Adverse Pregnancy Outcomes with Co-Occurring Opioid and Stimulant Use Disorders

Background/Objectives: Substance use disorder (SUD) in pregnancy is an increasingly complex public health challenge that is known to worsen maternal and neonatal outcomes. Rates of polysubstance use are steadily rising. The objective of this study was to assess the impact of co-occurring opioid and stimulant use disorder on adverse pregnancy outcomes (APOs) among inpatient pregnancy hospitalizations. Methods: We conducted a cross-sectional analysis of inpatient pregnancy hospitalizations for delivery admissions from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2016 to 2020. ICD-10 codes were used to identify patients with opioid and stimulant use disorder and with APOs. APO was defined as a composite to include hypertensive disorders of pregnancy, antepartum hemorrhage, postpartum hemorrhage, preterm birth, and fetal growth restriction. Multivariable logistic regression analyses were undertaken to predict the likelihood of APOs among pregnancy hospitalizations with opioid use, stimulant use, or co-occurring (opioid and stimulant) use disorders. Sociodemographic covariates, including age, race and/or ethnicity, insurance payor type, and income level, were accounted for. Results: From 2016 to 2020, 32,602 delivery hospitalizations complicated by stimulant or opioid use disorder were identified. Of these admissions, 21,049 (64.6%) had opioid use disorder, 9472 (29.1%) had stimulant use disorder, and 2081 (6.4%) had co-occurring opioid and stimulant use disorder. In the entire cohort, the prevalence of APOs was significantly highest among pregnancy delivery hospitalizations with co-occurring opioid use and stimulant use disorder (1136/2081-54.6%, p < 0.001), as compared with opioid use disorder (8923/21,049-42.4%) or stimulant use disorder alone (4654/9472-49.1%). Rates of APOs increased in subsequent years for all cohort groups. Adjusting for relevant sociodemographic covariates, co-occurring opioid and stimulant use disorder was an independent predictor of APO (aOR 3.65; CI 95%, 3.34-3.99). In comparison, opioid use disorder and stimulant use disorder were independent predictors of APOs with a less strong correlation, aOR 2.22 (CI 95%, 2.16-2.29) and aOR 2.89 (CI 95%, 2.77-3.02), respectively. Conclusions: Patients with co-occurring opioid and stimulant use disorder have the highest exposure risk for APOs, acting as an independent predictor for APOs when adjusting for sociodemographic covariates.