Relationship between Self-Reported Maternal Substance Abuse and Adverse Outcomes in the Premature Newborn

Abstract

Objective This study aims to compare neonatal and long-term outcomes among preterm newborns from women with reported versus those who did not report substance abuse.

Study Design Secondary analysis of a trial of magnesium sulfate for cerebral palsy prevention. Cases were pregnant women who reported substance abuse, controls were those who denied it. Study outcomes included (1) composite neonatal morbidity, defined as any of the following: Apgar score ≤ 3 at 5 minutes, seizures, culture-proven sepsis, necrotizing enterocolitis grades 2 or 3, intraventricular hemorrhage grades 3 or 4, and/or death before discharge; (2) infant and childhood morbidity, defined as stillbirth or death by 1 year, or moderate/severe cerebral palsy by age of 2.

Results Among 1,972 women meeting the inclusion criteria, 197 (10%) reported substance abuse. Composite neonatal, infant, and childhood morbidity rates were similar between cases and controls. However, women reporting substance abuse who delivered between 32^0/7 and 36^6/7 weeks had a higher frequency of composite infant and childhood morbidity (6.5 vs. 1.0%; adjusted odds ratio, 6.5; 95% confidence interval, 1.14–36.99).

Conclusions Preterm birth was associated with similar composite neonatal morbidity between cases and controls. After 32 weeks, self-reported substance abuse was associated with a sevenfold increase in the rates of stillbirth and long-term infant morbidity.

Keywords

cocaine - marijuana - opioids - preterm birth

Note

This article was presented as oral presentation at 81st Annual Meeting of the Central Association of Obstetricians and Gynecologists held in Albuquerque, NM, from October 8–11, 2014.

• References

• 1 Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13–4795. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013
• 2 Behnke M, Smith VC ; Committee on Substance Abuse; Committee on Fetus and Newborn. Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics 2013; 131 (3) e1009-e1024
• 3 Pinto SM, Dodd S, Walkinshaw SA, Siney C, Kakkar P, Mousa HA. Substance abuse during pregnancy: effect on pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2010; 150 (2) 137-141
• 4 Myles TD, Espinoza R, Meyer W, Bieniarz A, Nguyen T. Effects of smoking, alcohol, and drugs of abuse on the outcome of “expectantly” managed cases of preterm premature rupture of membranes. J Matern Fetal Med 1998; 7 (3) 157-161
• 5 Rouse DJ, Hirtz DG, Thom E , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (9) 895-905
• 6 Dinsmoor MJ, Irons SJ, Christmas JT. Preterm rupture of the membranes associated with recent cocaine use. Am J Obstet Gynecol 1994; 171 (2) 305-308 , discussion 308–309
• 7 Mastrogiannis DS, Decavalas GO, Verma U, Tejani N. Perinatal outcome after recent cocaine usage. Obstet Gynecol 1990; 76 (1) 8-11
• 8 Cherukuri R, Minkoff H, Feldman J, Parekh A, Glass L. A cohort study of alkaloidal cocaine (“crack”) in pregnancy. Obstet Gynecol 1988; 72 (2) 147-151
• 9 Slutsker L. Risks associated with cocaine use during pregnancy. Obstet Gynecol 1992; 79 (5 ( Pt 1)) 778-789
• 10 Gillogley KM, Evans AT, Hansen RL, Samuels SJ, Batra KK. The perinatal impact of cocaine, amphetamine, and opiate use detected by universal intrapartum screening. Am J Obstet Gynecol 1990; 163 (5 Pt 1) 1535-1542
• 11 Burkett G, Yasin SY, Palow D, LaVoie L, Martinez M. Patterns of cocaine binging: effect on pregnancy. Am J Obstet Gynecol 1994; 171 (2) 372-378 , discussion 378–379