Prenatal hazardous substance use and adverse birth outcomes

Abstract

Objective: Assess the relative effects of a variety of illicit and licit drugs on risk for adverse birth outcomes. Methods: We used data from two large prospective investigations, and a novel analytic method, recursive partitioning class analysis to identify risk factors associated with preterm birth and delivering a small for gestational age infant. Results: Compared to cocaine and opiate non-users, cocaine users were 3.53 times as likely (95% CI: 1.65-7.56; p = 0.001) and opiate users 2.86 times as likely (95% CI: 1.11-7.36; p = 0.03) to deliver preterm. The odds of delivering a small for gestational age infant for women who smoked more than two cigarettes daily was 3.74, (95% CI: 2.47-5.65; p<0.0001) compared to women who smoked two or less cigarettes daily and had one previous child. Similarly, less educated, nulliparous women who smoked two or fewer cigarettes daily were 4.12 times as likely (95% CI: 2.04-8.34; p < 0.0001) to have a small for gestational age infant. Conclusions: Among our covariates, prenatal cocaine and opiate use are the predominant risk factors for preterm birth; while tobacco use was the primary risk factor predicting small for gestational age at delivery. Multi-substance use did not substantially increase risk of adverse birth outcomes over these risk factors.

Keywords::

• Preterm birth
• PTB
• small for gestational age
• SGA
• cocaine
• opiate
• cigarette
• poly-substance use

Acknowledgements

This work was supported by a grant from the Doris Duke Charitable Foundation and the Yale Child Study Center. The PRIDE-P study was supported by Grant R01 DA 019135 from the National Institute on Drug Abuse to Drs. Yonkers, and Rounsaville and Grant R01HD045735 from the National Institute of Child Health and Human Development to Dr. Yonkers.

Declaration of Interest: Dr Yonkers is recipient of honoraria from Up To Date. Grants given to Yale but used by Dr. Yonker’s lab include an investigator initiated grant to treat postpartum depression that is funded by Lilly. In addition, study medications have been received from Pfizer to support a multicenter study on the treatment of premenstrual dysphoric disorder. We have no other disclosures among the remaining authors.