Milken Institute School of Public Health, The George Washington University, Washinon, DC, USA.
Newborn Services, the George Washington University Hospital, Children's National, Washington, DC, USA.
Matern Child Health J. 2021 Oct;25(10):1575-1580. doi: 10.1007/s10995-021-03174-8. Epub 2021 May 24.
The growing opioid crisis increasingly affects maternal care in the US and it is unknown if opioid use puts pregnant women at increased odds for cesarean delivery (CD). Understanding how opioids influence CD trends is important in improving maternal and neonatal outcomes. This study aims to understand the association of opioid use with CD in the context of the demographic, clinical, behavioral, and health system complexity.
This retrospective cross-sectional analysis used representative data from the 2012-2014 National Inpatient Sample. Opioid use during pregnancy, CD, and other clinical variables were identified using ICD9 codes. Characteristics were assessed using bivariate and multivariate statistics. A logistic regression model was used to determine the association between opioid use and CD while controlling for confounders. Adjustments were made for rural/urban hospital location, regional median income, maternal age, race, and medical and pregnancy-related conditions.
The rate of CD in the overall sample was about 30%. Among opioids-users, the overall proportion of CD was significantly less (24.7%). The adjusted odds ratio for CD among opioids users was 0.74 (CI: 0.73-0.76, p < 0.001). This finding is unique to pregnant women who are covered by public insurance. In rural areas, the relationship between opioid use and CD was not significant.
Opioid use during pregnancy is associated with lower CD rates in urban settings. This evidence suggests that maternal care varies between rural and urban areas in relation to CD of pregnant opioid users compared to non-opioid users.
日益严重的阿片类药物危机越来越影响美国的产妇护理，目前尚不清楚阿片类药物的使用是否会使孕妇更有可能进行剖腹产（CD）。了解阿片类药物如何影响 CD 趋势对于改善母婴和新生儿结局非常重要。本研究旨在了解在人口统计学、临床、行为和医疗体系复杂性背景下，阿片类药物使用与 CD 的关系。
本回顾性横断面分析使用了 2012-2014 年全国住院患者样本的代表性数据。使用 ICD9 代码识别怀孕期间使用阿片类药物、CD 和其他临床变量。使用双变量和多变量统计方法评估特征。使用逻辑回归模型来确定阿片类药物使用与 CD 之间的关联，同时控制混杂因素。调整了农村/城市医院位置、区域中位数收入、产妇年龄、种族以及医疗和妊娠相关状况。
总体样本中 CD 的发生率约为 30%。在阿片类药物使用者中，CD 的总体比例明显较低（24.7%）。阿片类药物使用者发生 CD 的调整后优势比为 0.74（CI：0.73-0.76，p<0.001）。这一发现仅适用于有公共保险的孕妇。在农村地区，阿片类药物使用与 CD 之间的关系并不显著。
怀孕期间使用阿片类药物与城市地区 CD 发生率较低相关。这一证据表明，与非阿片类药物使用者相比，农村和城市地区的产妇护理在对待怀孕阿片类药物使用者的 CD 方面存在差异。
