Abstract
Objective The objective of this study was to derive profiles of alcohol, tobacco, and recreational
drug use during pregnancy for first-time mothers with latent class growth analysis
(LCGA) and determine the association of these classes with the risk of adverse pregnancy
outcomes (APO).
Study Design A secondary analysis of a prospective cohort of Nulliparous Outcomes in Pregnancy:
Monitoring Mothers-to-Be was conducted in eight medical centers across the United
States from September 30, 2010, to September 23, 2013. Self-reported use of any alcohol,
tobacco, or recreational drugs in the 1 month prior to the visit was assessed at up
to four visits throughout pregnancy, and APOs included a composite of preterm birth,
hypertensive disorder of pregnancy (HDP), small for gestational age (SGA) infant,
or stillbirth, and each adverse outcome separately.
Results Four latent classes were identified from the LCGA for 10,031 nulliparous pregnant
women that were on average 26.9 years old (standard deviation [SD] = 5.7) and mostly
non-Hispanic White (59.7%). Classes included consistent tobacco users (N = 517, 5.2%), nonusers (N = 8,945, 89.2%), alcohol users (N = 500, 5.0%), and a combination of alcohol/tobacco/drug users (N = 69, 0.7%). Logistic regression demonstrated that the class of tobacco users was
more likely to have an APO (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.22–1.81),
preterm birth (OR = 1.53, 95% CI = 1.15–2.02), and SGA (OR = 1.79, 95% CI = 1.36–2.35)
relative to the class of nonusers. The class of alcohol users was more likely to have
HDP (OR = 1.37, 95% CI = 1.11–1.70) and less likely to have preterm birth (OR = 0.59,
95% CI = 0.38–0.90) and SGA (OR = 0.61, 95% CI = 0.40–0.93) compared to nonusers.
Conclusion Trajectories of substance use are associated with APOs; thus, interventions to mitigate
the use when encountered early in pregnancy are warranted.
Key Points
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Four classes of substance use were identified.
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Tobacco users were at a higher risk of APO and alcohol users were at higher risk of
HDP.
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Mitigation strategies are warranted to reduce APO.
Keywords
substance use - latent class growth analysis - adverse pregnancy outcomes - preterm
birth - hypertensive disorder of pregnancy - small for gestational age infant - stillbirth
