Emergency Department Utilization for Substance Use Disorder During Pregnancy and Postpartum in the United States (2006–2016)



      We aimed to better understand emergency department (ED) use, admission patterns, and demographics for substance use disorder in pregnancy and postpartum (SUDPP).


      In this longitudinal study, the United States Nationwide Emergency Department Sample was queried for all ED visits by 15- to 50-year-old women with a primary diagnosis defined by International Classification of Diseases, 9th or 10th edition Clinical Modification, codes of SUDPP between 2006 and 2016. Patterns of ED visit counts, rates, admissions, and ED charges were analyzed.


      Annual national estimated ED visits for SUDPP increased from 2,919 to 9,497 between 2006 and 2016 (a 12.4% annual average percentage change), whereas admission rates decreased (from 41.9% to 32.0%). ED visits were more frequent among women who were 20–29 years old, using Medicaid insurance, in the lowest income quartile, living in the South, and in metropolitan areas. Compared with the proportion of ED visits, 15- to 19-year-olds had significantly lower admission rates, whereas women with Medicaid and in the lowest income quartile had higher admission rates (p < .001). Opioid use, tobacco use, and mental health disorders were most commonly associated with SUDPP. The ED average inflation-adjusted charges for SUDPP increased from $1,486 to $3,085 between 2006 and 2016 (7.1% annual average percentage change; p < .001), yielding total annual charges of $4.02 million and $28.53 million.


      Despite the decrease in admissions, the number and charges for ED visits for SUDPP increased substantially between 2006 and 2016. These increasing numbers suggest a continuous need to implement preventive public health measures and provide adequate outpatient care for this condition in this population specifically.
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      Emma Giuliani, MD, is a Reproductive Endocrinology and Infertility specialist. Some of her special interests include fertility preservation as it relates to oncology patients, recurrent pregnancy loss, and endometriosis.


      Courtney D. Townsel, MD, MSc, is a board-certified Maternal Fetal Medicine specialist. Her research interests include health disparities, substance use disorders in pregnancy, and translational research. She is currently investigating the placental epigenome in opioid exposed fetuses.


      Li Jiang, MS, is a high-level analyst who supports statistical analysis throughout the Obstetrics and Gynecology Department.


      Dayna J. Leplatte-Ogini, MD, is board certified in General Psychiatry and Child/Adolescent Psychiatry. She works in the child/adolescent outpatient clinic and provides psychiatric consultation. She is the Assistant Director of Medical Student Education for the Department of Psychiatry.


      Martina T. Caldwell, MD, is an Emergency Medicine physician and is the Medical Director of Diversity & Inclusion for Henry Ford Medical Group. Her research focuses on ED interventions to improve reproductive health equity using community-based participatory research, mixed methods, and implementation science.


      Erica E. Marsh, MD, MSCI, is a Professor and Chief of the Division of Reproductive Endocrinology and Infertility. She leads several NIH studies investigating reproductive issues in underrepresented populations and is very interested in use of the emergency department for women’s health issues.