Association of Substance Use and Psychological Conditions With Adverse Pregnancy Outcomes

BACKGROUND: Evidence is limited on how concurrent substance use (SU) and psychological conditions influence the risk of adverse pregnancy outcomes (APOs). OBJECTIVES: The objective of the study was to explore the association between SU and APOs among hospitalized pregnant women with psychological health conditions. METHODS: A cross-sectional analysis of the National Inpatient Sample (2016-2022) identified pregnant patients hospitalized for delivery with psychological disorders (major depressive disorder, anxiety, bipolar disorder, and post-traumatic stress disorder) and SU (amphetamine/methamphetamine, cocaine, opioid, cannabis, and alcohol). Propensity scores were estimated using stepwise logistic regression, followed by 1:1 greedy matching (0.2 caliper). Logistic regression in the matched cohort estimated ORs for APOs comparing those with and without SU. RESULTS: Among 2,040,635 weighted pregnancy- and delivery-related hospitalizations with psychological conditions, propensity score matching identified 170,745 hospitalizations with SU matched to 170,745 without SU. Compared to the group without SU, the SU group was associated with higher odds of composite APOs, adjusted OR (aOR): 1.20 (95% CI: 1.16-1.24), hypertensive disorders of pregnancy (aOR: 1.14; 95% CI: 1.09-1.18), preterm delivery (aOR: 1.51; 95% CI: 1.43-1.61), fetal growth restriction (aOR: 1.43; 95% CI: 1.35-1.51), and abruptio placenta (aOR: 1.80, 95% CI: 1.63-1.99). We observed lower odds of gestational diabetes mellitus (aOR: 0.61; 95% CI: 0.58-0.65) among the cohort with SU compared to those without. CONCLUSIONS: SU among pregnant women with psychological conditions increased the odds of most APOs (excluding gestational diabetes), highlighting the need for integrated screening and coordinated multidisciplinary care.