Meth and opioid use among expectant moms has grown significantly in the U.S. over a decade, a new study suggests, and the use is associated with worse outcomes compared with other baby deliveries.
The findings – published this week in the American Journal of Public Health – highlight the nation’s current drug crisis and appear to echo national trends in drug use.
“Basically what we found is amphetamine and opioid use disorders are increasing among delivering women in the U.S., and they’re increasing disproportionately across rural compared to urban counties across most of the United States,” says Dr. Lindsay Admon, an OB-GYN at Michigan Medicine Von Voigtlander Women’s Hospital and the lead author of the study. “When we compared delivery-related outcomes, or birth outcomes, among moms with opioid and amphetamine use disorders, outcomes were actually much worse with methamphetamine use disorders compared to opioid use disorders.”
Using data from the federal Agency for Healthcare Research and Quality, Admon and fellow researchers examined the trends in rates of amphetamine- and opioid-affected births in the U.S. from 2004 to 2015, drilling down to incidence by census region and among rural and urban residents.
The researchers noted that while they could not distinguish between methamphetamine use and other categories of amphetamine use, recent data show that “the majority (94 percent) of individuals with amphetamine use disorders seek care for methamphetamine-related use.”
The analysis revealed that from the 2008-2009 period to the 2014-2015 period, the estimated rate of amphetamine use among pregnant women across the U.S. doubled, from 1.2 per 1,000 hospital deliveries affected to 2.4. The rate of opioid-affected births more than quadrupled, from 1.5 per 1,000 deliveries to 6.5.
Researchers found that amphetamine- and opioid-related deliveries were both associated with worse health outcomes, longer lengths of stay and higher delivery costs than other hospital deliveries. Amphetamine-related deliveries were associated with higher rates of preeclampsia, placental abruption, preterm delivery and severe maternal morbidity and mortality than all other deliveries.
The adverse outcomes could be directly related to the drug use, researchers said, though they also noted that other factors may play a role. Substance use, for example, is associated with later prenatal care and fewer prenatal appointments, and access to treatment for pregnant women with addiction is often insufficient, especially in rural areas, the study said.
Higher rates for use of both amphetamines and opioids among pregnant women also varied by geographic location.
“By 2014 to 2015, amphetamine use disorder was identified among approximately 1 percent of deliveries in the rural Western United States, and that was higher than the incidence of opioid use in most other regions,” Admon says. Meanwhile, the incidence of opioid use disorder was estimated at 3 percent of all deliveries in the rural Northeast, higher than previously estimated, she says.
“When we looked into it, it’s been over 10 years since anybody has really looked at trends of amphetamine use, or methamphetamine use, in pregnancy, so these findings were really startling to us,” Admon says.
Still, Admon says she thinks her group’s estimates are probably conservative, as they rely on conditions such as clinicians screening for drug use, patients’ disclosure of substance use and proper recording of diagnoses.
“With substance use, it’s not just the opioid epidemic. There are other substances such as methamphetamine use that are also increasing, and I think we really need to think carefully about ways to connect women with the treatment resources that they need,” Admon says. “We have these really clear treatment guidelines for treating patients with opioid use disorder, and we don’t have the same type of guidance, certainly not in obstetrics, about how to best treat women with amphetamine use disorder, and I think there’s definitely a need for that.”
By Katelyn Newman, Staff Writer Nov. 30, 2018, at 1:54 p.m.
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