Perinatal Substance Use: Ups Risk for Mothers and Babies?
Among individuals with perinatal substance use disorder, the odds of maternal and neonatal morbidity and infant mortality were increased and were influenced by factors such as location, type of substance used, and demographics.
METHODOLOGY:
A retrospective cohort study was conducted in British Columbia, Canada, to assess the link between clinical and sociodemographic factors and maternal and neonatal morbidity and mortality among people with perinatal substance use disorder.
A total of 22,856 individuals with perinatal substance use disorder (median maternal age, 28 years), linked to 27,637 deliveries and 27,774 live births, were identified using data from nine linked health administrative databases from April 2010 to March 2021.
Perinatal substance use disorder was defined by the presence of opioid, alcohol, or other substance use disorders within the period from 12 months before the first pregnancy-related healthcare record to delivery; cannabis use disorder was the most common substance use disorder (60.8%).
Maternal and neonatal morbidity were assessed using admissions to hospitals and emergency departments; outcomes were measured up to 42 days postpartum for mothers and 28 days of age for infants, with 1337 and 4129 cases identified, respectively.
All-cause maternal and infant mortality were recorded within 1 year postpartum, with infant mortality defined as death within 12 months following birth.
TAKEAWAY:
Regional factors were associated with increased morbidity; residing in Vancouver Coastal area increased the odds of maternal morbidity by 35% compared with the provincial average (adjusted odds ratio [aOR], 1.35; P < .01), while residing in Interior or Vancouver Island was associated with 16% and 10% higher odds of neonatal morbidity (aOR, 1.16 and aOR, 1.10; P < .01 for both), respectively.
Opioid use disorder, stimulant use disorder, multifetal pregnancy, and hypertensive disorder during pregnancy were independently associated with higher odds of maternal and neonatal morbidity.
Receiving five or more visits for prenatal care and delivering vaginally were linked to reduced odds of maternal and neonatal morbidity.
The odds of maternal mortality increased by 11% annually (P = .04), with over half of maternal deaths being drug-related (52%). Attending five or more visits for prenatal care was associated with reduced odds of both maternal mortality (aOR, 0.48; P = .04) and infant mortality (aOR, 0.23; P < .01).
IN PRACTICE:
'During heightened drug toxicity and mortality, enhancing PSU [perinatal substance use] care and health surveillance should be prioritized to inform strategies to remove barriers in access to care related to resources, stigma, and lack of understanding of PSU to address health disparities among birthing people who use substances and their infants,' the authors of the study wrote.
SOURCE:
This study was led by Micah Piske, MSc, of the Health Economic Research Unit at the Centre for Advancing Health Outcomes, St. Paul's Hospital in Vancouver, British Columbia, Canada. It was published online on July 10, 2025, in Pediatrics.
LIMITATIONS:
The findings may have been influenced by factors not captured in the analysis. Differences in coding systems for measures of morbidity may have affected the comparability of data. The results may not be generalizable to populations outside of British Columbia.
DISCLOSURES:
This study was supported by the Health Canada Substance Use and Addictions Program. No relevant conflicts of interest were disclosed by the authors.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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