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The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts

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Abstract

Objectives Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003–2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from 1-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women’s perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Results 5.5% of Massachusetts’s deliveries between 2003 and 2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28–1.41) and low birth weight (LBW) (AOR 1.73, 95% CI 1.64–1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95% CI 0.55–0.68) and LBW (AOR 0.54, 95% CI 0.49–0.61). Conclusions for Practice SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don’t receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.

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Funding

Supported in part by NIH NIAAA R21AA018395, NIH NIDA R21DA027181, and supplemental funding from the Massachusetts Department of Public Health Bureau of Substance Abuse Services.

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Authors and Affiliations

  1. Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, MA, USA

    Milton Kotelchuck

  2. Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Erika R. Cheng

  3. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA

    Candice Belanoff, Howard J. Cabral, Stephen R. Evans & Judith Bernstein

  4. Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA

    Hermik Babakhanlou-Chase

  5. Center on Education and Human Services, Education Division, SRI International, Menlo ParkCA, USA

    Taletha M. Derrington

  6. Office of Data Translation, Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA

    Hafsatou Diop

Authors
  1. Milton Kotelchuck
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  2. Erika R. Cheng
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  3. Candice Belanoff
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  4. Howard J. Cabral
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  5. Hermik Babakhanlou-Chase
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  6. Taletha M. Derrington
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  7. Hafsatou Diop
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  8. Stephen R. Evans
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  9. Judith Bernstein
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Corresponding author

Correspondence to Milton Kotelchuck.

Appendix

Appendix

See Table 5.

Table 5 Association between substance use disorder treatments and preterm birth and low birthweight among singleton deliveries with identified SUD need, overall and by specific drug mentioned
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Kotelchuck, M., Cheng, E.R., Belanoff, C. et al. The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts. Matern Child Health J 21, 893–902 (2017). https://doi.org/10.1007/s10995-016-2190-y

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  • DOI: https://doi.org/10.1007/s10995-016-2190-y

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