(76) Association of Substance Use and Perinatal Mood and Anxiety Disorders in Pregnancy

Background & Introduction: Perinatal mood and anxiety disorders (PMAD) and substance use disorders (SUD) are each associated with adverse pregnancy-related outcomes (Chang, 2020; Van Neil, 2022). PMAD and SUD have both independently contributed to maternal suicide and drug overdose becoming the leading causes of maternal mortality (Bruzelius, 2022; Chin, 2022). However, there is a paucity of data on whether PMAD and SUD co-occur in pregnancy (Pentecost, 2021). The purpose of this study is to assess the relationship of co-occurring PMAD and SUD among a population of Medicaid-covered births.

Methods: We conducted a cross sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified SUD and PMAD diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 9/10 codes. We compared rates of SUD by diagnosis of PMAD using chi-square tests.

Results: Out of 184,981 births, 18,967 (10.3%) were identified as having a SUD and 35,427 with a PMAD (19.2%). There were 6,907 (3.7%) births with co-occurring PMAD and SUD. Of all births with a PMAD, 19.4% had a co-occurring SUD. Of those without a diagnosed PMAD, a smaller but substantial portion (8.7%) had a SUD diagnosis. Of those with any substance use disorder, 25.3% had opioid use disorder. In those with PMAD and substance use disorder, 31.9% had opioid use disorder.

Conclusion & Discussion: Although SUD is more prevalent in patients with PMAD, there are also a substantial number of patients with SUD who do not have a co-occurring diagnosis of a PMAD. Our study demonstrates the importance of screening for substance use in pregnancy, regardless of maternal mental health diagnoses. Because Medicaid patients are less likely than privately insured patients to be screened for mental health needs (Sidebottom, 2021), our study most likely presents the lower bounds of PMAD detection in patients with SUD, emphasizing the need for robust SUD and mental health screening in pregnancy. Strengths of this study include its large, diverse population. Further research is needed on the impact of co-occurring diagnoses on perinatal outcomes and on developing effective interventions to address the intersection in addiction and mental health care in this high-risk and under-studied population.

References: Bruzelius E, Martins SS. US Trends in Drug Overdose Mortality Among Pregnant and Postpartum Persons, 2017-2020. JAMA. 2022 Dec 6;328(21):2159-2161.

Chang G. Maternal Substance Use: Consequences, Identification, and Interventions. Alcohol Res. 2020 Jun 30;40(2):06. 

Pentecost R, Latendresse G, Smid M. Scoping Review of the Associations Between Perinatal Substance Use and Perinatal Depression and Anxiety. J Obstet Gynecol Neonatal Nurs. 2021 Jul;50(4):382-391.

Sidebottom A, Vacquier M, LaRusso E, Erickson D, Hardeman R. Perinatal depression screening practices in a large health system: identifying current state and assessing opportunities to provide more equitable care. Arch Womens Ment Health. 2021 Feb;24(1):133-144.

Van Niel MS, Payne JL. Perinatal depression: A review. Cleve Clin J Med. 2020 May;87(5):273-277.