Abstract 4370995: The Combined Impact of Substance Use and Psychological Disturbances on Adverse Pregnancy Outcomes – A Propensity-Score Matched Analysis

Introduction: Substance use disorder (SUD) in pregnancy is associated with co-occurring psychological health conditions, and both are independently linked to an increased risk of adverse pregnancy outcomes (APOs). Previous studies have evaluated their effects on APOs in isolation, with limited research examining their combined effects. Research Question: What is the impact of SUD on APOs (hypertensive disorders of pregnancy, preterm delivery, fetal growth restriction, abruptio placentae, and gestational diabetes mellitus) among hospitalized pregnant women with psychological health conditions? Methods: Using ICD-10 codes for diagnoses and procedures, along with the National Inpatient Sample (NIS) data from 2016 to 2022, we identified the population hospitalized for pregnancy and delivery as well as those with a history of psychological disturbances (major depressive disorder, anxiety disorder, bipolar disorder, post-traumatic stress disorder, and adverse childhood experiences), and SUD (amphetamine/methamphetamine, cocaine, opioid, cannabis, or alcohol use disorder). Propensity scores for SUD were estimated using logistic regression based on sociodemographic and clinical variables. One-to-one greedy matching was used to create a balanced cohort. Logistic regression was then conducted on the matched sample to estimate odds ratios for APOs, comparing those with SUD to those without SUD. Results: There was a total of 1,154,465 weighted pregnancy and delivery-related hospitalizations with psychological concerns. After propensity score matching, 86,725 weighted pregnancy and delivery-related hospitalizations with SUD were matched with 89,460 hospitalizations without SUD. Compared to the group without SUD, the SUD group was associated with higher odds of all APOs OR: 1.21 (95% C.I.: 1.18 - 1.23), hypertensive disorders of pregnancy OR: 1.17 (95% C.I.: 1.14 - 1.20), preterm delivery OR: 1.57 (95% C.I.: 1.51 - 1.63), fetal growth restriction OR: 1.45 (95% C.I.: 1.40 - 1.51), and abruptio placenta OR: 1.79 (95% C.I.: 1.68 - 1.90) but not for gestational diabetes mellitus OR: 0.62 (95% C.I.: 0.59 - 0.64). Conclusions: SUD was associated with higher odds of all APOs except for gestational diabetes among pregnant patients with psychological health conditions. These patients may benefit from tailored interventions and support beyond routine screening. Further research is needed to evaluate the risk interactions between SUD and psychological conditions on APOs.