tetano
Editor, Senior Moderator
Am J Obstet Gynecol
. 2021 Jun 8;S0002-9378(21)00635-9.
doi: 10.1016/j.ajog.2021.06.004. Online ahead of print.
Differences in coronavirus disease 2019 screening, diagnosis, and hospitalization rates among U.S. pregnant women with and without a substance use disorder
Yitong Alice Gao[SUP] 1 [/SUP], Marian P Jarlenski[SUP] 2 [/SUP], Qingwen Chen[SUP] 2 [/SUP], Elizabeth E Krans[SUP] 3 [/SUP]
Affiliations
Abstract
Objective: Pregnant women are at increased risk for severe morbidity and mortality due to respiratory infections like SARS-CoV-2 (COVID-19) during pregnancy[SUP]1[/SUP]. Those with substance use disorders (SUD) may be especially vulnerable due to high rates of smoked tobacco, cannabis and methamphetamine use which adversely affect pulmonary function.[SUP]2[/SUP] However, little is known about differential effects of COVID-19 on pregnant women with and without SUD.
Study design: This was a retrospective cohort study of commercially insured pregnant women ages 15-44 using national administrative healthcare data from Optum's deidentified Clinformatics® Data Mart Database version 8.1 (2007-2020). Women with a delivery hospitalization between January 1, 2020-August 19, 2020 continuously enrolled in insurance for ≥8 weeks during pregnancy and 6 weeks postpartum were included. SUD was defined using ICD-10 diagnoses for ≥ 1 SUD during pregnancy including alcohol, amphetamine, cannabis, cocaine, opioid or other substance use disorder.[SUP]3[/SUP] COVID-19 screening and diagnosis were defined using ICD-10 coding and reporting guidelines published by the CDC.[SUP]4, 5[/SUP] We used T-tests, Fisher's exact tests, and quantile regression (percentiles) to examine statistical differences. This study was exempt by the University of Pittsburgh IRB because deidentified healthcare data were used.
Results: Among 65,009 pregnancies, 2,616 (4.0%) had ≥1 SUD diagnosis. Almost half of the pregnant women in the cohort were non-Hispanic White (48%) and most lived in the South (41%) or the Midwest (28%) region of the United States (Table). Pregnant women with an SUD diagnosis were significantly more likely to be younger (30±6 vs 32±5; p<.05). Compared with the overall sample, non-Hispanic Black (10% vs 7%; p,.05) and non-Hispanic White (54% vs 48%; p<.05) women were overrepresented among those with SUD as opposed to Hispanic and non-Hispanic Asian women. Overall, 27% of pregnant women were screened and evaluated for COVID-19 during pregnancy or postpartum. Women without an SUD diagnosis were significantly more likely to be screened for COVID-19 during pregnancy (27% vs 24%; p<0.001) than those with an SUD. Overall, 3.4% of pregnant women were diagnosed with COVID-19, mostly (86%) in the third trimester. The prevalence of a COVID-19 diagnosis was higher among those with a SUD compared to those without an SUD (5% vs 3%; p<0.05). Further, there was a higher percentage of COVID-19 related hospitalizations among pregnant women with an SUD (36%) than those without an SUD (8%) (p<0.001). The median length of stay was one day longer among those with a SUD (3 vs 2 days; p<0.01) compared to those without an SUD. There were no COVID-19 related deaths reported during pregnancy or postpartum.
Conclusion: In this national cohort, pregnant women with a SUD had a higher COVID-19 diagnosis rate than those without a SUD, despite lower screening rates. Among those with a COVID-19 diagnosis, pregnant women with a SUD had a significantly higher rate of COVID-19 related hospitalizations and longer median length of stay than those without a SUD. Efforts to improve COVID-19 screening rates and decrease morbidity associated with COVID-19 diagnosis among pregnant women with SUDs may be warranted.
. 2021 Jun 8;S0002-9378(21)00635-9.
doi: 10.1016/j.ajog.2021.06.004. Online ahead of print.
Differences in coronavirus disease 2019 screening, diagnosis, and hospitalization rates among U.S. pregnant women with and without a substance use disorder
Yitong Alice Gao[SUP] 1 [/SUP], Marian P Jarlenski[SUP] 2 [/SUP], Qingwen Chen[SUP] 2 [/SUP], Elizabeth E Krans[SUP] 3 [/SUP]
Affiliations
- PMID: 34116037
- PMCID: PMC8184873
- DOI: 10.1016/j.ajog.2021.06.004
Abstract
Objective: Pregnant women are at increased risk for severe morbidity and mortality due to respiratory infections like SARS-CoV-2 (COVID-19) during pregnancy[SUP]1[/SUP]. Those with substance use disorders (SUD) may be especially vulnerable due to high rates of smoked tobacco, cannabis and methamphetamine use which adversely affect pulmonary function.[SUP]2[/SUP] However, little is known about differential effects of COVID-19 on pregnant women with and without SUD.
Study design: This was a retrospective cohort study of commercially insured pregnant women ages 15-44 using national administrative healthcare data from Optum's deidentified Clinformatics® Data Mart Database version 8.1 (2007-2020). Women with a delivery hospitalization between January 1, 2020-August 19, 2020 continuously enrolled in insurance for ≥8 weeks during pregnancy and 6 weeks postpartum were included. SUD was defined using ICD-10 diagnoses for ≥ 1 SUD during pregnancy including alcohol, amphetamine, cannabis, cocaine, opioid or other substance use disorder.[SUP]3[/SUP] COVID-19 screening and diagnosis were defined using ICD-10 coding and reporting guidelines published by the CDC.[SUP]4, 5[/SUP] We used T-tests, Fisher's exact tests, and quantile regression (percentiles) to examine statistical differences. This study was exempt by the University of Pittsburgh IRB because deidentified healthcare data were used.
Results: Among 65,009 pregnancies, 2,616 (4.0%) had ≥1 SUD diagnosis. Almost half of the pregnant women in the cohort were non-Hispanic White (48%) and most lived in the South (41%) or the Midwest (28%) region of the United States (Table). Pregnant women with an SUD diagnosis were significantly more likely to be younger (30±6 vs 32±5; p<.05). Compared with the overall sample, non-Hispanic Black (10% vs 7%; p,.05) and non-Hispanic White (54% vs 48%; p<.05) women were overrepresented among those with SUD as opposed to Hispanic and non-Hispanic Asian women. Overall, 27% of pregnant women were screened and evaluated for COVID-19 during pregnancy or postpartum. Women without an SUD diagnosis were significantly more likely to be screened for COVID-19 during pregnancy (27% vs 24%; p<0.001) than those with an SUD. Overall, 3.4% of pregnant women were diagnosed with COVID-19, mostly (86%) in the third trimester. The prevalence of a COVID-19 diagnosis was higher among those with a SUD compared to those without an SUD (5% vs 3%; p<0.05). Further, there was a higher percentage of COVID-19 related hospitalizations among pregnant women with an SUD (36%) than those without an SUD (8%) (p<0.001). The median length of stay was one day longer among those with a SUD (3 vs 2 days; p<0.01) compared to those without an SUD. There were no COVID-19 related deaths reported during pregnancy or postpartum.
Conclusion: In this national cohort, pregnant women with a SUD had a higher COVID-19 diagnosis rate than those without a SUD, despite lower screening rates. Among those with a COVID-19 diagnosis, pregnant women with a SUD had a significantly higher rate of COVID-19 related hospitalizations and longer median length of stay than those without a SUD. Efforts to improve COVID-19 screening rates and decrease morbidity associated with COVID-19 diagnosis among pregnant women with SUDs may be warranted.