ABSTRACT
Background: Recent studies describe increasing rates of cannabis use among pregnant women. Gestational cannabis use has been associated with adverse neonatal outcomes and maternal reports of domestic violence. Domestic violence reportedly increased in Australia during the COVID-19 pandemic. We examined trends and outcomes of gestational cannabis use before and during the COVID-19 pandemic and sought associations with domestic violence. Method(s): The study population comprised women who attended the antenatal clinic and childbirth between 1 January 2019 and 31 December 2021 at an Australian tertiary hospital. Maternal socio-demographic, pregnancy progress and neonatal outcomes were recorded from the clinical records. We sought associations between maternal cannabis use and self-reported domestic violence during the study period, and the relationship with pregnancy outcomes. Result(s): Cannabis use was reported by 165/10,263 (1.6%) pregnant women. Cannabis use remained consistent during the study period, but reports of domestic violence increased from 2.9% pre-COVID to 6.7% during the COVID-19 pandemic. During the pandemic, women with gestational cannabis use were more likely to be young (40% <25 years vs. 11.8% .25 years), underweight (3.5% vs. 2.4%) and reported more domestic violence (33.0% vs. 6.3%), compared with non-users. The most common co-consumed substances by cannabis-users were tobacco (63.5%), alcohol (13.9%) and amphetamines (9.6%). Gestational cannabis use was associated with smaller neonates (median birth weight 2900 vs. 3330 g), higher preterm births (33% vs. 8.6%) and increased stillbirths (1.7% vs. 0.4%) Conclusion(s): Although domestic violence increased, gestational cannabis use remained constant during the COVID-19 pandemic and was associated with worse neonatal outcomes.
ABSTRACT
Background. Early data suggest that people with substance use disorder (SUD) who develop coronavirus disease 2019 (COVID-19) have increased intubation and mortality rates when compared to those without SUD. Information on other COVID-19-related complications in this population is limited. We evaluated COVID-19 outcomes in patients with and without SUD. Methods. We created a retrospective cohort of patients with COVID-19 admitted to an urban safety net hospital from 3/16/2020 to 4/8/2020. Inclusion criteria were admission with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 and age greater than 18 years. SUD included alcohol use disorder or heavy alcohol use as defined by the National Institute on Alcohol Abuse and Alcoholism, use of cocaine, non-prescribed opioids or amphetamines. Primary outcome was inpatient mortality. Secondary outcomes were clinical complications (intubation, secondary infections, renal failure, venous thromboembolism, stroke, hepatitis, myocardial infarct, multisystem organ failure) and resource utilization (length of stay, intensive care unit [ICU] admission, ICU days, readmission). We used multivariable regression to assess factors associated with mortality and length of stay, and univariate analyses for other outcomes. Results. Of 409 included patients, 70 (17.1%) had SUD. Those with SUD were more likely to be male and have pulmonary disease or hepatitis C. There were no differences in other comorbidities, mean age or race/ethnicity. After multivariable analysis, SUD was not associated with mortality (aOR 1.60;95% CI, 0.60-3.81). Similarly baseline oxygenation defined as the ratio of oxygen saturation to fraction of inspired oxygen (aOR 1.57;0.11-13.0) and administration of immunomodulatory therapy (tocilizumab, sarilumab or anakinra) (aOR 1.41;0.65-3.01) did not affect mortality. In contrast, age (aOR 1.06;1.03-1.09), sex (aOR 2.30;1.04-5.47) and obstructive sleep apnea (aOR 4.07;1.64-9.66) were associated with mortality. We did not find any associations with secondary outcomes. Conclusion. Our findings suggest that substance use alone may not increase COVID-19 adverse outcomes. Future studies should evaluate these results in the current period of improved COVID-19 therapy.