Am J Perinatol 2003; 20(5): 255-262
DOI: 10.1055/s-2003-42336
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Treatment of Substance Abuse During Pregnancy and Infant Outcome

Bertis B. Little1 , Laura M. Snell3 , Toosje T. Van Beveren4 , R. Becca Crowell5 , Stacey Trayler5 , Walter L. Johnston2
  • 1Associate Vice President for Research, Tarleton State University, Stephenville, Texas
  • 2Director of Data Warehouse and Data Mining Programs, Tarleton State University, Stephenville, Texas
  • 3Family Practice and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
  • 4Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, Texas
  • 5Nexus Recovery Center, Inc., Dallas, Texas
Further Information

Publication History

Publication Date:
18 September 2003 (online)

ABSTRACT

The objective of this study is to analyze the effects of residential substance abuse treatment on pregnancy outcome among gravidas in a gender-specific program. All clients (cases) who entered a residential substance abuse program for pregnant and postpartum women were eligible for inclusion in the study (n = 95). Only those who were in treatment at the time of delivery were included in the present analysis (n = 57). Two comparison groups were used: (1) substance abusers who received no treatment during pregnancy (positive control group) and (2) pregnant women who were not substance abusers (negative control group). Cases were matched to controls on ethnicity (negative and positive controls) and drug of choice (positive controls only). Medical records were reviewed and abstracted for cases and controls. The primary drug of choice was cocaine for 56% of clients in the study, heroin 15.8%, and alcohol 10.8%. Average length of time in treatment before delivery was 11.7 weeks. The frequency of pregnancy complications allowing treatment and position controls was significantly higher than the negative control group (p < 0.0001). The frequency of perinatal infant complications was increased among treatment group infants (p < 0.0001). Two infants in the treatment group were positive for a substance of abuse at birth. In the treatment versus positive control group, mean birth weight (BW) was 3227 versus 2800 g (p < 0.01), estimated gestational age (EGA) was 38.9 versus 39 weeks, average head circumference (FOC) was 33.8 versus 32.5 cm (p < 0.05), and mean birth length (BLT) was 48.7 cm versus 46.9 (p < 0.05). No significant differences were found between treatment and negative control groups. Maternal syphilis was increased in frequency in the positive control group compared with the negative control group (p < 0.07). Thirty-percent of mothers had sexually transmitted diseases (STDs) for which infants were at risk and treated prophylactically; no infant in the treatment group contracted a vertically transmitted STD. For every 10 weeks in treatment, BW was increased 340 g, EGA 1 week, FOC 0.8 cm, and BLT 1.8 cm. Thus, substance abuse treatment for pregnant women in the program increased fetal growth, which significantly decreased the risk for poor neonatal outcomes. Importantly, maternal and infant perinatal complications in the treatment group were increased in frequency compared with the two control groups. This may possibly have occurred because healthcare providers were not blinded to maternal treatment status.

REFERENCES

  • 1 Singer L, Yamashita T S, Hawkins S. et al . Increased incidence of intraventricular hemorrhage and developmental delay in cocaine-exposed very low birth weight infants.  J Pediatr . 1994;  124 765-771
  • 2 Mayes L C, Cicchetti D V. Prenatal cocaine exposure and neurobehavioral development: how subjects lost to follow-up bias study results.  Child Neuropsychol . 1995;  1 128-139
  • 3 Jacobson S W, Jacobson J L, Sokol R J, Martier S S, Chiodo L M. New evidence for neurobehavioral effects of in utero cocaine exposure.  J Pediatr . 1996;  129 581-590
  • 4 Kistin N, Handler A, Davis F, Ferre C. Cocaine and cigarettes: a comparison of risks.  Paediatr Perinat Epidemiol . 1996;  10 269-278
  • 5 Tarr S J, Pyfer J L. Physical and motor development of neonates/infants prenatally exposed to drugs in utero: a meta-analysis.  Adapt Phys Activ Q . 1996;  13 269-287
  • 6 Dawkins J L, Tylden E, Colley N, Evans C. Drug abuse in pregnancy-obstetric and neonatal problems: ten years' experience.  Drug Alcohol Rev . 1997;  16 25-31
  • 7 Balshem M, Oxman G, Van Rooyen D, Girod K. Syphilis, sex and crack cocaine: images of risk and morality.  Soc Sci Med . 1991;  35 147-160
  • 8 Carlson R G, Siegal H A. The crack life: an ethnographic overview of crack use and sexual behavior among African-Americans in a midwest metropolitian city.  J Psychoactive Drugs . 1991;  23 11-20
  • 9 Cox J M, D'Angelo L J, Silber T J. Substance abuse and syphilis in urban adolescents: a new risk factor for an old disease.  J Adolesc Health . 1992;  13 483-486
  • 10 Battin M, Albersheim S, Newman D. Congenital genitourinary tract abnormalities following cocaine exposure in utero.  Am J Perinatol . 1995;  12 425-428
  • 11 Wagner C L, Katikaneni L D, Cox T H, Ryan R M. The impact of prenatal drug exposure on the neonate: substance abuse in pregnancy.  Obstet Gynecol . 1998;  1 169-194
  • 12 Singer L, Arendt R, Song L Y, Warshawsky E, Kliegman R. Direct and indirect interactions of cocaine with childbirth outcomes.  Arch Pediatr Adolesc Med . 1994;  148 939-964
  • 13 Little B B, Snell L M, Klein V R, Gilstrap L C. Cocaine abuse during pregnancy: maternal and fetal complications.  Obstet Gynecol . 1989;  73 157-160
  • 14 Van Baar L A, Soepatmi S, Gunning W B, Akkerhuis G W. Development after prenatal exposure to cocaine, heroine, and methadone.  Acta Paediatr Suppl . 1994;  404 40-46
  • 15 Mastrogiannis D S, Decavalas G O, Verma U, Tejani N. Perinatal outcome after recent cocaine usage.  Obstet Gynecol . 1990;  76 8-11
  • 16 MacGregor S N, Keith L G, Bachicha J A, Chasnoff I J. Cocaine abuse during pregnancy: correlation between prenatal care and perinatal coutcome.  Am J Obstet Gynecol . 1989;  74 882-885
  • 17 Racine A, Joyce T, Anderson R. The association between prenatal care and birth weight among women exposed to cocaine in New York City.  JAMA . 1993;  270 1581-1586
  • 18 Chazotte C, Youchah J, Freda M C. Cocaine use during pregnancy and low birth weight: the impact of prenatal care and drug treatment.  Semin Perinatol . 1995;  91 293-300
  • 19 Laken M P, McComish J F, Ager J. Predictors of prenatal substance use and birth weight during outpatient treatment.  J Subst Abuse Treat . 1997;  14 359-366
  • 20 Phibbs C S, Bateman D A, Schwartz R M. The neonatal costs of maternal cocaine use.  JAMA . 1991;  11 1521-1586
  • 21 Svikis D S, Golden A S, Huggins G R. et al . Cost-effectiveness of treatment for drug-abusing pregnant women.  Drug Alcohol Depend . 1997;  14 105-113
  • 22 Chasnoff I J, Griffith D R, MacGregor S. et al . Temporal patterns of cocaine use in pregnancy.  J Am Med Assoc . 1989;  261 1741-1744
  • 23 Ryan L, Ehrlich S, Finnegan L. Cocaine abuse in pregnancy: effects on the fetus and newborn.  Neurotoxicol Teratol . 1987;  9 295-299
  • 24 Martin S L, Haeslock K, Kupper L L. et al . Is incarceration during pregnancy associated with infant birth weight?.  Am J Public Health . 1997;  87 1526-1531
  • 25 Martin S L, Rieger R H, Kupper L L. et al . The effect of incarceration during pregnancy on birth outcomes.  Public Health Rep . 1997;  112 340-346
    >