BACKGROUND Substance use during pregnancy has increased in the United States, with adverse consequences for mother and baby. Similarly, postpartum readmission (PPR) imposes physical, emotional, and financial stressors causing disruption to family functioning and childcare. We used national data to estimate the extent to which women who used opiates, cocaine, and amphetamines during pregnancy are at increased risk of PPR. METHODS We analyzed 2010-2014 data from the Nationwide Readmissions Database (NRD). Our exposure, drug use during pregnancy, was identified using diagnosis codes indicative of opioid, cocaine or amphetamine use, abuse, or dependence. The outcome was all-cause PPR, maternal readmission within 42 days following discharge from the delivery hospitalization. Multivariable logistic regression was used to estimate odds ratios (OR) that represented associations between drug use and PPR. RESULTS Among 11 million delivery hospitalizations, nearly 1 % had documented use of opiates, cocaine and/or amphetamines. The crude PPR rate was nearly four times higher among users (54.6 per 1000) compared to non-users (14.0 per 1000), and 1 in 10 women who had documented use of more than one drug category experienced postpartum readmission. Even after controlling for sociodemographic and clinical confounders, we observed a two-fold increased odds of PPR among users compared to non-users (OR = 1.95; 95 % CI: 1.82, 2.07). CONCLUSIONS The national opioid epidemic should encourage a paradigm shift in health care public policy to facilitate the management of all substance use disorders as chronic medical conditions through evidence-based public health initiatives to prevent these disorders, treat them, and promote recovery.

中文翻译：

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美国在怀孕期间使用鸦片制剂，可卡因和苯丙胺与母亲产后再入院之间的关联：全国再入院数据库的回顾性分析。

背景技术在美国，怀孕期间的物质使用有所增加，对母亲和婴儿都有不利影响。同样，产后再入院（PPR）施加了身体，情感和经济压力，导致家庭功能和育儿中断。我们使用国家数据来估计在怀孕期间使用鸦片，可卡因和苯丙胺的妇女发生PPR的风险增加的程度。方法我们分析了来自美国全国再入院数据库（NRD）的2010-2014年数据。我们使用指示阿片类药物，可卡因或苯丙胺使用，滥用或依赖的诊断代码确定了我们在怀孕期间的药物使用暴露。结果为全因PPR，即分娩住院后42天内再次入院。多变量逻辑回归用于估计代表药物使用与PPR之间关联的比值比（OR）。结果在1100万例分娩住院中，近1％的人记录了鸦片，可卡因和/或苯丙胺的使用。使用者中的粗略PPR率（每千人中54.6）比非使用者（每千人中14.0）高出将近四倍，并且在记录使用一种以上药物类别的妇女中，十分之一的妇女经历了产后再入院。即使在控制了社会人口统计学和临床​​混杂因素之后，我们仍然观察到与非使用者相比，使用者中PPR的几率增加了两倍（OR = 1.95； 95％CI：1.82，2.07）。