Socioeconomic Disparities in Perinatal Substance Use Emergency Department Visits Before and During COVID-19.

Background: Substance use during pregnancy threatens maternal and fetal health, and the COVID-19 pandemic may have altered patterns of use and disparities. Methods: We analyzed 2019-2021 Nationwide Emergency Department Sample data to examine emergency department visits among pregnant individuals with documented substance use (opioids, cannabis, alcohol, or nicotine). A difference-in-differences approach assessed pandemic-related changes and disparities by race/ethnicity and insurance status. Results: During the pandemic, odds of emergency department visits involving alcohol use increased by 16% (adjusted odds ratio [aOR] = 1.16, 95% confidence interval [CI] = 1.05-1.27) and cannabis use by 10% (aOR = 1.10, 95% CI = 1.01-1.20). Prepandemic, Native American individuals had markedly higher odds of opioid use, while African American individuals had higher odds of cannabis and nicotine use. Disparities in cannabis use narrowed for Hispanic and Native American individuals compared to White individuals. Uninsured and Medicaid-insured patients showed consistently elevated odds for opioid, cannabis, and nicotine use. Conclusions: The pandemic was associated with increased alcohol and cannabis use in pregnancy and shifting disparities across racial and insurance groups. Targeted public health strategies are needed to address substance use among pregnant individuals, especially during societal disruptions.