Obstetric Delivery Involving Substance Use Disorders and Related Clinical Outcomes

Obstetric Delivery Inpatient Stays Involving Substance Use Disorders and Related Clinical Outcomes, a statistical brief from the Healthcare Cost and Utilization Project, presents statistics on delivery-related inpatient stays involving substance use disorder (SUD), overall and for select types of substances: opioids, cocaine, and other stimulants, as well as for both urban and rural areas. Clinical outcomes at delivery are examined, including preterm delivery (birth before 37 weeks of gestation), severe pre-eclampsia/eclampsia (a condition marked by high blood pressure, protein in the urine, and/or organ dysfunction, which can progress to the onset of seizures), obstetric hemorrhage/placenta accreta (a condition in which the placenta grows too deeply into the uterine wall, causing severe blood loss after delivery), and placental abruption (early separation of the placenta from the uterus).

Highlights:

In 2016, 91,800 obstetrical delivery inpatient stays had a SUD diagnosis (24.3 per 1,000 deliveries).
SUD-related deliveries involving opioids (7.6 per 1,000 deliveries) were more common than those involving cocaine (1.5) and other stimulants (2.8).
Compared with opioid-related deliveries, deliveries with a diagnosis of cocaine use or other stimulants use had higher rates of: preterm delivery (349.3 and 295.9 vs. 229.1 per 1,000 delivery stays), severe pre-eclampsia/eclampsia (58.7 and 80.1 vs. 38.4), placental abruption (69.3 and 60.2 vs. 36.8), and obstetric hemorrhage/placenta accreta (52.4 and 53.6 vs. 42.4). These rates all were higher than those for deliveries with no SUD diagnosis.
The rate of SUD-related deliveries was higher for patients from rural than from urban areas (35.7 vs. 22.5 per 1,000 stays).
Among SUD-related deliveries, some adverse clinical outcomes were more common for patients residing in urban areas. For instance, among SUD-related deliveries, severe pre-eclampsia/eclampsia was more common for urban compared with rural residents (44.3 vs. 31.8 per 1,000 delivery stays).
In contrast, rates of placental abruption were higher for rural compared with urban residents, and the difference was greatest among opioid-related delivery stays (41.6 vs. 35.7).

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