Download PDF
Am J Perinatol
DOI: 10.1055/s-0042-1753502
Original Article

The Impact of Self-Reported Alcohol, Tobacco, and Recreational Drug Use during Pregnancy on Adverse Pregnancy Outcomes in First-Time Mothers

Joanne K. Daggy 
1   Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
,
Robert M. Silver
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
David Guise
1   Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
,
David M. Haas
3   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations Funding This work was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to Research Triangle Institute (U10 HD063036); Case Western Reserve University (U10 HD063072); Columbia University (U10 HD063047); Indiana University (U10 HD063037); Magee-Women's Hospital (U10 HD063041); Northwestern University (U10 HD063020); University of California at Irvine (U10 HD063046); University of Pennsylvania (U10 HD063048); and University of Utah (U10 HD063053). In addition, support was provided by respective Clinical and Translational Science Institutes to Indiana University (UL1TR001108) and the University of California Irvine (UL1TR000153).
› Further Information
    Permissions and Reprints

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

  • Four classes of substance use were identified.

  • Tobacco users were at a higher risk of APO and alcohol users were at higher risk of HDP.

  • 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

Authors' Contributions

J.K.D. had full access to the deidentified data in the study and takes responsibility for the integrity of the data and the accuracy of the data analyses.


D.G., J.K.D., and D.M.H. are responsible for acquisition, analysis, and interpretation of data. D.G. was the data manager.


J.K.D. and D.M.H. are responsible for the drafting of the manuscript.


D.M.H. and R.M.S. were responsible for the critical revision of the manuscript for important intellectual content.


J.K.D. was responsible for statistical analysis.


Disclaimer

Comments and views of the author do not necessarily represent the views of the National Institutes of Health.


Trial Registration

CLINICAL TRIAL REGISTRATION: NCT01322529, clinicaltrials.gov.


Supplementary Material



Publication History

Received: 20 January 2022

Accepted: 03 June 2022

Article published online:
12 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Pollard MS, Tucker JS, Green Jr HD. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Netw Open 2020; 3 (09) e2022942-e2022942
    CrossrefPubMedGoogle Scholar
  • 2 Tobacco and nicotine cessation during pregnancy. ACOG Committee Opinion No. 807. Obstet Gynecol 2020; 135 (05) e221-e229
    CrossrefPubMedGoogle Scholar
  • 3 Bernstein IM, Mongeon JA, Badger GJ, Solomon L, Heil SH, Higgins ST. Maternal smoking and its association with birth weight. Obstet Gynecol 2005; 106 (5 Pt 1): 986-991
    CrossrefPubMedGoogle Scholar
  • 4 Chiolero A, Bovet P, Paccaud F. Association between maternal smoking and low birth weight in Switzerland: the EDEN study. Swiss Med Wkly 2005; 135 (35–36): 525-530
    PubMedGoogle Scholar
  • 5 Ko T-J, Tsai L-Y, Chu L-C. et al. Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: a birth cohort study. Pediatr Neonatol 2014; 55 (01) 20-27
    CrossrefPubMedGoogle Scholar
  • 6 Wisborg K, Kesmodel U, Henriksen TB, Olsen SF, Secher NJ. Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life. Am J Epidemiol 2001; 154 (04) 322-327
    CrossrefPubMedGoogle Scholar
  • 7 Leeners B, Neumaier-Wagner P, Kuse S, Rath W. Smoking and the risk of developing hypertensive diseases in pregnancy: what is the effect on HELLP syndrome?. Acta Obstet Gynecol Scand 2006; 85 (10) 1217-1224
    CrossrefPubMedGoogle Scholar
  • 8 McCarthy FP, O'Keeffe LM, Khashan AS. et al. Association between maternal alcohol consumption in early pregnancy and pregnancy outcomes. Obstet Gynecol 2013; 122 (04) 830-837
    CrossrefPubMedGoogle Scholar
  • 9 Albertsen K, Andersen AM, Olsen J, Grønbaek M. Alcohol consumption during pregnancy and the risk of preterm delivery. Am J Epidemiol 2004; 159 (02) 155-161
    CrossrefPubMedGoogle Scholar
  • 10 Iwama N, Metoki H, Nishigori H. et al; Japan Environment & Children's Study Group. Association between alcohol consumption during pregnancy and hypertensive disorders of pregnancy in Japan: the Japan Environment and Children's Study. Hypertens Res 2019; 42 (01) 85-94
    CrossrefPubMedGoogle Scholar
  • 11 Popova S, Lange S, Probst C, Gmel G, Rehm J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob Health 2017; 5 (03) e290-e299
    CrossrefPubMedGoogle Scholar
  • 12 Warshak CR, Regan J, Moore B, Magner K, Kritzer S, Van Hook J. Association between marijuana use and adverse obstetrical and neonatal outcomes. J Perinatol 2015; 35 (12) 991-995
    CrossrefPubMedGoogle Scholar
  • 13 Kharbanda EO, Vazquez-Benitez G, Kunin-Batson A, Nordin JD, Olsen A, Romitti PA. Birth and early developmental screening outcomes associated with cannabis exposure during pregnancy. J Perinatol 2020; 40 (03) 473-480
    CrossrefPubMedGoogle Scholar
  • 14 Varner MW, Silver RM, Rowland Hogue CJ. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network. Association between stillbirth and illicit drug use and smoking during pregnancy. Obstet Gynecol 2014; 123 (01) 113-125
    CrossrefPubMedGoogle Scholar
  • 15 Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in pregnancy and birth outcomes: a review of the literature. J Pediatr Genet 2015; 4 (02) 56-70
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Kelly L, Dooley J, Cromarty H. et al. Narcotic-exposed neonates in a First Nations population in northwestern Ontario: incidence and implications. Can Fam Physician 2011; 57 (11) e441-e447
    PubMedGoogle Scholar
  • 17 Källén B, Borg N, Reis M. The use of central nervous system active drugs during pregnancy. Pharmaceuticals (Basel) 2013; 6 (10) 1221-1286
    CrossrefPubMedGoogle Scholar
  • 18 Maghsoudlou S, Cnattingius S, Montgomery S. et al. Opium use during pregnancy and infant size at birth: a cohort study. BMC Pregnancy Childbirth 2018; 18 (01) 358
    CrossrefPubMedGoogle Scholar
  • 19 McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med 2016; 375 (25) 2468-2479
    CrossrefPubMedGoogle Scholar
  • 20 Ko JY, Tong VT, Bombard JM, Hayes DK, Davy J, Perham-Hester KA. Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study. Drug Alcohol Depend 2018; 187: 72-78
    CrossrefPubMedGoogle Scholar
  • 21 Page K, Murray-Krezan C, Leeman L, Carmody M, Stephen JM, Bakhireva LN. Prevalence of marijuana use in pregnant women with concurrent opioid use disorder or alcohol use in pregnancy. Addict Sci Clin Pract 2022; 17 (01) 3
    CrossrefPubMedGoogle Scholar
  • 22 Haas DM, Parker CB, Wing DA. et al; NuMoM2b study. A description of the methods of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b). Am J Obstet Gynecol 2015; 212 (04) 539.e1-539.e24
    CrossrefPubMedGoogle Scholar
  • 23 Denny CH, Acero CS, Naimi TS, Kim SY. Consumption of alcohol beverages and binge drinking among pregnant women aged 18-44 years—United States, 2015-2017. MMWR Morb Mortal Wkly Rep 2019; 68 (16) 365-368
    CrossrefPubMedGoogle Scholar
  • 24 Haas DM, Mahnke B, Yang Z. et al. Profile of reported alcohol, tobacco, and recreational drug use in nulliparous women. Obstet Gynecol 2020; 135 (06) 1281-1288
    CrossrefPubMedGoogle Scholar
  • 25 Muthén B, Asparouhov T. Beyond multilevel regression modeling: multilevel analysis in a general latent variable framework. In: Hox JJRJ. ed. Handbook for Advanced Multilevel Analysis. New York, NY: Routledge/Taylor and Francis Group; 2011: 15-40
    Google Scholar
  • 26 Muthén B, Muthén LK. Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcohol Clin Exp Res 2000; 24 (06) 882-891
    CrossrefPubMedGoogle Scholar
  • 27 McCulloch CE, Lin H, Slate EH, Turnbull BW. Discovering subpopulation structure with latent class mixed models. Stat Med 2002; 21 (03) 417-429
    CrossrefPubMedGoogle Scholar
  • 28 Celeux G, Soromenho G. An entropy criterion for assessing the number of clusters in a mixture model. J Classif 1996; 13 (02) 195-212
    CrossrefPubMedGoogle Scholar
  • 29 Little RJA, Rubin DB. Statistical Analysis with Missing Data. 2nd Edition. Hoboken, New Jersey: John Wiley & Sons, Inc.; 2002
    CrossrefGoogle Scholar
  • 30 Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B 1995; 57 (01) 289-300
    PubMedGoogle Scholar
  • 31 Muthén LK, Muthén BO. Mplus User's Guide. 6th ed.. Los Angeles, CA: Muthén & Muthén; 2010
    Google Scholar
  • 32 Cheng D, Kettinger L, Uduhiri K, Hurt L. Alcohol consumption during pregnancy: prevalence and provider assessment. Obstet Gynecol 2011; 117 (2, Pt 1): 212-217
    CrossrefPubMedGoogle Scholar
  • 33 Haas DM, Morgan AM, Deans SJ, Schubert FP. Ethanol for preventing preterm birth in threatened preterm labor. Cochrane Database Syst Rev 2015; (11) CD011445
    PubMedGoogle Scholar
  • 34 Ying W, Catov JM, Ouyang P. Hypertensive disorders of pregnancy and future maternal cardiovascular risk. J Am Heart Assoc 2018; 7 (17) e009382
    CrossrefPubMedGoogle Scholar
  • 35 Melchiorre K, Thilaganathan B, Giorgione V, Ridder A, Memmo A, Khalil A. Hypertensive disorders of pregnancy and future cardiovascular health. Front Cardiovasc Med 2020; 7: 59
    CrossrefPubMedGoogle Scholar
  • 36 Tobacco, alcohol, drugs, and pregnancy. 2021 . Accessed July 06, 2022 at: https://www.acog.org/Patients/FAQs/Tobacco-Alcohol-Drugs-and-Pregnancy#amount
    PubMedGoogle Scholar
  • 37 Wei J, Liu C-X, Gong T-T, Wu Q-J, Wu L. Cigarette smoking during pregnancy and preeclampsia risk: a systematic review and meta-analysis of prospective studies. Oncotarget 2015; 6 (41) 43667-43678
    CrossrefPubMedGoogle Scholar
  • 38 Wang J, Yang W, Xiao W, Cao S. The association between smoking during pregnancy and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Int J Gynaecol Obstet 2022; 157 (01) 31-41
    CrossrefPubMedGoogle Scholar
  • 39 Garg M, Garrison L, Leeman L. et al. Validity of self-reported drug use information among pregnant women. Matern Child Health J 2016; 20 (01) 41-47
    CrossrefPubMedGoogle Scholar
  • 40 Ondersma SJ, Chang G, Blake-Lamb T. et al. Accuracy of five self-report screening instruments for substance use in pregnancy. Addiction 2019; 114 (09) 1683-1693
    CrossrefPubMedGoogle Scholar
  • 41 Hall ES, Wexelblatt SL, Greenberg JM. Self-reported and laboratory evaluation of late pregnancy nicotine exposure and drugs of abuse. J Perinatol 2016; 36 (10) 814-818
    CrossrefPubMedGoogle Scholar
  • 42 Williams PP, Mathews C, Jordaan E, Washio Y, Terplan M, Parry CDH. Validation of simple dichotomous self-report on prenatal alcohol and other drug use in women attending midwife obstetric units in the Cape Metropole, South Africa. Clin Ethics 2020; 15 (04) 181-186
    CrossrefPubMedGoogle Scholar
  • 43 Rodriguez CE, Sheeder J, Allshouse AA. et al. Marijuana use in young mothers and adverse pregnancy outcomes: a retrospective cohort study. BJOG 2019; 126 (12) 1491-1497
    CrossrefPubMedGoogle Scholar