The Impact of Smoking and Other Substance Use by Urban Women on the Birthweight of Their Infants

Abstract

The impact of maternal smoking and other substance use during pregnancy on infant birthweight is demonstrated in a sample of 766 urban women, using data collected in the Washington, D.C. Metropolitan Area Drug Study (DC*MADS). Women residing and giving birth in the District of Columbia were interviewed in 1992. A multivariable linear regression model was used to quantify the association between birthweight and the mother's use of cigarettes, alcohol, or illicit drugs during pregnancy, while controlling for possible confounding variables. The analysis focused on factors, including prenatal care and substance use during pregnancy that may contribute to low birthweight infants born to this sample of urban, predominantly black women. A woman's use of cigarettes, marijuana, and heroin during pregnancy was related to infant birthweight, but her use of alcohol and cocaine during pregnancy was not significantly related. Smoking during pregnancy was a strong predictor for low birthweight, suggesting that targeting more smoking cessation programs for pregnant women, particularly those who may also be illicit drug users, could help reduce adverse health consequences for low birthweight infants.

• Tobacco
• Smoking
• Pregancy
• Low birthweight
• Prenatal substance use

Resumen

El impacto que tiene el fumar y usar otras substancias durante el embarazo sobre el recién nacido, se comprueba mediante una muestra de 766 mujeres de una zona urbana. Los datos recopilados provienen del Estudio de Drogas del Área Metropolitana de Washington, DC (DC* MADS, por sus siglas en inglés). En 1992 se entrevistaron a las mujeres residentes de esa zona que dieron a luz en el Distrito de Columbia. Se utilizó un modelo de regresión lineal multivariable para cuantificar la asociación entre el peso al nacer y el uso de cigarrillos, alcohol o drogas ilícitas por parte de las madres durante el embarazo, controlando las variables confusoras. El análisis se enfocó en factores que incluyen el cuidado prenatal y el uso de substancias durante el embarazo, que pueden contribuir al bajo peso de los recién nacidos de las mujeres en su mayoría de raza negra, en esta muestra urbana. El uso de cigarrillos, marihuana y heroína por una mujer durante el embarazo estuvo relacionado con el peso del recién nacido, pero no hubo una relación significativa con el consumo de alcohol y cocaína. El fumar durante el embarazo resultó ser un factor importante para predecir el bajo peso de los recién nacidos, lo que sugiere que el enfocarse en programas para que las mujeres embarazadas dejen de fumar, específicamente aquellas que usan drogas ilegales, podría ayudar a reducir las consecuencias adversas sobre la salud de los recién nacidos de bajo peso.

Résumé

L'impact sur le poids du nourrisson de la consommation de tabac et d'autres substances par la mère au cours de la grossesse est mis en évidence à partir d'un échantillon de 766 femmes en milieu urbain, sur la base de données collectées dans le cadre de l'étude sur la consommation de drogues menée dans la région métropolitaine de Washington, DC (Metropolitan Area Drug Study, DC*MADS). En 1992, des femmes résidant et ayant accouché dans le District of Columbia ont été interrogées. Un modéle de régression linéaire à plusieurs variables a été appliqué pour quantifier la corrélation entre le poids à la naissance et la consommation de cigarettes, d'alcool ou de drogues illicites par la mère au cours de la grossesse, tout en contrôlant la présence d'éventuelles variables parasites. L'analyse a porté sur les divers facteurs (dont les soins prénataux et la consommation de substances au cours de la grossesse) susceptibles de contribuer, pour cet échantillon de femmes originaires de milieux urbains et à prédominance noire, à la naissance d'enfants ayant un poids insuffisant. La consommation de cigarettes, de marijuana et d'héroïne par des femmes durant leur grossesse a été mise en relation avec le poids de l'enfant, mais la consommation d'alcool ou de cocaïne au cours de cette période n'a pas fait apparaître de corrélations significatives. Le tabagisme en cours de grossesse s'est avéré constituer une variable prédictive importante du poids trop faible à la naissance, ce qui laisse penser que le fait d'axer davantage de programmes de désaccoutumance au tabac sur les femmes enceintes, et notamment sur celles qui seraient susceptibles d'être également consommatrices de substances illicites, pourrait contribuer à réduire les effets néfastes pour la santé chez les bébés présentant un poids insuffisant à la naissance.

Additional information

Notes on contributors

Wendy A. Visscher

Wendy A. Visscher, Ph.D., is an epidemiologist with almost 20 years of health research experience. She has designed and directed epidemiologic surveys, case-control studies, and cohort studies. She is experienced with all modes of data collection, including record abstraction, mail surveys, household screening, in-person and telephone interviewing, biological specimen collection, and clinical interviews and exams. Dr. Visscher has worked in a variety of research areas, including diabetes, drug abuse, mental health, global disease burden, HIV, reproductive epidemiology, radiation, cancer, influenza, and patient outcomes studies. She currently serves as Chair of one of RTI's three Institutional Review Boards (IRBs), and so is familiar with the ethical issues and regulations surrounding research with human subjects. She earned her Ph.D. and M.P.H. in Epidemiology from the University of Minnesota.

Moshe Feder

Moshe Feder, D.Sc., has more than 10 years' experience in statistics including survey sampling, time series analysis of cross-sectional survey data, longitudinal analysis of panel survey data, and other data analyses. Additionally, Dr. Feder has a strong background in mathematics and computing. He is proficient in a number of statistical software packages including Gauss, S-PLUS, R, and SAS, as well as programming languages such as Pascal. Prior to coming to RTI in 2000, Dr. Feder worked on statistics research projects and taught statistics and statistical computing at the University of Southampton, UK, and at Statistics Canada. He earned his D.Sc. in Mathematics from Technion-Israel Institute of Technology, Haifa, Israel, his M.Sc. in Statistics from Carleton University, Ottawa, Ontario, Canada, and his M.Sc. in Mathematics from Technion-Israel Institute of Technology, Haifa, Israel.

Allison M. Burns

Allison M. Burns is a statistician who has been with RTI since June 2000. She applies SAS programming skills to data analysis, quality control, and data management. She has experience with the development of statistical documentation and report tables, data file construction, and developing algorithms for use in data analysis. She has assisted in the development of multivariate logistic models and linear regression models, using both SAS and SUDAAN. Ms. Burns earned a B.S. in Biostatistics and is currently an M.P.H. candidate in Biostatistics at the University of North Carolina at Chapel Hill.

Thomas M. Brady

Thomas M. Brady, Ph.D., is a Service Fellow at the Office of Applied Studies at SAMHSA. His research interests are in maternal child health and dual disorders. He received his Ph.D. (December, 2001) in Public Health Sciences from the University of Illinois School of Public Health in Chicago. He is a native of Philadelphia, Pennsylvania.

Robert M. Bray

Robert M. Bray, Ph.D., is a senior research psychologist and a Principal Investigator and Project Director at RTI with over 25 years of experience directing and analyzing complex studies. His research interests focus on the epidemiology of substance use and other health behaviors in military and civilian populations with an emphasis on understanding the prevalence, causes, correlates, and consequences of these behaviors. Dr. Bray is principal editor of Drug Use in Metropolitan America, which describes, relates, and integrates findings from a large-scale study of drug use among diverse populations in the Washington, D.C. metropolitan area. He has published and presented widely in the area of substance use and health behaviors. Dr. Bray received his Ph.D. in Social Psychology from University of Illinois at Urbana-Champaign.