Substance use impacts maternal morbidity and maternal delivery outcomes in women who presented for delivery in a large healthcare system

Background: Pregnant women with a substance related diagnosis (SRD) are a vulnerable population who may be experiencing disproportionate prevalence of maternal morbidity compared to pregnant women without an SRD. Although research on prenatal substance use is robust in terms of understanding fetal and newborn health, far less is known about morbidity among pregnant women with an SRD. The primary goals of this research were to evaluate the relationships between maternal SRDs and preterm delivery, cesarean delivery, and severe maternal morbidity (SMM) in a large healthcare system. Methods: This retrospective study retrieved electronic medical record data on women (ages 18 and 44 years) who delivered a single live or stillbirth at ≥ 20 weeks of gestation from April 1st, 2011-September 30th, 2019. The Andersen Model was applied to guide the analysis and structure patient characteristics. Chapter 2 evaluates independent associations between an SRD and preterm delivery and cesarean delivery. Chapter 3 evaluates associations and trends between an SRD and SMM (≥ 1 SMM and blood transfusions). Chapter 4 uses latent class analysis to characterize the patterns of SRD, mental illness, and pre-existing health conditions among women with and without SMM. Results: Chapter 2 shows that having an SRD was associated with preterm delivery (n=2,158, adjusted odds ratio (AOR) = 1.60 [95% CI, 1.20-2.14], p-value = 0.0192) and cesarean delivery (n=2,154, AOR = 1.50 [95% CI, 1.13-1.99], p-value = 0.0050). Chapter 3 shows that having an SRD was associated with having SMM (AOR = 1.81 [95% CI, 1.14-2.88], p-value = 0.0124). Chapter 4 reveals a two-class solution for those with and without SMM best fit the data producing clinically distinct classes. SRDs were common in the groups with high and moderate co-occurring mental and physical health outcomes in both the SMM and non-SMM classes. Conclusion: Having an SRD is associated with preterm delivery, cesarean delivery, and SMM. Future research should focus on identifying strategies and therapeutic interventions in pregnant women with an SRD to prevent, screen, and treat maternal morbidity in this vulnerable population