(375) Opioid Use Disorder and Severe Maternal Morbidity

Opioid use disorder (OUD) in pregnancy increased nationally more than four-fold from 1999-2014. OUD has been associated with adverse perinatal outcomes, including preterm labor, growth restriction, and low birth weight. We hypothesize that OUD is likewise associated with severe maternal morbidity (SMM).

Study Design:

We performed a retrospective cohort study of delivery admissions at a large regional health system from May 2018 to April 2023. Patients with multiple delivery admissions were limited to only the first pregnancy.  Those without delivery outcome information and prenatal care in the system were excluded. OUD was defined by ICD-10 code documentation in the electronic medical record. The primary outcome was the Centers for Disease Control-defined SMM. Baseline characteristics were compared via chi-square test or t-test. Outcomes were compared with regression analysis controlling for age, obesity, nulliparity, pre-gestational diabetes, chronic hypertension and public insurance. Secondary outcomes included cesarean delivery, preterm delivery, and low birth weight.

Results:

Among 57,023 deliveries, OUD was diagnosed in 534 (0.9%) patients. OUD was more prevalent among patients with age > 35 years, multiparity, chronic hypertension, and public insurance (Table 1). Obesity was less common among patients with OUD (Table 1). SMM was more common in OUD patients compared to those without the diagnosis (11.6% vs 4.0%); difference persisted when controlling for age, obesity, nulliparity, pre-gestational diabetes, chronic hypertension and public insurance (aOR 3.10, 95% CI 1.84 – 5.21, Figure). OUD was also associated with an increase in cesarean (aOR 1.44, 95% CI 1.03 – 2.02) and low birth weight (aOR 1.61, 1.02 – 2.54). Preterm delivery outcomes did not differ.

Conclusion:

OUD is associated with three-fold increased odds of SMM, as well as increased in cesarean and low birth weight.