(89) Risk Factors of Severe Maternal Morbidity in Individuals with Methamphetamine Use

Background & Introduction: Prevalence of prenatal methamphetamine use has been steadily increasing, with rising rates of stimulant-related fatal overdoses and other adverse perinatal outcomes. Previous literature has illustrated that use of methamphetamines in pregnancy is associated with poor obstetric outcomes, including hypertensive disorders, NICU admission, and infant demise. However, there is overall limited data in this area and even less understanding of the risk factors that further contribute to these outcomes. Given that little is understood about the risk factors of severe maternal morbidity (SMM) as it relates to stimulant use, our objective was to further understand factors that lead to non-transfusion SMM in this population.

Methods: This secondary data analysis used California-linked vital statistics and hospital discharge data from 2008-2020. We included singleton, live born, non-anomalous births between 23-42 weeks gestational age among individuals with methamphetamine use. We used the CDC definition of SMM and identified adverse outcomes by ICD-9/ICD-10 codes. Given the uneven prevalence of blood transfusion in SMM as a composite outcome, we chose to examine non-transfusion SMM to evaluate more uncommon, impactful outcomes. We performed Chi-squared and multivariable logistic regression for statistical analysis.

Results: There were 23,180 births with an amphetamine-related diagnosis, of which 431 (1.86%) had non-transfusion SMM. Regarding sociodemographic factors, patients with and without non-transfusion SMM were significantly different by educational attainment, prenatal care attendance, and hospital location at delivery. Regarding medical co-morbidities, chronic hypertension (aOR 3.36, 95% CI: 2.54, 4.44), co-occurring opioid use (aOR 1.48, 95% CI: 1.03, 2.14), elevated BMI (aOR 1.62, 95% CI: 1.24, 2.11), and advanced maternal age at 35 years or older (aOR 1.95, 95% CI: 1.53, 2.49) were significantly associated with non-transfusion SMM. Delivery characteristics associated with non-transfusion SMM included preterm birth (aOR 2.99, 95% CI: 2.39, 3.76) and induction of labor (aOR 1.44, 95% CI 1.10, 1.88).

Conclusion & Discussion: While prior research has illustrated the impacts of methamphetamine use in pregnancy, our study helps better define these impacts and multiple associated risk factors for non-transfusion SMM. Our findings can help inform interventions to mitigate maternal morbidity and improve pregnancy outcomes to achieve health equity in people with substance use in pregnancy.

References: Hayer, S., Garg, B., Wallace, J., Prewitt, K. C., Lo, J. O., & Caughey, A. B. (2024). Prenatal methamphetamine use increases risk of adverse maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, 231(3), 356.e1-356.e15. https://doi.org/10.1016/j.ajog.2024.05.033
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