The association between use of opiates, cocaine, and amphetamines during pregnancy and maternal postpartum readmission in the United States: A retrospective analysis of the Nationwide Readmissions Database

Drug Alcohol Depend. 2020 May 1;210:107963. doi: 10.1016/j.drugalcdep.2020.107963. Epub 2020 Mar 20.


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.

Keywords: Amphetamines; Cocaine; Hospital discharge data; Nationwide Readmissions Database; Obstetric comorbidities; Opioids; Postpartum readmission; Pregnancy; Substance use.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Amphetamines / adverse effects*
  • Cocaine / adverse effects*
  • Databases, Factual / trends*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Opiate Alkaloids / adverse effects*
  • Patient Discharge / trends
  • Patient Readmission / trends*
  • Postpartum Period / drug effects*
  • Postpartum Period / physiology
  • Postpartum Period / psychology
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / epidemiology*
  • Pregnancy Complications / psychology
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology
  • Young Adult


  • Amphetamines
  • Opiate Alkaloids
  • Cocaine