Recent and lifetime maternal substance use: Rurality and economic distress.
Jennifer S Miller, Henrietta Bada, Caitlin Dunworth and 1 others
PMID 37515582WHAT IT FOUND
Most pregnant women with opioid use disorder in Kentucky looked similar whether rural or urban.
Urban women reported more recent methamphetamine use and inadequate prenatal care; rural women reported longer recent abstinence. Geography alone should not drive care assumptions.
Key findings
01Apart from prenatal care, maternal characteristics did not differ significantly between rural and urban women.
02Urban mothers reported inadequate prenatal care more often than rural mothers (30% vs 11%, p = 0.024).
03In the past 30 days, 20.6% of urban women used amphetamines/methamphetamines versus none of rural women (p < 0.001), while rural women had a longer median recent abstinence period (7.0 vs 2.8 months, p = 0.049).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis included 93 women from 120 consented participants, and 27 did not complete the interview, which may have reduced power and introduced bias. The study was cross-sectional and exploratory, so it cannot show that rural or urban living caused any difference. Many comparisons were made, increasing the chance of false-positive findings. Most data were self-reported, and the Addiction Severity Index has not been rigorously validated in pregnant women. The Addiction Severity Index category other opiates may mix prescribed treatment medications with non-prescribed opioid use. Participants were mostly white women from Kentucky whose newborns were transferred to one regional center, so results may not apply elsewhere. The study did not examine confounding or effect modification.
Declared interests
The authors declared no conflicts of interest. The article is listed as supported by NIH extramural funding.
The easy way to misread this
Do not conclude that rural women with opioid use disorder are lower risk or that medication for opioid use disorder caused the differences. This was a small observational subset, most comparisons were not significant, and the study did not test treatment effects.