospitalizations in 2014-2015. The rate of opioid use quadrupled, from 1.5 per 1,000 delivery hospitalizations to 6.5. The risk of severe maternal morbidity and mortality was 1.6 times higher in pregnant women who used amphetamine than those who used opioids. Incidence of preterm delivery, preeclampsia or eclampsia, heart failure or heart attack, and blood transfusions were also higher among the amphetamine group. The study was published on November 29, 2018, in the American Journal of Public Health.

“Early and adequate access to prenatal care for women with substance use has been shown to improve birth outcomes. Optimizing access to prenatal care is a crucial mechanism to connect women with the services they need for their health and their baby's health,” said lead author Lindsay Admon, MD, MSc, of U-M. “We need to find better ways to prevent, detect, and treat maternal amphetamine and opioid use. Developing treatment programs that can reach women in the geographic areas most affected by these epidemics is key to improving outcomes for mothers and newborns.”

“We have seen a significant increase in infants born with symptoms of drug withdrawal. We need to devote more resources to prevent and treat substance use in pregnancy, especially in low-income and rural communities,” said senior author Tyler Winkelman MD, MSc, of Hennepin Healthcare. “Neonatal intensive care units in rural counties may also not have adequate capacity to care for babies born with neonatal abstinence syndrome, which describe health problems a baby experiences when withdrawing from exposure to narcotics.”

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University of Michigan