(75) Impact of Opioid and Stimulant Co-Use on Perinatal Outcomes

Background & Introduction: The rise of the opioid epidemic has coincided with an increase in stimulant use among people with opioid use disorder (OUD). In the non-obstetric population, concurrent use of opioids and stimulants increases the risk for overdose, hospitalizations, and poor response to substance use treatment. Despite the public health relevance, there is limited safety data on opioid and stimulant co-use in pregnancy. The goal of this study is to assess the impact of opioid and stimulant co-use in pregnancy on maternal and neonatal outcomes.

Methods: This is a retrospective cohort using California linked vital statistics-hospital discharge data from 2008-2019. We included pregnant patients with opioid use and singleton, non-anomalous gestations between gestational ages of 23-42 weeks. Patients were categorized into either only opioid use or using both opioid and stimulants (cocaine or amphetamine). Opioid- and stimulant-related diagnosis were identified using ICD-9 and ICD-10 codes from hospital discharge data. Chi-squared and multivariable Poisson regression were utilized to examine risk of adverse perinatal outcomes among patients with co-use and patients with only opioid use.

Results: A total of 8,795 pregnant patients with opioid use were included, of which 1,935 (22%) had co-use with opioids and stimulants. Compared to patients with only opioid use, co-use had a higher risk of preeclampsia (aRR 1.61; 95% CI: 1.33, 1.96), placental abruption (aRR 1.81, 95% CI 1.39, 2.34), cardiovascular composite (aRR 1.60, 95% CI 1.06, 2.42) and severe maternal morbidity (aRR 1.71, 95% CI 1.33, 2.20). Neonates with in-utero exposure to co-use had higher risk of preterm birth < 37 weeks (aRR 1.41. 95% CI 1.27, 1.56) and respiratory distress syndrome (aRR 1.25, 95% CI 1.07, 1.46) as compared to neonates of patients with opioid use.

Conclusion & Discussion: Compared to opioid use alone, there is a higher risk of adverse perinatal outcomes with combined stimulant co-exposure. Our results impact provider counseling and patient knowledge on polysubstance use. The strengths of this study include the large sample size and diverse state-level data. Although necessary to identify cases, the use of ICD codes for drug-related diagnoses is a limitation, leading to ascertainment bias. To our knowledge, this is the first study to examine the impact of prenatal opioid and stimulant co-use on maternal and neonatal outcomes.

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