Effect of the COVID-19 Pandemic on Substance Use in Pregnancy and Associated Neonatal Outcomes [ID: 1342912

Abstract

INTRODUCTION: We sought to determine whether the COVID-19 pandemic resulted in an increase in positive urine drug screens (UDSs) in labor and delivery and whether the effect of drug use on neonatal outcomes differed before versus during the pandemic. METHODS: In this retrospective chart review, we identified patients from February 4, 2018, to May 11, 2022, with a completed UDS test and classified them into time periods: pre-COVID-19 and COVID-19. Pearson's χ2 test or Fisher's exact test was used to assess whether the proportion of positive tests and the presence of each drug type differed between the periods. A logistic regression was used to explore the effect of time period and test result on neonatal outcomes. RESULTS: We identified 7,648 UDS results; 3.6% were positive in the pre-COVID-19 period and 1.6% were positive in the COVID-19 period (P<.001). We found higher proportions of benzodiazepine and cannabinoid detection in the pre-COVID-19 period (P=.045 and P=.005, respectively). In the COVID-19 period, we found higher proportions of buprenorphine detection (P=.004). In the COVID-19 period, there was a stronger association between positive UDS results and neonatal intensive care unit (NICU) admission compared to the pre-COVID-19 period (odds ratio [OR] 16.78 [95% CI: 9.9, 28.6], 6.2 [95% CI: 3.8, 10.0], respectively). During the COVID-19 period, drug use was found to be a risk factor for small for gestational age (SGA) (OR 4.1 [95% CI: 2.3, 7.4]). CONCLUSION: We found a decrease in drug use during the COVID-19 pandemic. However, drug use during the pandemic was more strongly associated with NICU admission and was a risk factor for SGA.