Polysubstance use in pregnancy: Findings from a population-based cross-sectional cohort study of pregnant women with opioid use.

PURPOSE: Prior work suggests that pregnant women with opioid use may be especially likely to use multiple substances. Given the risks of substance use and polysubstance use during pregnancy, this study explored rates and covariates of polysubstance use in women with and without opioid use during pregnancy.

PROCEDURES: We conducted a population-based cross-sectional cohort study of pregnancies delivering at or after 35 weeks' gestation in 15 Kaiser Permanente Northern California (KPNC) hospitals. Among 369,199 women delivering past 35 weeks' gestation between 2010 and 2019, we extracted data on substance use, lifetime psychiatric diagnoses, diagnoses of opioid use disorder (OUD) and depression, and sociodemographic characteristics FINDINGS: Compared to women without opioid use during pregnancy (n = 361,144), those with opioid use during pregnancy (n = 8055) were significantly more likely to use all other classes of substances (p < 0.001) and significantly more likely to have lifetime and maternal depression diagnoses (p < 0.001). Additionally, those with opioid use during pregnancy had significantly higher neighborhood deprivation index scores, were significantly more likely to be insured by Medicare or Medicaid, had lower educational attainment, and were more likely to identify as Black (p < 0.001). Comparisons by opioid use type suggest that those with heroin use had heavier patterns of polysubstance use compared to those with methadone, buprenorphine or prescribed opioid medication use (p < 0.001).

CONCLUSIONS

Findings shed light on the prevalence of polysubstance use among pregnant women with opioid use (15.5 % used cannabis, 9.3 % used tobacco, 5.2 % used benzodiazepines, 2.8 % used methamphetamines, 1.6 % used barbiturates and 1.0 % used cocaine), and highlight key differences in drug exposure between pregnant women with prescribed opioid use versus MOUD use versus heroin use (namely lower rates of polysubstance use among pregnant women with MOUD exposure compared to those with heroin use). Together, findings support a potentially protective role of methadone and buprenorphine for this population with regards to polysubstance use, and a need for more integrated psychiatric care among this population.