Opioid use disorder at delivery hospitalization in the United States: 2012-2016.

Abstract

The objective of this paper is to evaluate national trends, socioeconomic risk factors, and maternal and obstetric outcomes for patients with and without opioid use disorder (OUD) at delivery hospitalization. This is a retrospective cohort using the National Inpatient Sample 2012-2016 of 3,554,477 deliveries to analyze trends in OUD in patients at delivery hospitalization. We conducted univariable and multivariable logistic regression to compare clinical, demographic, hospital, and geographic associations for patients with OUD during delivery hospitalization. The incidence of OUD at delivery hospitalization increased from 4.48 per 1000 deliveries in 2012 to 7.67 in 2016. The highest rate of OUD was in the Northeast and the lowest in the West (9.29 vs. 4.13 per 1000, respectively, p < .001). After adjusting for confounders, history of concurrent cocaine use (adjusted odds ratio [aOR] = 5.95, 95% confidence interval [CI]: 5.38-6.59), sedative use (aOR = 17.28, 95% CI: 14.71-20.31), and amphetamine use (aOR = 4.05, 95% CI: 3.71-4.43), were strongly associated with OUD. Additionally, hepatitis C infection, (aOR = 21.98, 95% CI: 20.89-23.11), white race (aOR = 3.12, 95% CI: 3.00-3.24), and public insurance (aOR = 3.92, 95% CI: 3.77-4.08) were also associated with OUD. The continued increase in rates of OUD at delivery hospitalization and its association with adverse perinatal outcomes highlights the need for universal screening and resource allocation for programs directed toward pregnant people. Our study builds upon the prior literature that reports trends in OUD at delivery hospitalization from 1998 to 2011 as well as presents a more in-depth look at risk factors and adverse pregnancy outcomes than previously reported.