Amphetamine and opioid use among pregnant women has increased significantly over the last decade in the United States, particularly in rural counties, according to a new study from the University of Michigan.
The study sample included around 47 million deliveries occurring in U.S. hospitals over a 12-year-period.
The findings, published in the American Journal of Public Health, show that among pregnant women in all parts of the country, opioid-affected births quadrupled from 1.5 per 1,000 delivery hospitalizations in 2004-2005 to 6.5 per 1,000 delivery hospitalizations in 2014-2015.
Amphetamine-affected births (mostly attributed to methamphetamine) doubled, from 1.2 per 1,000 hospitalizations in 2008-2009 to 2.4 per 1,000 delivery hospitalizations by 2014-2015.
Amphetamines are a group of stimulant drugs with psychoactive properties that affect the central nervous system, Methamphetamine, also known as meth/crystal meth, is a stimulant within the amphetamine class.
“It is critical that health providers employ universal screening for substance use early in pregnancy,” said lead author Lindsay Admon, M.D., M.Sc., an obstetrician-gynecologist at University of Michigan (U-M) Von Voigtlander Women’s Hospital. “Optimizing access to prenatal care is a crucial mechanism to connect women with the services they need for their health and their baby’s health.”
“We need to find better ways to prevent, detect, and treat maternal amphetamine and opioid use. Developing treatment programs that can reach women in the geographic areas most affected by these epidemics is key to improving outcomes for mothers and newborns.”
Among amphetamine-affected births, the risk of severe maternal morbidity and mortality was 1.6 times the rate identified among moms with opioid use. The incidence of preterm delivery, pre-eclampsia or eclampsia, heart failure or heart attack, and need for a blood transfusion were also higher among deliveries to moms with amphetamine use compared to opioid use.
“We know from our previous research on maternal health disparities that there are disproportionately higher rates of substance affected births in rural communities,” said Admon.
“When we looked at the specific types of substances driving this disparity, we were surprised to find that amphetamine use accounted for such a significant portion,” she said, noting that few, if any, studies have examined the incidence of amphetamine use in pregnancy in the last decade.
“Our findings suggest both amphetamine and opioid use are growing public health crises that affect delivery and birth outcomes.”
Higher proportions of women in both substance use groups were non-Hispanic white, from lower-income communities, and had public insurance compared to other hospital deliveries.
“Early and adequate access to prenatal care for women with substance use has been shown to improve birth outcomes,” Admon says. “However, geographic disparities have a major impact on the health and well-being of pregnant women and infants. There are significant barriers to obstetric care access in many rural communities, particularly for women with substance use.”
Rural areas have the double whammy of greater access to amphetamines but less access to addiction treatment services. Further complicating the matter are laws that criminalize substance use during pregnancy that may discourage women from disclosing the concern to their health provider.
Neonatal intensive care units in rural counties may also not have adequate capacity to care for babies born with neonatal abstinence syndrome, which describe health problems a baby experiences when withdrawing from exposure to narcotics.
“We have seen a significant increase in infants born with symptoms of drug withdrawal,” says senior author Tyler Winkelman, M.D., M.Sc., of Hennepin Healthcare in Minneapolis and graduate of the National Clinician Scholar’s Program at U-M’s IHPI.
“We need to devote more resources to prevent and treat substance use in pregnancy, especially in low-income and rural communities.”