Department of Psychiatry, University of California San Diego, La Jolla, CA (Dr Courchesne-Krak, Mr Kepner, and Dr Marienfeld).
Department of Psychiatry, University of California San Diego, La Jolla, CA (Dr Courchesne-Krak, Mr Kepner, and Dr Marienfeld).
Am J Obstet Gynecol MFM. 2022 Mar;4(2):100559. doi: 10.1016/j.ajogmf.2021.100559. Epub 2022 Jan 3.
As a vulnerable population, pregnant women with a substance-related diagnosis (ie, substance use, misuse, or dependence) may use healthcare disproportionately.
The primary goal of this study was to evaluate the differences in the use of outpatient clinical visits, emergency department visits, and inpatient days in the hospital among women with and without a substance-related diagnosis during the antepartum period.
This retrospective study retrieved electronic health record data on women (age, 18-44 years) who delivered a single live birth or stillbirth at ≥20 weeks of gestation from April 1, 2012, to September 30, 2019. Imbalance in measured maternal sociodemographic and obstetrical characteristics between women with and without a substance-related diagnosis was attenuated using propensity score matching on key demographic characteristics (eg, age), yielding a matched 1:1 sample. Unadjusted and adjusted logistic regressions models were used to determine the association between a substance-related diagnosis and outpatient visits, emergency visits, and inpatient days.
From the total sample (n=16,770), the matched cohort consisted of 1986 deliveries. Of these, most were White (51.0%), or mixed or of some other race (31.1%). The mean age was 29.8 (standard deviation, 5.6). A substance-related diagnosis was identified in 993 women (50%) because of matching. Women with a substance-related diagnosis were more likely to have ≤10 outpatient visits than women without a substance-related diagnosis (adjusted odds ratio, 1.81 [95% confidence interval, 1.44-2.28]; P<.0001). Alcohol-, opioid-, and stimulant-related diagnoses were independently associated with ≤10 outpatient visits (adjusted odds ratio, 3.16 [95% confidence interval, 1.67-6.04]; P=.0005; adjusted odds ratio, 3.02 [95% confidence interval, 1.79-5.09]; P<.0001; adjusted odds ratio, 2.18 [95% confidence interval, 1.39-3.41]; P=.0007, respectively). Women with a substance-related diagnosis were more likely to have ≥1 emergency visit than women without a substance-related diagnosis (adjusted odds ratio, 1.36 [95% confidence interval, 1.00-1.85]; P<.0001). Opioid-, stimulant-, and nicotine-related diagnoses were independently associated with ≥1 emergency visit (adjusted odds ratio, 2.28 [95% confidence interval, 1.09-4.77]; P=.0287; adjusted odds ratio, 2.01 [95% confidence interval, 1.07-3.78]; P=.0301; adjusted odds ratio, 3.38 [95% confidence interval, 1.90-6.02]; P<.0001, respectively). Women with a substance-related diagnosis were more likely to have ≥3 inpatient days than women without a substance-related diagnosis (adjusted odds ratio, 1.69 [95% confidence interval, 1.07-2.67]; P=.0256). Opioid-, stimulant-, and nicotine-related diagnosis were independently associated with ≥3 inpatient days (adjusted odds ratio, 3.52 [95% confidence interval, 1.42-8.75]; P=.0067; adjusted odds ratio, 3.51 [95% confidence interval, 1.31-9.34]; P=.0123; adjusted odds ratio, 2.74 [95% confidence interval, 1.11-6.73]; P=.0285, respectively).
Women with a substance-related diagnosis during the antepartum period who delivered a single live birth or stillbirth at ≥20 weeks of gestation were experiencing fewer outpatient visits, more emergency department visits, and more inpatient days than women without a substance-related diagnosis. The type of substance-related diagnosis (eg, alcohol, opioids, stimulants, or nicotine) was associated with different patterns of healthcare use. The results from this study have reinforced the need to identify substance-related diagnoses in pregnant women early to minimize disproportionate healthcare service utilization through intervention and treatment.
作为一个弱势群体，有物质相关诊断（即物质使用、滥用或依赖）的孕妇可能会不成比例地使用医疗保健。
本研究的主要目标是评估在产前期间有物质相关诊断和没有物质相关诊断的女性在门诊就诊次数、急诊就诊次数和住院天数方面的差异。
本回顾性研究从 2012 年 4 月 1 日至 2019 年 9 月 30 日期间，检索了在≥20 孕周分娩单活产或死产的 18-44 岁女性的电子健康记录数据。通过对关键人口统计学特征（如年龄）进行倾向评分匹配，减轻了有物质相关诊断和没有物质相关诊断的女性之间在测量的母体社会人口统计学和产科特征方面的不平衡，产生了 1:1 的匹配样本。使用未调整和调整后的逻辑回归模型来确定物质相关诊断与门诊就诊、急诊就诊和住院天数之间的关联。
在总样本（n=16770）中，匹配队列由 1986 次分娩组成。其中，大多数是白人（51.0%）或混合或其他种族（31.1%）。平均年龄为 29.8（标准差，5.6）。由于匹配，在 993 名女性（50%）中确定了物质相关诊断。与没有物质相关诊断的女性相比，有物质相关诊断的女性门诊就诊次数≤10 次的可能性更低（调整后的优势比，1.81[95%置信区间，1.44-2.28]；P<.0001）。酒精、阿片类药物和兴奋剂相关诊断与门诊就诊次数≤10 次独立相关（调整后的优势比，3.16[95%置信区间，1.67-6.04]；P=.0005；调整后的优势比，3.02[95%置信区间，1.79-5.09]；P<.0001；调整后的优势比，2.18[95%置信区间，1.39-3.41]；P=.0007，分别）。与没有物质相关诊断的女性相比，有物质相关诊断的女性有≥1 次急诊就诊的可能性更高（调整后的优势比，1.36[95%置信区间，1.00-1.85]；P<.0001）。阿片类药物、兴奋剂和尼古丁相关诊断与≥1 次急诊就诊独立相关（调整后的优势比，2.28[95%置信区间，1.09-4.77]；P=.0287；调整后的优势比，2.01[95%置信区间，1.07-3.78]；P=.0301；调整后的优势比，3.38[95%置信区间，1.90-6.02]；P<.0001，分别）。与没有物质相关诊断的女性相比，有物质相关诊断的女性住院天数≥3 天的可能性更高（调整后的优势比，1.69[95%置信区间，1.07-2.67]；P=.0256）。阿片类药物、兴奋剂和尼古丁相关诊断与住院天数≥3 天独立相关（调整后的优势比，3.52[95%置信区间，1.42-8.75]；P=.0067；调整后的优势比，3.51[95%置信区间，1.31-9.34]；P=.0123；调整后的优势比，2.74[95%置信区间，1.11-6.73]；P=.0285，分别）。
在产前期间有物质相关诊断并在≥20 孕周分娩单活产或死产的女性与没有物质相关诊断的女性相比，门诊就诊次数较少，急诊就诊次数更多，住院天数更长。物质相关诊断的类型（例如，酒精、阿片类药物、兴奋剂或尼古丁）与不同的医疗保健使用模式相关。本研究的结果强化了早期识别孕妇物质相关诊断的必要性，以通过干预和治疗来最小化不成比例的医疗保健服务利用。
