Substance-related diagnosis type predicts the likelihood and co-occurrence of preterm and cesarean delivery

Abstract

Objective:

This article aimed to evaluate whether a substance-related diagnosis (SRD; i.e., alcohol, opioids, cannabis, stimulants, nicotine) predicts the likelihood and co-occurrence of preterm (20–37 weeks’ gestation) and cesarean delivery.

Methods:

This study reviewed electronic health record data on women (aged 18–44 years) who delivered a single live or stillbirth at ≥ 20 weeks of gestation from 2012 to 2019. Women with and without an SRD were matched on key demographic characteristics at a 1:1 ratio. Adjusting for covariates, odds ratios and 95% confidence intervals were calculated.

Results:

Of the 19,346 deliveries, a matched cohort of 2,158 deliveries was identified. Of these, 1,079 (50%) had an SRD, 280 (13%) had a preterm delivery, 833 (39%) had a cesarean delivery, and 166 (8%) had a co-occurring preterm and cesarean delivery. An SRD was significantly associated with preterm and cesarean delivery (AOR = 1.84 [95% CI, 1.41–2.39], p-value= <0.0001; AOR = 1.51 [95% CI, 1.23–1.85], p-value= <0.0001). An alcohol-related diagnosis (AOR = 1.82 [95% CI, 1.01–3.28], p-value= 0.0471), opioid-related diagnosis (AOR = 1.94 [95% CI, 1.26–2.98], p-value= 0.0027), stimulant-related diagnosis (AOR = 1.65 [95% CI, 1.11–2.45], p-value= 0.0142), and nicotine-related diagnosis (AOR = 1.54 [95% CI, 1.05–2.26], p-value= 0.0278) were associated with co-occurring preterm and cesarean delivery.

Conclusions:

Pregnant women with an SRD experienced disproportionally higher odds of preterm and cesarean delivery compared to pregnant women without an SRD. Substance-type predicts the type of delivery outcome. An SRD in pregnant women should be identified early to reduce potential harm through intervention and treatment.

Keywords:

• Substance use
• pregnancy
• preterm delivery
• cesarean delivery
• electronic health record data

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research is funded by Dr. Carla Marienfeld research funds through the Department of Psychiatry at the University of California, San Diego School of Medicine. Dr. Laramie R. Smith’s contributions to this work were facilitated by National Institute on Drug Abuse Career Development Award (grant no. K01 DA039767).