The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts
The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts
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DOI：
10.1007/s10995-016-2190-y
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发表时间：
2017-04-01
影响因子：
2.3
通讯作者：
Bernstein, Judith
中科院分区：
文献类型：
--
作者：
Kotelchuck, Milton;Cheng, Erika R.;Bernstein, Judith
目的尽管物质使用障碍（SUD）对妇女、儿童和社会的负面影响广为人知，但对围产期SUD和SUD治疗的人群患病率和影响的了解有限。方法从2003 - 2007年马萨诸塞州375，851例单胎分娩的人群数据中提取母婴相关的全州生命统计数据集，出院（包括急诊室（艾德）访视）和SUD治疗记录。母亲SUD和SUD治疗确定从1年前的概念，通过交付。我们确定（1）SUD和SUD治疗的患病率;（2）SUD与妇女围产期保健服务利用，产科经验和出生结局的相关性;（3）SUD治疗与出生结局的相关性，使用双变量和调整分析。结果2003 - 2007年马萨诸塞州5.5%的分娩发生在SUD母亲中，但只有66%的母亲在分娩前接受了SUD治疗。SUD的妇女更贫穷，受教育程度更低，有更多的健康问题;利用较少的产前护理，但更多的产前艾德访问和住院，并有更糟糕的产科和分娩结果。在校正分析中，SUD与早产（AOR 1.35，95% CI 1.28 - 1.41）和低出生体重（LBW）（AOR 1.73，95% CI 1.64 - 1.82）风险较高相关。接受SUD治疗的女性早产（AOR 0.61，95% CI 0.55 - 0.68）和LBW（AOR 0.54，95% CI 0.49 - 0.61）的几率较低。实践SUD治疗的结论可以改善围产期结果与SUD孕妇，但许多谁需要治疗不接受it.Longitudinally连接现有的公共卫生和项目记录提供了机会，国家监测SUD识别和治疗。
Objectives Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003-2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from 1-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women's perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Results 5.5% of Massachusetts's deliveries between 2003 and 2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28-1.41) and low birth weight (LBW) (AOR 1.73, 95% CI 1.64-1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95% CI 0.55-0.68) and LBW (AOR 0.54, 95% CI 0.49-0.61). Conclusions for Practice SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don't receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.