Psychiatric illness increases maternal morbidity in women with opioid use disorder
Pregnant women with opioid use disorder who had a psychiatric diagnosis were more likely to experience adverse maternal outcomes than those without a diagnosis, researchers reported.
“Opioid use in pregnancy has increased dramatically in recent years and has been linked to many adverse maternal and neonatal outcomes,” Nikita Patel, a second-year medical student at the University of Pittsburgh School of Medicine, told Healio. “Pregnant patients with opioid use disorder (OUD) often have additional psychiatric diagnoses, with depression and anxiety being among the most common. However, this cohort of patients is understudied, and little data exists examining the effects of psychiatric diagnoses on pregnancy outcomes in patients with opioid use disorder.”
Patel and colleagues retrospectively reviewed the charts of 319 pregnant patients with OUD who were admitted from 2011 to 2018. They stratified patients by self-reported psychiatric diagnosis and compared outcomes between patients who reported a diagnosis (56.1%) with those who did not.
In the study, maternal morbidity was a composite of ICU admission, intubation, peripartum hemorrhage, readmission for complications after birth, unexpected reoperation and death. For neonates, composite morbidity included preterm birth before 34 weeks’ gestation, respiratory distress syndrome, pulmonary hypertension, congenital anomaly, being born small for gestational age and stillbirth after 20 weeks’ gestation.
Results of the study, presented at the Society for Reproductive Investigation Annual Meeting, showed that among the 60% patients who reported a psychiatric diagnosis, 51% had more than one diagnosis, 68.9% had depression, 61% had anxiety, 26% had bipolar disorder and 6% had psychotic disorder.
“Despite the overlap in psychiatric diagnosis and OUD in pregnancy, only 42% of patients had psychiatric evaluation during their hospital stay,” Patel said.”
Mothers with a psychiatric diagnosis were significantly more likely to have composite maternal morbidity than those without a diagnosis (14% vs. 5.5%; P = .02). According to the researchers, patients with and without comorbid psychiatric diagnoses showed no significant differences in age, multiparity, medical comorbidities, tobacco use, readmission for substance abuse, IV drug-associated infection and insufficient prenatal care — defined as having fewer than four prenatal visits.
Additionally, regarding neonatal characteristics, there were no significant differences in birth weight, neonatal length of admission, neonatal abstinence syndrome or composite neonatal morbidity.
Patel suggested future research should use a prospective cohort to evaluate “the effect of psychiatric consultation or ongoing care and morbidity in this high-risk population.
“Additionally, we would be interested in a quality improvement study looking at missed opportunities and maternal morbidity after the incorporation of psychiatry into a multidisciplinary team to care for these women,” Patel said.