Substance use and pregnancy: What we know and what we can do

The U.S. is experiencing a significant increase in births affected by substance use disorders (SUDs), particularly opioid or methamphetamine (or meth) use disorder. Untreated SUDs during pregnancy pose increased risks for life-threatening health problems, even death, for mothers and their infants.

April 2019

Takeaways from our research

1. Opioid-affected births have quadrupled over the last decade, to 6.5/1000 deliveries. 2. Methamphetamine-affected births have also increased over the last decade, to 2.4/1,000 deliveries. 3. Opioid use in pregnancy increases the risk of death and life-threatening health issues by 50%, and meth use increases these risks by 150%.4. SUDs are increasing among all groups of childbearing women, but the largest increases are among women in rural communities, low-income communities, and those with Medicaid coverage for their pregnancy care. 5. Women of color have greater risk for life-threatening health issues compared to white women when their pregnancies are complicated by SUD and other behavioral health conditions. 6. Substance-affected deliveries result in increased healthcare costs. Neonatal abstinence syndrome, a group of problems that can affect infants exposed to opioids in the womb, accounted for $3 billion in hospital costs over the last decade.

What does this mean for health policy and practice decisions?

Improving health outcomes for pregnant and postpartum women with SUD requires coordinated clinical and policy-level interventions that are tailored to meet the needs of those at greatest risk.

  • Health systems should adopt coordinated evidence-based patient safety practices (bundles) intended to address SUD and racial/ethnic disparities in maternal health. This includes implementing universal screening and referral to treatment for pregnant and postpartum women with SUD.
  • Improved quality and availability of local, state, and national surveillance and survey data, specifically linking mothers and newborns, is needed to better understand outcomes after delivery for mothers with SUD and their children, and how to promote continued access to care and long-term recovery.
  • Research and clinical guidance on the treatment of methamphetamine use among pregnant and postpartum women is lacking and urgently needed.

Referenced studies on maternal health and substance use by IHPI members

Kozhimannil KB, Admon LK. Structural Factors Shape the Opioid Epidemic’s Effects on Pregnant Women and Infants. JAMA. 2019;321(4):352-353. doi:10.1001/jama.2018.20395

Martin CE, Admon LK, Terplan M. Behavioral Health in Pregnancy and Postpartum: Contributors to Maternal Mortality. Contemporary OBGYN. Dec. 10, 2018. https://www.contemporaryobgyn.net/pregnancy-and-birth/behavioral-healthpregnancy-and-postpartum

Admon LK, Winkelman TNA, Zivin K, Terplan M, Mhyre JM, Dalton VK. Racial and Ethnic Disparities in the Incidence of Severe Maternal Morbidity in the United States, 2012-2015. Obstetrics & Gynecology. 2018; 2018 Nov 1;132(5):1158-66. PMID: 30303912. doi:10.1097/AOG.0000000000002937

Admon LK, Bart G, Kozhimannil KB, Richardson CR, Dalton VK, Winkelman TNA. Amphetamine- and Opioid- Related Births: Incidence, Outcomes, and Costs, United States 2004-2015. AJPHAJPH. 2018;Jan(0):e1-7. PMID: 30496001. doi:10.2105/AJPH.2018.304771

Winkelman TNA, Admon LK, Jennings L, Shippee N, Richardson C, Bart G. Evaluation of Amphetamine-Related Hospitalizations and Associated Clinical Outcomes and Costs in the United States. JAMA Network Open. 2018;1(6):e183758. doi:10.1001/jamanetworkopen.2018.3758

Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004–2014. Pediatrics. 2018;141(4):e20173520. doi:10.1542/peds.2017-3520

Admon LK, Winkelman TNA, Moniz MH, Davis MM, Heisler M, Dalton VK. Disparities in chronic conditions among women hospitalized for delivery, United States 2005-2014. Obstetrics & Gynecology. 2017; 130(6): 1319-1326. PMID:29112666. doi:10.1097/AOG.0000000000002357
 

AUTHORS
Lindsay Admon, MD, MSc, University of Michigan
Tyler Winkelman, MD, MS, University of Minnesota/Hennepin Healthcare Research Institute, Former Robert Wood Johnson Foundation Clinical Scholar, University of Michigan

CONTRIBUTORS
Vanessa Dalton, MD, MPH, University of Michigan

FOR MORE INFORMATION
Please contact Eileen Kostanecki, IHPI’s Director of Policy Engagement & External
Relations, at ekostan@umich.edu or 202-554-0578.

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