Keller Justine M, Al-Hammadi Noor, Bass Sabel, Chavan Niraj R
Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal Fetal Medicine, Saint Louis University/SSM Health, St. Louis, MO (Keller and Chavan).
Department of Health and Clinical Outcomes Research, Advanced HEAlth (AHEAD) Research Institute, Saint Louis University, St. Louis, MO (Al-Hammadi).
Am J Obstet Gynecol MFM. 2025 Jan;7(1):101544. doi: 10.1016/j.ajogmf.2024.101544. Epub 2024 Nov 4.
Substance use disorder (SUD) is a disease characterized by behavior patterns of substance use leading to dysfunction in cognition, mood, and quality of life. The prevalence of perinatal SUD in the United States continues to rise and has adverse effects on the maternal-infant dyad. Mirroring the rise in SUD is an increasing prevalence of severe maternal morbidity (SMM). However, this relationship needs further examination.
OBJECTIVE(S): The primary objective of this study was to evaluate the association between perinatal SUD and SMM. We hypothesized that SUD would predict a significantly increased risk for SMM events, both as a composite and individually, in adjusted multivariable regression analyses.
We conducted a cross-sectional analysis of inpatient pregnancy hospitalizations from the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020. ICD-10 codes were used to identify patients with an SUD and/or a SMM event. SUD was defined as a composite. Our primary outcome was rate of SMM as defined by the Centers for Disease Control and Prevention. Multivariable logistic regression analyses were performed to predict the likelihood of SMM among pregnancy hospitalizations with and without SUD as well as to predict the likelihood of SMM for each individual type of SUD in a subgroup of hospitalizations with SUD and SMM.
Of the 3672,932 inpatient pregnancy hospitalizations included in the analyses, 6.27% (230,110/3,672,932) had SUD diagnosis and 2.10% (77,021/3,672,932) had an SMM diagnosis. The prevalence of SMM was significantly higher among patients with SUD (7357/230,110%-3.20%) vs without SUD (69,664/3442,822-2.02%, P<.0001). Patients with SUD were 1.5 times more likely to have a SMM event as compared to those without SUD (aOR 1.52; 95% CI 1.48-1.56). In subgroup analyses based on SUD type-the likelihood of SMM was strongest for stimulants (aOR 3.86; 95% CI 3.61-4.13) and sedatives (aOR 3.82; 95% CI 3.08-4.75). In subgroup analyses based on SMM event, SUD was a strong positive predictor for acute myocardial infarction (aOR 3.63; 95% CI 2.78-4.74) and aneurysm (aOR 6.28; 95% CI 2.77-14.21).
CONCLUSION(S): Pregnant patients with SUD carry significantly increased risk of experiencing an SMM event. These events occur more readily in patients with certain patterns of SUD use-most notably sedatives and stimulants. Patients with SUD were most likely to experience a cardiovascular-related SMM event, thus informing care.
物质使用障碍（SUD）是一种以物质使用行为模式为特征的疾病，可导致认知、情绪和生活质量方面的功能障碍。美国围产期物质使用障碍的患病率持续上升，对母婴二元组产生不利影响。与物质使用障碍患病率上升相对应的是，严重孕产妇发病率（SMM）的患病率也在增加。然而，这种关系需要进一步研究。
本研究的主要目的是评估围产期物质使用障碍与严重孕产妇发病率之间的关联。我们假设在调整后的多变量回归分析中，物质使用障碍将预测严重孕产妇发病事件的风险显著增加，无论是作为一个综合指标还是单独来看。
我们对2016年至2020年医疗成本和利用项目国家住院样本中的住院妊娠病例进行了横断面分析。使用国际疾病分类第十版（ICD-10）编码来识别患有物质使用障碍和/或严重孕产妇发病事件的患者。物质使用障碍被定义为一个综合指标。我们的主要结局是疾病控制和预防中心定义的严重孕产妇发病率。进行多变量逻辑回归分析，以预测有和没有物质使用障碍的住院妊娠中严重孕产妇发病的可能性，以及在患有物质使用障碍和严重孕产妇发病的住院病例亚组中，每种物质使用障碍类型导致严重孕产妇发病的可能性。
在纳入分析的3672932例住院妊娠病例中，6.27%（230110/3672932）有物质使用障碍诊断，2.10%（77021/3672932）有严重孕产妇发病诊断。患有物质使用障碍的患者中严重孕产妇发病率显著高于没有物质使用障碍的患者（7357/230110 - 3.20%对比69664/3442822 - 2.02%，P <.0001）。与没有物质使用障碍的患者相比，患有物质使用障碍的患者发生严重孕产妇发病事件的可能性高1.5倍（调整后比值比1.52；95%置信区间1.48 - 1.56）。在基于物质使用障碍类型的亚组分析中，兴奋剂（调整后比值比3.86；95%置信区间3.61 - 4.13）和镇静剂（调整后比值比3.82；95%置信区间3.08 - 4.75）导致严重孕产妇发病的可能性最强。在基于严重孕产妇发病事件的亚组分析中,物质使用障碍是急性心肌梗死（调整后比值比3.63；95%置信区间2.78 - 4.74）和动脉瘤（调整后比值比6.28；95%置信区间2.77 - 14.21）的强阳性预测因素。
患有物质使用障碍的孕妇发生严重孕产妇发病事件的风险显著增加。这些事件在具有特定物质使用障碍模式的患者中更容易发生，最明显的是镇静剂和兴奋剂。患有物质使用障碍的患者最有可能经历与心血管相关的严重孕产妇发病事件，从而为护理提供参考。
