639 Co-occuring opioid and methamphetamine use disorder and severe maternal morbidity and mortality in Utah

Abstract

Co-occurring opioid use disorder (OUD) and methamphetamine use disorder (MUD) are increasingly common in the United States. Individually, these conditions increase risk of severe maternal morbidity and mortality (SMM). However, less is known about SMM risk among women with co-occurring OUD/MUD. We aimed to characterize the risk of SMM among women with OUD/MUD, OUD, MUD compared to unaffected women. This is a retrospective cohort study of the first delivery for any woman giving birth in Utah between 2014-2016. The Utah Population Database provided linked data including vital records, Department of Health inpatient data, and the Utah All Payer Claims Data. We defined OUD and MUD using ICD-9/10 codes. Our primary outcome was SMM, defined by Centers for Disease Control and Prevention, and maternal death. Our secondary outcomes were SMM without blood transfusion and maternal death. We compared maternal characteristics and co-morbidities across the four groups using chi-square and Fisher’s exact tests. Logistic regression was used to estimate odds of SMM associated with OUD/MUD, OUD and MUD compared to unaffected women adjusted for potential confounders. In this cohort (N=136,446), 60 women (0.04%) had co-occurring OUD/MUD, 166 (0.12%) had OUD, and 71 (0.05%) had MUD. We detected differences in race/ethnicity, frequency of mental health conditions, other substance use, medical co-morbidities and insurance by group (Table). Women with OUD/MUD more frequently experienced SMM (n=13, 22%) compared to women with OUD (n=26, 16%), MUD (n=9, 13%) and unaffected (n=4040, 3%) (p<.001) (Table). Nearly 2% of women with OUD/MUD and OUD died compared to women with no women with MUD and <0.1% of unaffected women (p<.001) (Table). After adjustment for confounders, higher odds of SMM among women with OUD/MUD, OUD and MUD compared to those who are unaffected persisted (Figure). More than 1 in 5 women with co-occurring OUD/MUD and more than 1 in 10 with OUD or MUD experienced SMM. Urgent attention is needed to mitigate risks of SMM in this high-risk population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)