Cocaine is Associated with Intrauterine Fetal Death in Women with Suspected Preterm Labor

Abstract

The objectives of this study were to determine the rate of recent cocaine use in a metropolitan population of predominantly Hispanic and African-American women with suspected preterm labor and to evaluate the impact of recent cocaine use on intrapartum complications in this population. Urine toxicology screens were prospectively obtained on 102 women with suspected preterm labor. The urine screen did not influence management decisions. Gestational age at delivery, birthweight, and intrapartum complications were compared using Student's t-test, chi-square analysis, or Fisher's exact test. The rate of positive urine drug screens for cocaine was 12.7%. Women with positive toxicology were older (27.8 +/- 5.7 versus 22.1 +/- 4.8 years, p = 0.002) and of higher parity (2 [1 to 7] versus 1 [0 to 7], p = 0.0). Women with positive toxicology were more likely to be black (92.3%) than Hispanic (7.7% [p = 0.0004]). They had more advanced cervical dilation at presentation (3 cm [0 to 6] versus 1 cm [0 to 8], p = 0.008), were more likely to be admitted (85% versus 32%, p < 0.0001), but less likely to receive tocolysis due to advanced dilation or pregnancy complication (36% versus 79%, p = 0.0002). There was no difference in gestational age or birthweight at delivery. There was a significantly higher intrauterine fetal death rate in the cocaine positive group (18.2% versus 0%, p = 0.02). These data suggest that recent cocaine use among women with suspected preterm labor is common in only some segments of an urban population and significantly impacts pregnancy outcome.

Consumption of coffee during pregnancy: Authors should adjust for history of drug abuse

“…They tend to be older, more often multiparous, more likely to be single, less likely to be students, and they had fewer years of education. Interestingly this description matches with the profile of drug users 3 4. For the above reasons we believe that the exclusion of the information of drug abuse from the study is a methodological error.…”

Substance use in pregnancy: The medical challenge

“…152,153 The negative pregnancy outcomes associated with cocaine use include preterm premature rupture of membranes, 154 preeclampsia, placental abruption and infarction, 155 preterm birth, 156 low birth weight, 156 small-for-gestational age, 156 and intrauterine death. 157…”

Preterm Premature Rupture of the Membranes Associated with Recent Cocaine Use

“…In our study, there was a much higher rate of recent cocaine use among African-American women (20.4%) as compared to non-African-Americans (1.2%, p = 0.0001). We have previously reported a very low rate of cocaine use in urban Hispanic women with low socioeconomic status, 9 who comprised 54.6% of this study population. The low rate of use among this group may explain the relatively low rate of positive urine screens in this study.…”

“…Also, we have also previously noted that women with preterm uterine contractions and recent cocaine use present with more advanced cervical dilation than women with a negative urine screen for cocaine. 9 Therefore, we hypothesized that recent cocaine use would be associated with a shorter latency period between rupture of membranes and delivery. To our surprise, we found that women with documented recent cocaine use had a statistically significantly longer latency period than women with negative urine drug screens.…”