(191) Nicotine and Mental Health: Risk of Neonatal Outcomes in Pregnancy

Objective: Maternal mental health and substance use in pregnancy are leading causes of maternal mortality. Nicotine is the most used substance in pregnancy and the prevalence of mental health disorders in pregnancy is rising. In this study, we analyzed the impact of nicotine use and mental health disorders, separately and together, on neonatal outcomes, an understudied area.

Study Design: This retrospective cohort study used California linked vital statistics and hospital discharge data (2008-2020). Patients were categorized into nicotine users, mental health disorders, both, or neither. We included singleton gestations delivered between 23-42 weeks and excluded individuals using other substances. Exposure (mental health disorders) and outcomes were identified using birth certificate and ICD-9/10 codes. Results were analyzed by chi-square tests and multivariable Poisson regression models. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated.

Results: 5,466,352 pregnant individuals were included, of whom 1.6% (89,278) had a nicotine-use diagnosis, 2.9% (161,590) had a mental health disorder, and 0.2% (9,722) had both in pregnancy. The impact of nicotine-use and mental health disorders (0.5%; aRR=3.35 (2.51-4.46)) had an additive effect compared to either nicotine use (0.3%; aRR=1.98 (1.74-2.25)) or mental health disorders (0.1%; aRR=1.26 (1.09-1.45)) on post-neonatal deaths. Compared to no nicotine use or mental health disorders, the risk of NICU admissions was higher with both nicotine-use and mental health disorders (16.8%; aRR=1.50 (1.44-1.57)), nicotine use (10.0%; aRR=1.28 (1.26-1.31)) and mental health disorders (11.2%; aRR=1.12 (1.10-1.14)). Similarly, the risk of infant deaths and preterm delivery was significantly higher in individuals with both nicotine use and mental health disorders.

Conclusion: The risk of infant and post neonatal death, and neonatal morbidity is significantly higher in individuals with mental health disorders that use nicotine. This patient population will benefit from nicotine cessation counseling.