Pregnancy and Pregnancy Outcomes in a National Population Cohort of Patients Treated for Substance Use Disorders

Systematic Review of Obstetric and Child Outcomes of Prenatal Exposure to Inhalants in the Context of a Use Disorder

Published: March/April 2025
Journal Article

Overview

This one-hour, on-demand, journal article-based activity examines the risks associated with pregnancy and elective termination among females receiving treatment for substance use disorder (SUD) compared to those not in treatment. It also explores strategies to improve reproductive health during SUD treatment, including the integration of family planning guidance into care plans.

The target audience for this intermediate continuing education activity includes: physicians, nurse practitioners, PAs, pharmacists and other clinicians, researchers, students, and policymakers.

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, Systems-Based Practice

Abstract

Aims 
The objectives of this study were to: i) provide population-level prevalence rates of pregnancy, birth, elective termination, and miscarriage among females treated for SUDs and their demographic counterparts; ii) examine associations between SUD treatment and pregnancy and elective terminations

Methods
Data were analyzed from a prospective registry-linkage study of all females (15-45 years) recorded as treated for SUDs in the Norwegian Patient Registry (NPR) over a two-year period (N=6,470) and a non-treated frequency-matched cohort of females from the general population (N=6,286). Pregnancy and pregnancy outcomes over a four-year follow-up were retrieved from the NPR. Multivariable logistic regression models tested for associations of SUD treatment with pregnancy and with elective termination among pregnant females.

Results
Annual pregnancy and elective termination rates per 1,000 females were significantly higher for the SUD cohort than the non-treated cohort (94.2 versus 71.3 for pregnancy, p<0.001; 54.7 versus 17.8 for elective termination, p<0.001), the annual birth rate was lower for the SUD cohort (25.3 versus 41.8, p<0.001), and the rate of miscarriage did not differ across cohorts. Multivariable analysis showed that SUD treatment was associated with a significant increase in the odds of pregnancy (aOR 1.34, CI [1.18-1.54]) and the odds of an elective termination, conditional on pregnancy (aOR 2.55, CI [1.97-3.29]).

Conclusion
Females treated for SUDs had substantially higher odds of pregnancy and elective terminations than the non-treated cohort. To improve their reproductive health, targeted interventions such as free long-acting contraception and integration of family planning guidance into substance use treatment should be considered.

Learning Objectives

Upon completion of this activity, learners will be able to:

1. Analyze the relationship between SUD treatment in females and the risk of pregnancy and elective termination.

2. Evaluate strategies to improve reproductive health outcomes for females receiving SUD treatment.

Registration Rates

*Residents, Fellows-in-training, Interns, and Students must join ASAM to receive a discounted registration rate. Click here to become an ASAM member. National and Chapter membership dues apply. There is no charge for Students to become a Member, but verification of student status is required.

Membership Question?  Call ASAM at 1.301.656.3920, email us, or view the ASAM website for more information.

Refunds & Cancellations

All ASAM eLearning Center refund requests must be made in writing to education@asam.org within 90 days of purchase. Those requesting refunds for courses that are in progress will receive partial refunds or eLearning Center credit. Automatic full refunds will be made for any course with a live-course component that has been canceled.

Open Registration: 02/03/2025 - 02/03/2028

Close Access Date: 03/03/2028

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click View Journal Article and read the journal article in its entirety. 
3. Click Complete Post Test to answer multiple choice questions. Participants will have 10 attempts to pass and must answer 2 out of 3 questions correctly.
4. Click Complete Evaluation to provide valuable activity feedback. Scroll down on all questions as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

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Accreditation & Credits

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credits Available

• Physicians: 1.00 Credit
• Nurses & NPs: 1.00 Nursing Contact Hour
• PAs: 1.00 Credit
• Interprofessional Continuing Education: 1.00 Credit
• Certified Counselors: NBCC Contact Hours Not Offered

  

  American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. American Society of Addiction Medicine is solely responsible for all aspects of the programs.

Maintenance of Certification (MOC)/Continuing Certification Program (CCP)

This activity is designed to meet the requirements for MOC/CCP for several primary physician boards and for state licensing CME requirements. MOC Credit is only reported and designated for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• ABIM MOC Points: 1.00 Medical Knowledge
• ABP MOC: 1.00 Lifelong Learning & Self-Assessment
• ABS Continuing Certification: 1.00 Accredited CME
• ABA MOCA 2.0®*: 1.00 Lifelong Learning MOCA 2.0® is a trademark of the American Board of Anesthesiology®. This activity contributes to the CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology's (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, https://www.theaba.org/, for a list of all MOCA 2.0 requirements.

Additionally, this activity has been designed to satisfy the requirements of the following primary physician board certification requirements. Please confirm with your individual Board.

• American Board of Addiction Medicine (ABAM)
• American Board of Preventive Medicine (ABPM)
• American Board of Psychiatry and Neurology (ABPN)
• Royal College of Physicians and Surgeons of Canada (RCPSC)

Certificates for other professions

All participants may request a certificate of participation upon completion of the activity and an online evaluation confirming their participation. Learners are strongly advised to contact their professional licensing board or professional association to confirm this certificate will be accepted as evidence supporting continuing education requirements.

California Association for Drug/Alcohol Educators (CAADE)

This educational program is approved by CAADE: #CP40 999 1225.

California Association of DUI Treatment Centers (CADTP)

This educational program is approved by CADTP: #205.

California Consortium of Addiction Programs and Professionals (CCAPP)

This educational program is approved by CCAPP: #OS-20-330-0227.

Disclosure Information

In accordance with the disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all accredited continuing education activities. These policies include identifying and mitigating all relevant financial relationships with ineligible companies for those involved in the creation and dissemination of accredited continuing education. 

See the attached article and pdf for a list of disclosures