Trends and adverse pregnancy and birth outcomes associated with stimulant-related disorder diagnosis

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2024-08-08 DOI:10.1111/add.16636

Nicole S. Pippard, Gretchen Bandoli, Rebecca J. Baer

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Abstract

Background and aims

Stimulant-related disorders (SRD), or the continued misuse of illicit or prescribed stimulants, during pregnancy can have adverse health effects for mothers and infants. This study aimed to measure prevalence and trends of SRD diagnosis in pregnancy, and associations between SRD diagnosis and adverse maternal and infant health outcomes, among pregnant individuals in California.

Design

Retrospective cohort study.

Setting

California, USA.

Participants

Pregnant individuals from the Study of Outcomes in Mothers and Infants (SOMI) with singleton live births between 2012 and 2020 (n = 3 740 079).

Measurements

SRD diagnosis (excluding cocaine) and maternal (gestational diabetes, gestational hypertension [gHTN], severe maternal morbidity [SMM]) and infant (very preterm birth [gestational age <32 weeks], preterm birth [gestational age 32–37 weeks], neonatal intensive care unit [NICU] admission, small for gestational age [SGA]) outcomes were classified using International Classification of Disease (ICD) codes and vital statistics. Risk ratios were estimated with modified Poisson log linear regression that accounted for sibling pregnancies. Covariates included maternal sociodemographic characteristics, mental and physical health problems, nicotine use and co-occurrence of other diagnosed substance use disorders. Bias analyses were conducted to address unmeasured confounding and exposure misclassification.

Findings

SRD diagnosis among pregnant individuals increased from 2012 to 2020 (554 to 748 per 100 000 births). SRD diagnosis was associated with an increased risk of SMM (adjusted risk ratio [aRR] = 2.3; 95% confidence interval [CI] = 2.2–2.5), gHTN (aRR = 1.8; 95% CI = 1.7–1.9), very preterm birth (aRR = 2.2, 95% CI = 2.0–2.5), preterm birth (aRR = 2.1, 95% CI = 2.1–2.2) and NICU admission (aRR = 2.0, 95%CI = 1.9–2.0), and a decreased risk of gestational diabetes (aRR = 0.8; 95% CI = 0.8–0.9). SRD diagnosis was not associated with infants born SGA. Findings were generally robust to unmeasured confounding and misclassification of diagnosis.

Conclusions

Stimulant-related disorder diagnosis during pregnancy appears to be associated with an increased risk for select adverse maternal and infant health outcomes including severe maternal morbidity, gestational hypertension, very preterm birth, preterm birth and neonatal intensive care unit admission.

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与兴奋剂相关疾病诊断有关的趋势及不良妊娠和分娩结果。

背景和目的：妊娠期兴奋剂相关紊乱（SRD）或持续滥用非法或处方兴奋剂会对母婴健康造成不良影响。本研究旨在测量加利福尼亚州孕妇在怀孕期间被诊断为 SRD 的流行率和趋势，以及 SRD 诊断与母婴不良健康后果之间的关联：设计：回顾性队列研究：地点：美国加利福尼亚州：2012年至2020年间单胎活产的母婴结局研究（SOMI）中的孕妇（n = 3 740 079）：SRD诊断（不包括可卡因）、孕产妇（妊娠糖尿病、妊娠高血压[gHTN]、严重孕产妇发病率[SMM]）和婴儿（极早产[胎龄调查结果]）：从 2012 年到 2020 年，诊断出 SRD 的孕妇人数有所增加（每 10 万名新生儿中有 554 人诊断出 SRD，而每 10 万名新生儿中有 748 人诊断出 SRD）。SRD 诊断与 SMM（调整风险比 [aRR] = 2.3；95% 置信区间 [CI] = 2.2-2.5）、gHTN（aRR = 1.8；95% CI = 1.7-1.9）、极早产（aRR = 2.2，95% CI = 2.0-2.5）、早产（aRR = 2.1，95% CI = 2.1-2.2）和入住 NICU（aRR = 2.0，95%CI = 1.9-2.0），以及妊娠糖尿病风险降低（aRR = 0.8；95% CI = 0.8-0.9）。SRD诊断与SGA新生儿无关。研究结果总体上对未测量混杂因素和诊断分类错误具有稳健性：结论：妊娠期兴奋剂相关障碍诊断似乎与某些不良母婴健康结果的风险增加有关，包括严重的孕产妇发病率、妊娠高血压、极早产、早产和新生儿重症监护室入院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.