1023: A comparison of BMI and drug screens among pregnant patients at an Appalachian clinic

Abstract

Appalachia has significantly higher rates of both obesity and opiate abuse compared to the national average. This study looks at the relationship of these two epidemics and how they may influence each other among pregnant women in one Appalachian clinic. This is a retrospective cohort study reviewing body mass index (BMI) at first prenatal visit to identify obesity (BMI >30kg/m2) and results of first urine drug screen (UDS) performed in pregnancy for all patients seen in one Appalachian clinic in the 2018 calendar year. Universal drug screening is performed on all pregnant patients in our population due to local high rates of substance abuse. A positive test for any one of the 12 drugs in the screening panel resulted in a “screen positive” result. Data was further analyzed using health insurance status as a socioeconomic marker. Data from 992 patients was collected and assessed. Data from 6 patients was not used because they lacked either BMI or UDS data. Screen positive samples were found in 318 UDS (32.3% of all samples); of these, 142 samples (14.4% of all samples) tested positive for buprenorphine. The median BMI for all patients was 27.5+/- 7.9 kg/m2. Obesity accounted for 35.6% of patients. Drug screen positive patients had an average BMI 2.5kg/m2 (p< 0.001) lower than drug screen negative patients. An even greater difference was seen when the subcategory of buprenorphine positive patients were compared to negative UDS patients. The buprenorphine positive patients had a BMI 3.6kg/m2 (p< 0.001) lower than drug screen negative patients. Among patients with insurance coverage through Medicaid, buprenorphine positive patients had a BMI 4.5kg/m2 (p< 0.001) lower than drug screen negative. Two separate epidemics appear to exist side by side in different populations of the same community. It is unclear whether the presence of one condition is protective against the occurrence of the other condition for an individual patient. Further research into socioeconomics, education, and experienced trauma could help better evaluate distinctions between these two epidemics.View Large Image Figure ViewerDownload Hi-res image Download (PPT)