The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts

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

Smoking among pregnant women with disabilities

PURPOSE: The purpose of this study was to examine the prevalence of smoking before, during, and after pregnancy among a representative sample of Massachusetts women with and without disabilities. METHODS: Data from the 2007 to 2009 Massachusetts Pregnancy Risk Assessment Monitoring System survey were used to estimate the prevalence of smoking by disability status. MAIN FINDINGS: Disability prevalence was 4.8% (n = 204) among Massachusetts women giving birth during 2007 through 2009. The prevalence of smoking during the 3 months before pregnancy among women with disabilities was 37.3% (95% CI, 28.3-47.2%) compared with 18.3% (95% CI, 16.6-20.1%) among women without disabilities. Similarly, 25.2% (95% CI, 17.3-35.2%) of women with disabilities, compared with 9.4% of women without disabilities (95% CI, 8.1-10.8%), smoked during the last trimester of their pregnancy, and 32.1% of women with disabilities (95% CI, 23.5-42.1%) compared with 12.5% of women without disabilities (95% CI, 11.1-14.1%), smoked after pregnancy. In the multivariate logistic regression models, women with disabilities had significantly higher risks of smoking before, during and after pregnancy than women without disabilities (adjusted relative risk [aRR], 1.7 [95% CI, 1.2-2.2]; aRR, 1.9 [95% CI, 1.3-2.8]; aRR, 1.8 [95% CI, 1.3-2.5], respectively) while adjusting for race/Hispanic ethnicity, marital status, education, age, household poverty status, and infant\u27s birth year. IMPLICATIONS: Women with disabilities are more likely to smoke before, during, and after their pregnancy and less likely to quit smoking during pregnancy. Efforts to integrate and target pregnant women with disabilities in smoking-cessation programs are vital

Autism Spectrum Disorders and Assisted Reproductive Technology: Massachusetts 2004-2010 Population-based Results from Data Linkage Efforts

ABSTRACT Objectives The etiology of autism spectrum disorders (ASD) is unknown. The impact, if any, of assisted reproductive technology (ART) on ASD has not been established. The study compares the prevalence of children 0-3 years with ASD conceived by mothers with infertility through ART (ART), mothers with infertility but not using ART (SUBFERT), and mothers without infertility spontaneously conceiving (FERTILE) – separately among singletons and twins. The importance of linked population-based data systems to this analysis will be highlighted. Approach This analysis requires linkage of three distinct data systems: the Society of Assisted Reproductive Technology Clinical Outcomes Reporting System (SART-CORS) clinical database; the Massachusetts Pregnancy to Early Life Longitudinal (PELL) public health data system (which includes birth certificate and hospital discharge data); and the Massachusetts’ children’s special needs Early Intervention (EI) program data. PELL data from 7/1/04-12/31/10 included 370,755 women with 474,784 deliveries resulting in 486,075 live births and fetal deaths. These were deterministically linked to 70,086 ART cycles among 28,490 women from SART-CORS; and then further linked to EI program participant data from 7/1/04-12/31/13. ASD was defined as a documented ASD diagnosis (ICD9 codes: 299) in the EI or hospital discharge records and/or claims documentation for autism-related EI specialty services. Chi-square and multivariate regression models estimated the association of ART, SUBFERT and FERTILE with ASD, controlling for maternal demographics, payer source, prenatal care, smoking, parity, delivery method, hypertension, obstetric or gynecologic health conditions, gender, paternal age and prematurity. Results Our final study population consisted of 481,575 children (460,117 singletons and 21,458 twins). Among singletons, the ASD prevalence was 1.7% and 1.3% in the ART and SUBFERT groups, respectively, compared to 1.0% in the FERTILE group. Among twins, the ASD prevalence was 2.3% and 2.4% in the ART and SUBFERT groups, respectively, compared to 2.0% in the FERTILE group. Among singletons, the adjusted odd ratios (aORs) were 1.0 [95% CI: 0.9-1.3] and 1.1 (95% CI: 0.9-1.4) for ART and SUBFERT compared to the FERTILE group. Among multiples, aORs were 1.1 (95% CI: 0.8-1.4) and 1.2 (95% CI: 0.8-1.8) for ART and SUBFERT compared to the FERTILE group. There were no significant differences in ASD prevalence between ART and SUBFERT groups. Conclusions The likelihood of an ASD diagnosis among singleton or twin children born to ART or SUBFERT mothers does not differ from FERTILE mothers. Population-based linkage of clinical and public health databases provides unique opportunities to examine longer-term outcomes of ART

Pregnancy outcomes among women with intellectual and developmental disabilities

BACKGROUND: There is currently no population-based research on the maternal characteristics or birth outcomes of U.S. women with intellectual and developmental disabilities (IDDs). Findings from small-sample studies among non-U.S. women indicate that women with IDDs and their infants are at higher risk of adverse health outcomes. PURPOSE: To describe the maternal characteristics and outcomes among deliveries to women with IDDs and compare them to women with diabetes and the general obstetric population. METHODS: Data from the 1998-2010 Massachusetts Pregnancy to Early Life Longitudinal database were analyzed between November 2013 and May 2014 to identify in-state deliveries to Massachusetts women with IDDs. RESULTS: Of the 916,032 deliveries in Massachusetts between 1998 and 2009, 703 ( \u3c 0.1%) were to women with IDDs. Deliveries to women with IDDs were to those who were younger, less educated, more likely to be black and Hispanic, and less likely to be married. They were less likely to identify the father on the infant\u27s birth certificate, more likely to smoke during pregnancy, and less likely to receive prenatal care during the first trimester compared to deliveries to women in the control groups (p \u3c 0.01). Deliveries to women with IDDs were associated with an increased risk of adverse outcomes, including preterm delivery, very low and low birth weight babies, and low Apgar scores. CONCLUSIONS: Women with IDDs are at a heightened risk for adverse pregnancy outcomes. These findings highlight the need for a systematic investigation of the pregnancy-related risks, complications, costs, and outcomes of women with IDDs. Inc

Prevalence of Adverse Pregnancy Outcomes, by Maternal Diabetes Status at First and Second Deliveries, Massachusetts, 1998–2007

Introduction: Understanding patterns of diabetes prevalence and diabetes-related complications across pregnancies could inform chronic disease prevention efforts. We examined adverse birth outcomes by diabetes status among women with sequential, live singleton deliveries. Methods: We used data from the 1998–2007 Massachusetts Pregnancy to Early Life Longitudinal Data System, a population-based cohort of deliveries. We restricted the sample to sets of parity 1 and 2 deliveries. We created 8 diabetes categories using gestational diabetes mellitus (GDM) and chronic diabetes mellitus (CDM) status for the 2 deliveries. Adverse outcomes included large for gestational age (LGA), macrosomia, preterm birth, and cesarean delivery. We computed prevalence estimates for each outcome by diabetes status. Results: We identified 133,633 women with both parity 1 and 2 deliveries. Compared with women who had no diabetes in either pregnancy, women with GDM or CDM during any pregnancy had increased risk for adverse birth outcomes; the prevalence of adverse outcomes was higher in parity 1 deliveries among women with no diabetes in parity 1 and GDM in parity 2 (for LGA [8.5% vs 15.1%], macrosomia [9.7% vs. 14.9%], cesarean delivery [24.7% vs 31.3%], and preterm birth [7.7% vs 12.9%]); and higher in parity 2 deliveries among those with GDM in parity 1 and no diabetes in parity 2 (for LGA [12.3% vs 18.2%], macrosomia [12.3% vs 17.2%], and cesarean delivery [27.0% vs 37.9%]). Conclusions: Women with GDM during one of 2 sequential pregnancies had elevated risk for adverse outcomes in the unaffected pregnancy, whether the diabetes-affected pregnancy preceded or followed it

Trends and inequities in severe maternal morbidity in Massachusetts: A closer look at the last two decades.

It is estimated that 50,000-60,000 pregnant people in the United States (US) experience severe maternal morbidity (SMM). SMM includes life-threatening conditions, such as acute myocardial infarction, acute renal failure, amniotic fluid embolism, disseminated intravascular coagulation, or sepsis. Prior research has identified both rising rates through 2014 and wide racial disparities in SMM. While reducing maternal death and SMM has been a global goal for the past several decades, limited progress has been made in the US in achieving this goal. Our objectives were to examine SMM trends from 1998-2018 to identify factors contributing to the persistent and rising rates of SMM by race/ethnicity and describe the Black non-Hispanic/White non-Hispanic rate ratio for each SMM condition. We used a population-based data system that links delivery records to their corresponding hospital discharge records to identify SMM rates (excluding transfusion) per 10, 000 deliveries and examined the trends by race/ethnicity. We then conducted stratified analyses separately for Black and White birthing people. While the rates of SMM during the same periods steadily increased for all racial/ethnic groups, Black birthing people experienced the greatest absolute increase compared to any other race/ethnic group going from 69.4 in 1998-2000 to 173.7 per 10,000 deliveries in 2016-2018. In addition, we found that Black birthing people had higher rates for every individual condition compared to White birthing people, with rate ratios ranging from a low of 1.11 for heart failure during surgery to a high of 102.4 for sickle cell anemia. Obesity was not significantly associated with SMM among Black birthing people but was associated with SMM among White birthing people [aRR 1.18 (95% CI: 1.02, 1.36)]. An unbiased understanding of how SMM has affected different race/ethnicity groups is key to improving maternal health and preventing SMM and mortality among Black birthing people. SMM needs to be addressed as both a medical and public health challenge

Severe maternal morbidity^a for Black and White birthing people: Massachusetts, 1998–2018.

aSevere maternal mortality without blood transfusion (SMM20).</p

Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery

Background and aimsOpioid-related overdose is increasingly linked to pregnancy-associated deaths, but factors associated with postpartum overdose are unknown. We aimed to estimate the strength of the association between maternal and infant characteristics and postpartum opioid-related overdose.DesignRetrospective cohort study using a linked, population-level data set.SettingMassachusetts, United States.ConclusionAmong women who delivered live infants in Massachusetts, USA between 2012 and 2014, maternal diagnosis of OUD, prior non-fatal overdose, infant diagnosis of NAS and high unscheduled health-care utilization appeared to be positively associated with postpartum opioid overdose. However, more than half of postpartum overdoses in that period were to women without a diagnosis of OUD. Engagement in methadone or buprenorphine treatment in the month prior to delivery was not sufficient to reduce the odds of postpartum overdose.ParticipantsWomen who delivered one or more live births from 2012 to 2014 (n&nbsp;=&nbsp;174 517).MeasurementsThe primary outcome was opioid-related overdose in the postpartum year. We used multivariable logistic regression to explore the independent associations of maternal (demographics, substance use, pregnancy) and infant [gestational age, birthweight, neonatal abstinence syndrome (NAS)] characteristics with postpartum opioid overdose. Findings were stratified by maternal opioid use disorder (OUD) diagnosis.FindingsThere were 189 deliveries to women who experienced ≥&nbsp;1 opioid overdose in the first year postpartum (11 of 10 000 deliveries). Among women with postpartum opioid overdose, 46.6% had an OUD diagnosis within 12&nbsp;months before delivery. In our adjusted model, maternal diagnosis of OUD [adjusted odds ratio (aOR)&nbsp;=&nbsp;3.61, 95% confidence interval (CI)&nbsp;=&nbsp;1.73-7.51] and prior non-fatal overdose (aOR&nbsp;=&nbsp;2.40, 95% CI&nbsp;=&nbsp;1.11-5.17) were most strongly associated with postpartum overdose. After stratifying by OUD status, infant diagnosis of NAS (OUD+ aOR&nbsp;=&nbsp;2.03, 95% CI&nbsp;=&nbsp;1.26-3.27; OUD- aOR&nbsp;=&nbsp;2.79, 95% CI&nbsp;=&nbsp;1.12-6.93) and high unscheduled health-care utilization (OUD+ aOR&nbsp;=&nbsp;2.27, 95% CI&nbsp;=&nbsp;1.38-3.73; OUD- aOR&nbsp;=&nbsp;2.11, 95% CI&nbsp;=&nbsp;1.24-3.58) were positively associated with postpartum overdose in both groups