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Principal Investigator: Hannah LF Cooper
Organization: EMORY UNIVERSITY
Fiscal Year: 2024
Award: $704,248
Funding agency: National Institute on Drug Abuse
Abstract: People who use drugs (PWUD) and are pregnant or postpartum are trying to survive at the
intersection of 2 of the gravest public health crises confronting the 21st century US: epidemics of (1)
drug-related harms, and (2) maternal morbidity and mortality. The US has the highest rate of maternal mortality
of all high-income countries, and analyses of death certificates suggest that 11% of deaths during pregnancy
and17% of postpartum deaths are drug-related. This crisis is escalating: rates of opioid use disorder diagnosis
at delivery quintupled between 2004-2015, and rates of amphetamine-related diagnosis at delivery doubled. In
the midst of this escalating crisis, public health has failed to adequately mobilize. Intervention develop-
ment is stymied by limited evidence about which harms PWUD suffer while pregnant or postpartum. Tailoring
and locating interventions is challenging, because we know exceptionally little about who suffers these harms,
overall or among structurally marginalized subpopulations; about where PWUD suffering these harms cluster
spatially; or about when during the highly dynamic 21 months of pregnancy and the postpartum year they suf-
fer them. Further, few studies have identified intervention targets: the decades of “risk environment” research
about why PWUD in the general (i.e., not pregnant or postpartum) population experience specific drug-related
harms has rarely focused on pregnant/ postpartum people. By generating essential evidence that answers
these fundamental questions, the proposed longitudinal study is designed to support a new arena of
interventions to help PWUD survive the 21 months they are pregnant and postpartum. By using rigorous
methods to analyze a novel longitudinal hospital database spanning 17 states from 2017-2022 and a recently
created CDC maternal mortality database spanning 36 states in 2018-2022, we will generate panoramic evi-
dence about (1a) the incidences of hospital encounters for specific drug-related morbidities across the 7 quar-
ters PWUD are pregnant and postpartum, overall and by race/ ethnicity, insurance status, and rurality, and (1b)
spatiotemporal variations in these incidences; and about (2a) the incidences of drug-related maternal mortality,
overall and by race/ethnicity, insurance status, and rurality; and (2b) spatiotemporal variations in these inci-
dences. Guided by the Intersectional Risk Environment Model, we will next (3) apply Bayesian models to iden-
tify risk environment features correlated with spatiotemporal variations in these morbidity and mortality inci-
dences, overall and by race/ethnicity, insurance status, and rurality. A National Advisory Board of PWUD, harm
reduction advocates, and reproductive justice advocates, and representatives of state agencies and Maternal
Mortality Review Committees, will inform the construction of Aim 1&2 incidence measures; prioritize which risk
environment features to analyze in Aim 3&4; and support dissemination of Aim 1-4 results so they rapidly in-
form the development of interventions to help PWUD survive the 21 months they are pregnant and postpartum.
Terms: <Advocate><Affect><Amphetamines><Autopsy><Bayesian Modeling><Bayesian adaptive designs><Bayesian adaptive models><Bayesian belief network><Bayesian belief updating model><Bayesian framework><Bayesian hierarchical model><Bayesian network model><Bayesian nonparametric models><Bayesian spatial data model><Bayesian spatial image models><Bayesian spatial models><Bayesian statistical models><Bayesian tracking algorithms><Behavioral><Cause of Death><Cessation of life><Clinical><Country><Data><Data Bases><Databases><Death><Death Certificates><Death Rate><Desoxynorephedrin><Development><Diagnosis><Disparities><Disparity><Drug usage><Drug user><Drugs><Economic Income><Economical Income><Economics><Endocarditis><Environment><Epidemic><Ethnic Origin><Ethnicity><Family><General Population><General Public><Generations><Geography><Gestation><Harm Minimization><Harm Reduction><Hospitals><Incidence><Income><Insurance Coverage><Insurance Status><Intervention><Intervention Strategies><Interview><Investigation><Justice><Law Enforcement><Letters><Longitudinal Studies><Maternal Health><Maternal Mortality><Measures><Medical><Medication><Methodology><Methods><Modeling><Morbidity><Morbidity - disease rate><Needle-Exchange Programs><Overdose><PWUD><Persons><Pharmaceutical Preparations><Phenamine><Phenopromin><Physiologic><Physiological><Population><Postpartum Period><Pregnancy><Pregnancy Trimesters><Public Health><Race><Races><Records><Research><Review Committee><Risk><Services><Shapes><Social Service><Social Work><Source><Syringe-Exchange Programs><System><Time><US State><Variant><Variation><data base><death risk><design><designing><develop therapy><developmental><dl-Amphetamine><drug metabolism><drug use><drug/agent><economic><experience><harm reduction programs><high risk group><high risk individual><high risk people><high risk population><incomes><innovate><innovation><innovative><intervention development><interventional strategy><long-term study><longitudinal outcome studies><longterm study><marginalization><marginalized group><marginalized individual><marginalized people><marginalized population><maternal death><maternal morbidity><mortality><mortality rate><mortality ratio><mortality risk><necropsy><needle exchange><novel><opiate use disorder><opioid use disorder><people who use drugs><people who use illicit drugs><persons who use drugs><post-partum><postmortem><pregnant><psychologic><psychological><public health intervention><racial><racial background><racial origin><reproductive><risk selection><rurality><social><spatiotemporal><substance use><substance use treatment><substance using><syringe exchange><syringe exchange services><syringe service programs><therapy development><tool><treatment development>