{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T01:06:51Z","timestamp":1783127211086,"version":"3.54.6"},"reference-count":50,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,9,19]],"date-time":"2021-09-19T00:00:00Z","timestamp":1632009600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcoholism Clin &amp;amp; Exp Res"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pregnant women with a substance\u2010related diagnosis, such as an alcohol use disorder, are a vulnerable population that may experience higher rates of severe maternal morbidity, such as hemorrhage and eclampsia, than pregnant women with no substance\u2010related diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cross\u2010sectional study reviewed electronic health record data on women (aged 18\u201344\u00a0years) who delivered a single live birth or stillbirth at \u2265 20\u00a0weeks of gestation from March 1, 2016, to August 30, 2019. Women with and without a substance\u2010related diagnosis were matched on key demographic characteristics, such as age, at a 1:1 ratio. Adjusting for these covariates, odds ratios and 95% confidence intervals were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 10,125 deliveries met the eligibility criteria for this study. In the matched cohort of 1,346 deliveries, 673 (50.0%) had a substance\u2010related diagnosis, and 94 (7.0%) had severe maternal morbidity. The most common indicators in women with a substance\u2010related diagnosis included hysterectomy (17.7%), eclampsia (15.8%), air and thrombotic embolism (11.1%), and conversion of cardiac rhythm (11.1%). Having a substance\u2010related diagnosis was associated with severe maternal morbidity (adjusted odds ratio\u00a0=\u00a01.81 [95% CI, 1.14\u20132.88], <jats:italic>p<\/jats:italic>\u2010value\u00a0=\u00a00.0126). In the independent matched cohorts by substance type, an alcohol\u2010related diagnosis was significantly associated with severe maternal morbidity (adjusted odds ratio\u00a0=\u00a03.07 [95% CI, 1.58\u20135.95], <jats:italic>p<\/jats:italic>\u2010value\u00a0=\u00a00.0009), while the patterns for stimulant\u2010 and nicotine\u2010related diagnoses were not as well resolved with severe maternal morbidity and opioid\u2010 and cannabis\u2010related diagnoses were not associated with severe maternal morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found that an alcohol\u2010related diagnosis, although lowest in prevalence of the substance\u2010related diagnoses, had the highest odds of severe maternal morbidity of any substance\u2010related diagnosis assessed in this study. These findings reinforce the need to identify alcohol\u2010related diagnoses in pregnant women early to minimize potential harm through intervention and treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.14671","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T01:39:59Z","timestamp":1627954799000},"page":"1829-1839","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Association of alcohol and other substance\u2010related diagnoses with severe maternal morbidity"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9231-647X","authenticated-orcid":false,"given":"Natasia S.","family":"Courchesne","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of California San Diego La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5371-3229","authenticated-orcid":false,"given":"Laramie R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health Department of Medicine University of California San Diego La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7324-3914","authenticated-orcid":false,"given":"Mar\u00eda Luisa","family":"Z\u00fa\u00f1iga","sequence":"additional","affiliation":[{"name":"School of Social Work College of Health and Human Services San Diego State University San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4675-7722","authenticated-orcid":false,"given":"Christina D.","family":"Chambers","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Family Medicine and Public Health University of California San Diego La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1750-2616","authenticated-orcid":false,"given":"Mark B.","family":"Reed","sequence":"additional","affiliation":[{"name":"School of Social Work College of Health and Human Services San Diego State University San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5174-6369","authenticated-orcid":false,"given":"Jerasimos","family":"Ballas","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology University of California San Diego La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3909-3318","authenticated-orcid":false,"given":"Carla B.","family":"Marienfeld","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of California San Diego La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304771"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31821e5f65"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012\u20103931"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.AJOG.2019.01.005"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0B013E3181A81CDD"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31826d60c5"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182a06f4e"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.13022"},{"key":"e_1_2_8_12_1","unstructured":"Center for Behavioral Health Statistics and Quality(2018)National Survey on Drug Use and Health: Detailed tables. Substance abuse and mental health services administration.https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/cbhsq\u2010reports\/NSDUHDetailedTabs2018R2\/NSDUHDetailedTabs2018.pdf[Accessed May 9 2020]"},{"key":"e_1_2_8_13_1","unstructured":"Center for Disease Control and Prevention(2017)Severe maternal morbidity in the United States.https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/severematernalmorbidity.html#anchor_References[Accessed May 9 2020]"},{"key":"e_1_2_8_14_1","unstructured":"Center for Disease Control and Prevention Hamilton B.E. Osterman M.J.K. Driscoll A.K.&Rossen L.M.(2018)Births: provisional data for 2017.https:\/\/stacks.cdc.gov\/view\/cdc\/55172"},{"key":"e_1_2_8_15_1","unstructured":"Centers for Medicare and Medicaid Services National Center for Health Statistics(2019)ICD\u201010\u2010CM: Official guidelines for coding and reporting FY. 2019 (October 1 2018\u2013September 30 2019).https:\/\/www.cdc.gov\/nchs\/data\/icd\/10cmguidelines\u2010FY2020_final.pdf"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.8734"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-33404-8_16"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2013.4617"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.00815"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11936\u2010019\u20100777\u20105"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/CHI.0b013e3181bfa8ee"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2013.02.015"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.AJOG.2010.11.013"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010017\u20101507\u20101"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.ANNEPIDEM.2010.02.006"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010011\u20100898\u20102"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/J.SEMPERI.2017.07.007"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/pan\/mpl013"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360\u20100443.2011.03613.x"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.REPROTOX.2009.04.010"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/pan\/mpr013"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.DRUGALCDEP.2020.108236"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.1965"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.15818"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000128"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.PRRV.2016.08.005"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.05.050"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.AJOG.2015.05.025"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108706"},{"key":"e_1_2_8_40_1","doi-asserted-by":"crossref","DOI":"10.17226\/24625","volume-title":"The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research","author":"National Academy of Medicine Committee on the Health Effects of Marijuana","year":"2017"},{"key":"e_1_2_8_41_1","volume-title":"Mental Illness","author":"National Institute of Mental Health","year":"2019"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.107817"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100038\u20101667291"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00127.2012"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31824265c7"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0000000000000418"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100412.2010.01030.x"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016340903214940"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2019.2899"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211214"},{"key":"e_1_2_8_51_1","unstructured":"World Health Organization(2004)International Classification of Diseases Tenth Revision: international statistical classification of diseases and related health problems: tenth revision 2nd ed.World Health Organization."}],"container-title":["Alcoholism: Clinical and Experimental Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acer.14671","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acer.14671","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acer.14671","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T23:09:28Z","timestamp":1693350568000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acer.14671"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":50,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1111\/acer.14671"],"URL":"https:\/\/doi.org\/10.1111\/acer.14671","archive":["Portico"],"relation":{},"ISSN":["0145-6008","1530-0277"],"issn-type":[{"value":"0145-6008","type":"print"},{"value":"1530-0277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]},"assertion":[{"value":"2021-02-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}