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A new study by Michigan Medicine reveals that the use of amphetamines and opioids during pregnancy has increased dramatically over the last decade in the United States. And a disproportionate increase has occurred in rural counties.
According to a new study, the number of births affected by amphetamines (mainly attributable to methamphetamine) doubled in pregnant women across the country: from 1.2 per 1,000 in 2008-2009 to 2.4 out of 1,000 after childbirth for the purpose of delivery.
The rate of opioid use also quadrupled, from 1.5 per 1,000 hospitalizations for delivery in 2004-2005 to 6.5 per 1,000 hospitalizations for delivery in 2014-2015, according to published findings. in the report. American Journal of Public Health. The study sample included approximately 47 million deliveries to US hospitals over the 12-year period.
For pregnant women consuming amphetamine, the risk of serious maternal morbidity and mortality was 1.6 times higher than the rate identified in mothers consuming opioids. The incidence of premature labor, preeclampsia or eclampsia, heart failure or heart attack and the need for a blood transfusion was also higher among the deliveries of mothers consuming amphetamine as opioids.
"Our previous research on maternal health disparities has revealed disproportionately higher rates of substance-affected births in rural communities," said lead author Lindsay Admon, MD, M.Sc., an obstetrician. Gynecologist at the University of Michigan, Von Voigtlander Women's Hospital and graduate of the National Clinician Scholars Program from the UM Institute for Health Policy and Innovation.
"When we examined the specific types of substances at the root of this disparity, we were surprised to find that the use of amphetamine accounted for such an important part," Admon adds, noting that little or no studies have examined the incidence of the use of amphetamine during pregnancy. in the last decade.
"Our findings suggest that amphetamine and opioid use is a growing public health crisis affecting the outcomes of childbirth and childbirth."
Admon, lead author of the study, Tyler Winkelman, MD, M.Sc., and colleagues recently examined 1.3 million amphetamine-related hospitalizations in the general adult population . They discovered that in 2015, amphetamine-related hospitalizations were badociated with a higher risk of hospitalization. mortality and accounted for $ 2.2 billion in hospitalization costs.
Geography influences health and recovery
In the ten years that lasted the study, approximately 82,254 postpartum hospitalizations included one or more diagnoses of amphetamine use and 170,164 one or more diagnoses of opioid consumption.
In 2014-2015, amphetamine use had complicated about 1% of deliveries in the rural West (11.2 per 1,000 hospital deliveries), which was higher than the average for women. incidence of opioid use by mothers in most areas. The highest incidence of opioid use by the mother was identified in rural northeastern, complicating nearly 3% of deliveries (28.7 per 1,000 deliveries at the time of birth). ;hospital).
Higher proportions of patients in both substance abuse groups were non-Hispanic whites, from low-income communities and benefiting from public insurance compared to other hospital deliveries.
"It has been shown that early and adequate access to prenatal care for drug-addicted women improves the outcome of childbirth," Admon said. "However, geographic disparities have a major impact on the health and well-being of pregnant women and infants.Access to obstetric care is a major obstacle in many rural communities, especially for women who are addicts. "
Barriers to treatment
Determining a specific treatment for prenatal use of amphetamine is also a challenge.
Although there is a medical reference treatment for the use of opioids by the mother, indicates Admon, evidence of a treatment of the disorder of the use of the drug. amphetamine in pregnant women are limited. Cessation is badociated with better birth outcomes, but obstetricians may be able to use more tips on how to promote cessation in their patients.
The federal government's efforts to limit access to the precursors used in the manufacture of methamphetamine in the mid-2000s have reduced the overall use of amphetamine, Admon says. But as new methods were used to make the drug, the use of methamphetamine increased again.
Rural areas have the dual benefit of having better access to amphetamines but less access to drug treatment services. Laws that criminalize substance use during pregnancy can discourage women from disclosing their problem to their health care provider.
Neonatal intensive care units in rural counties may also lack the capacity to care for babies born with neonatal abstinence syndrome, which describe the health problems that a baby experiences when desists from narcotics.
"We have seen a significant increase in the number of infants with withdrawal symptoms," says Winkelman of Hennepin Healthcare in Minneapolis and a graduate of the IHPI U-M National Clinician Scholars Program.
"We need to devote more resources to the prevention and treatment of substance abuse during pregnancy, particularly in low-income rural communities."
According to another study by Winkelman and colleagues, neonatal abstinence syndrome accounted for $ 3 billion in hospital costs between 2004 and 2014.
More intervention needed
The new U-M-led study follows previous research from Admon, which revealed that pre-existing chronic health problems in women who gave birth had increased dramatically and were linked to adverse pregnancy outcomes.
Previous work by Admon and his colleagues also examined racial and ethnic disparities in the incidence of behavioral problems, including substance use disorders. Consumption of psychoactive substances was less common among African American and Hispanic women, but, when present, it was badociated with a higher risk of adverse birth than non-Hispanic white women.
"It is essential that health care providers use a universal screening for substance use in early pregnancy," says Admon. "Optimizing access to prenatal care is an essential mechanism for getting women in touch with the services they need for their health and that of their baby."
"We need to find better ways to prevent, detect and treat amphetamine and opioid use in mothers." The development of treatment programs that can reach women in the geographic areas most affected by these diseases. outbreaks is essential to improve outcomes for mothers and newborns. "
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