Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH (NN, AF, KB), Cincinnati Children's Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Cincinnati, OH (NN, TEF, SW), University of Cincinnati College of Medicine, Cincinnati, OH (NN, TEF, SW, AF, KB), Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA (LRK), Department of Psychiatry and Behavioral Neuroscience University of Cincinnati College of Medicine, Cincinnati, OH (CW), Tri-State Maternal-Fetal Medicine Associates, Cincinnati, OH (MM), School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL (KT).
J Addict Med. 2022;16(1):84-92. doi: 10.1097/ADM.0000000000000843.
Prenatal and postpartum care for women with substance use is important due to increased risk of poor health outcomes. The influence of substance use on perinatal care utilization is not well characterized, especially postpartum care. The objective of this study was to examine the effect of substance use during pregnancy on prenatal and postpartum care utilization in a nationally representative sample and to identify maternal characteristics associated with inadequate prenatal and postpartum care among women with substance use.
Pregnancy Risk Assessment Monitoring System data (2016-2018) from 8 states were used for this study. Logistic regression models adjusted for complex survey weights and confounder variables were used to estimate the odds of not receiving adequate prenatal care and postpartum care. Weighted Rao-Scott chi-square tests were used to examine maternal characteristics associated with care utilization among women who reported substance use during pregnancy.
The study included 15,131 women, with 5.3% who reported illicit substance use during pregnancy. In multivariable models, substance use was associated with an increase in the odds of not receiving adequate prenatal care (OR 1.69, CI 1.32, 2.17) and not receiving postpartum care (OR: 1.47, CI 1.10, 1.95). Among women who reported substance use, depression and smoking status were associated with not receiving adequate prenatal or postpartum care.
Substance use during pregnancy is independently associated with disparities in prenatal and postpartum care access. Future studies are needed to identify how barriers lead to care inequalities and importantly, to identify strategies to improve care utilization.
由于健康状况不佳的风险增加，对有物质使用问题的妇女进行产前和产后护理非常重要。物质使用对围产期护理利用的影响尚未得到很好的描述，尤其是产后护理。本研究的目的是在全国代表性样本中研究怀孕期间物质使用对产前和产后护理利用的影响，并确定与物质使用妇女中产前和产后护理不足相关的产妇特征。
本研究使用了来自 8 个州的 2016-2018 年妊娠风险评估监测系统（PRAMS）数据。使用调整复杂调查权重和混杂变量的逻辑回归模型来估计未接受足够产前护理和产后护理的可能性。加权 Rao-Scott 卡方检验用于检查报告怀孕期间有物质使用的妇女中与护理利用相关的产妇特征。
本研究纳入了 15131 名妇女，其中 5.3%报告在怀孕期间使用非法物质。在多变量模型中，物质使用与未接受足够产前护理（OR 1.69，CI 1.32，2.17）和未接受产后护理（OR：1.47，CI 1.10，1.95）的几率增加相关。在报告有物质使用的妇女中，抑郁和吸烟状况与未接受足够的产前或产后护理有关。
怀孕期间物质使用与产前和产后护理获得方面的差异独立相关。需要进一步研究如何通过识别障碍导致护理不平等，并重要的是，确定改善护理利用率的策略。
