Am J Obstet Gynecol. 2021 Jun 8:S0002-9378(21)00635-9. doi: 10.1016/j.ajog.2021.06.004. Online ahead of print.
OBJECTIVE: Pregnant women are at increased risk for severe morbidity and mortality due to respiratory infections like SARS-CoV-2 (COVID-19) during pregnancy1. Those with substance use disorders (SUD) may be especially vulnerable due to high rates of smoked tobacco, cannabis and methamphetamine use which adversely affect pulmonary function.2 However, little is known about differential effects of COVID-19 on pregnant women with and without SUD.
STUDY DESIGN: This was a retrospective cohort study of commercially insured pregnant women ages 15-44 using national administrative healthcare data from Optum’s deidentified Clinformatics® Data Mart Database version 8.1 (2007-2020). Women with a delivery hospitalization between January 1, 2020-August 19, 2020 continuously enrolled in insurance for ≥8 weeks during pregnancy and 6 weeks postpartum were included. SUD was defined using ICD-10 diagnoses for ≥ 1 SUD during pregnancy including alcohol, amphetamine, cannabis, cocaine, opioid or other substance use disorder.3 COVID-19 screening and diagnosis were defined using ICD-10 coding and reporting guidelines published by the CDC.4, 5 We used T-tests, Fisher’s exact tests, and quantile regression (percentiles) to examine statistical differences. This study was exempt by the University of Pittsburgh IRB because deidentified healthcare data were used.
RESULTS: Among 65,009 pregnancies, 2,616 (4.0%) had ≥1 SUD diagnosis. Almost half of the pregnant women in the cohort were non-Hispanic White (48%) and most lived in the South (41%) or the Midwest (28%) region of the United States (Table). Pregnant women with an SUD diagnosis were significantly more likely to be younger (30±6 vs 32±5; p<.05). Compared with the overall sample, non-Hispanic Black (10% vs 7%; p,.05) and non-Hispanic White (54% vs 48%; p<.05) women were overrepresented among those with SUD as opposed to Hispanic and non-Hispanic Asian women. Overall, 27% of pregnant women were screened and evaluated for COVID-19 during pregnancy or postpartum. Women without an SUD diagnosis were significantly more likely to be screened for COVID-19 during pregnancy (27% vs 24%; p<0.001) than those with an SUD. Overall, 3.4% of pregnant women were diagnosed with COVID-19, mostly (86%) in the third trimester. The prevalence of a COVID-19 diagnosis was higher among those with a SUD compared to those without an SUD (5% vs 3%; p<0.05). Further, there was a higher percentage of COVID-19 related hospitalizations among pregnant women with an SUD (36%) than those without an SUD (8%) (p<0.001). The median length of stay was one day longer among those with a SUD (3 vs 2 days; p<0.01) compared to those without an SUD. There were no COVID-19 related deaths reported during pregnancy or postpartum.
CONCLUSION: In this national cohort, pregnant women with a SUD had a higher COVID-19 diagnosis rate than those without a SUD, despite lower screening rates. Among those with a COVID-19 diagnosis, pregnant women with a SUD had a significantly higher rate of COVID-19 related hospitalizations and longer median length of stay than those without a SUD. Efforts to improve COVID-19 screening rates and decrease morbidity associated with COVID-19 diagnosis among pregnant women with SUDs may be warranted.
Source: ncbi 2