Epidemiology and Effects of Substance Use in Pregnancy

Cook, Jocelynn L.; Green, Courtney R.; Ronde, Sandra de la; Dell, Colleen Anne; Graves, Lisa; Ordean, Alice; Ruiter, James; Steeves, Megan; Wong, Suzanne

doi:10.1016/j.jogc.2017.07.005

Cited by 61 publications

(70 citation statements)

References 54 publications

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“…We found that prevalence of preterm birth was similar to national estimates; prevalence of PPCM and GDM was similar to previous reports in smaller California cohorts in which diagnoses were confirmed by manual chart review 19 21. Reports of substance abuse were lower in our cohort than in other reports 39. Literature review of ICD-9 coding for pre-eclampsia, gestational HTN and HDP shows low sensitivity and high specificity,40 while ICD-9 coding for outcomes such as MI, HF and stroke shows high sensitivity and specificity 41–43.…”

Section: Discussioncontrasting

confidence: 63%

Pregnancy complications and premature cardiovascular events among 1.6 million California pregnancies

et al. 2019

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BackgroundCardiovascular complications of pregnancy present an opportunity to assess risk for subsequent cardiovascular disease. We sought to determine whether peripartum cardiomyopathy and hypertensive disorder of pregnancy subtypes predict future myocardial infarction, heart failure or stroke independent of one another and of other risks such as gestational diabetes, preterm birth and intrauterine growth restriction.Methods and resultsThe California Healthcare Cost and Utilization Project database was used to identify all hospitalised pregnancies from 2005 to 2009, with follow-up through 2011, for a retrospective cohort study. Pregnancies, exposures, covariates and outcomes were defined by International Classification of Diseases, Ninth Revision codes. Among 1.6 million pregnancies (mean age 28 years; median follow-up time to event excluding censoring 2.7 years), 558 cases of peripartum cardiomyopathy, 123 603 hypertensive disorders of pregnancy, 107 636 cases of gestational diabetes, 116 768 preterm births and 23 504 cases of intrauterine growth restriction were observed. Using multivariable Cox proportional hazards models, peripartum cardiomyopathy was independently associated with a 39.2-fold increase in heart failure (95% CI 30.0 to 51.9), resulting in ~1 additional hospitalisation per 1000 person-years. There was a 13.0-fold increase in myocardial infarction (95% CI 4.1 to 40.9) and a 7.7-fold increase in stroke (95% CI 2.4 to 24.0). Hypertensive disorders of pregnancy were associated with 1.4-fold (95% CI 1.0 to 2.0) to 7.6-fold (95% CI 5.4 to 10.7) higher risk of myocardial infarction, heart failure and stroke, resulting in a maximum of ~1 additional event per 1000 person-years. Gestational diabetes, preterm birth and intrauterine growth restriction had more modest associations.ConclusionThese findings support close monitoring of women with cardiovascular pregnancy complications for prevention of early cardiovascular events and study of mechanisms underlying their development.

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Section: Discussioncontrasting

confidence: 63%

Pregnancy complications and premature cardiovascular events among 1.6 million California pregnancies

et al. 2019

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“…Moreover, despite pregnancy recognition usually being a motivator for behavior change among pregnant women (Alshaarawy et al., ), many women continue to use alcohol and/or illicit drugs during pregnancy (Butt et al., ; Center for Behavioral Health Statistics and Quality, ; Forray, ; Terplan et al., ). Prenatal alcohol exposure can result in miscarriage, stillbirth, preterm birth, intrauterine growth restriction, neurodevelopmental deficits, speech and language delays and disorders, and fetal alcohol spectrum disorders (Cook et al., ; Forray and Foster, ; Jones and Smith, ; May et al., ; Williams and Smith, ), and prenatal illicit drug exposure increases the risks for miscarriage, intrauterine growth restriction, premature birth, and stillbirth (Behnke and Smith, ; Forray and Foster, ; Narkowicz et al., ). Furthermore, after the child is born, many women return to pre‐pregnancy levels of alcohol or drug consumption (de Vries et al., ; Forray et al., ; Lanting et al., ; May et al., ).…”

mentioning

confidence: 99%

The Efficacy of Technology‐Based Interventions for Alcohol and Illicit Drug Use Among Women of Childbearing Age: A Systematic Review and Meta‐Analysis

Hai

Hammock

Velasquez

2019

Alcoholism Clin & Exp Res

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Background: Alcohol and illicit drug use is prevalent among women of childbearing age and may lead to higher risk for substance-exposed pregnancy and related health consequences for both women and their offspring. Technology-based interventions (TBIs) are increasingly used to prevent or reduce substance use among women of childbearing age. The efficacy of these approaches, however, is unclear. This review critically reviewed existing research evidence from randomized controlled trials (RCTs) on the efficacy of TBIs in preventing and reducing alcohol and illicit drug use among childbearing-aged women.Methods: Seven electronic databases were searched to identify eligible studies. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Robust variance estimation in meta-regression was used to estimate effect sizes and conduct moderator analyses.Results: Fifteen RCTs including 3,488 participants were included in the systematic review. Metaanalysis results based on 13 RCTs suggest that TBIs were efficacious relative to control conditions in preventing and reducing substance use among women of childbearing age (d = 0.19, 95% CI = 0.02, 0.35). Preliminary moderator analysis results suggest that the efficacy of TBIs might not vary by participant age, race/ethnicity, the type of technology used, or whether a virtual health assistant was used. TBIs' efficacy in terms of specific substance use types (alcohol use and illicit drug use) or control types (inactive control and active controls) was inconclusive, due to the limited number of studies in each category.Conclusions: This systematic review and meta-analysis found evidence of TBIs' efficacy in reducing alcohol and illicit drug use among women of childbearing age. Implications for future research and practice are discussed.

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“…This nding is comparable to surveys across jurisdictions that have found 1-5% of women report illicit drug use in pregnancy. [10][11][12][13][14][15][16] Within the present sample, maternal ACEs were common and associated with a two to four-fold increase in illicit drug use during pregnancy. A US study among young, single, low-income, African-American women found a strong dose-dependent association between maternal ACEs and illicit drug use in pregnancy.…”

Section: Discussionmentioning

confidence: 91%

“…[7][8][9] Across surveys, approximately 1-5% of women report illicit drug use in pregnancy, with biomarker research suggesting the actual prevalence is higher. [10][11][12][13][14][15][16] Illicit drug use has acute and long term toxic impacts on pregnant women and children due to exposure to the drug, the uncertainty of the dose being taken, and the contamination of illicit drugs with other substances and chemicals. 11,17−21 In Canada, fentanyl has been detected in the illegal drug supply country-wide across jurisdictions.…”

Section: Introductionmentioning

confidence: 99%

Adverse Childhood Experiences are Associated with illicit drug use among pregnant women with middle to high socioeconomic status: Findings from the All Our Families Cohort

Currie

Tough

2020

Preprint

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Abstract Background: Adverse childhood experiences (ACEs) are associated with illicit drug use among pregnant women who are socioeconomically vulnerable. While it is assumed that the impact of ACEs on illicit drug use is reduced among pregnant women who are well educated and have higher socioeconomic status, this assumption has not been well tested in the literature. The objective of this study was to examine the impact of maternal ACEs on illicit drug use among pregnant women who are well-educated women, have middle to high household incomes, and seeking regular prenatal care. Findings can inform clinicians about potential associations between ACEs and drug use in pregnancy within a population that they are frequently in contact with. Methods: This study is a secondary analysis of a prospective cohort study that collected data from 1,680 women during and after pregnancy in Calgary, Canada between 2008-2011 using mailed surveys. Illicit drug use in pregnancy was self-reported by women at 34-36 weeks gestation. An established scale examined maternal ACEs before 18 years. Logistic regression models and 95% confidence intervals tested associations between maternal ACE scores and illicit drug use in pregnancy. Results: Overall, 3.3% of women in this predominantly married, well-educated, middle and upper middle income sample (mean age 31 years) reported illicit drug use in pregnancy. Women with 2-3 ACEs had more than a two-fold increase, and women with 4 or more ACEs had almost a four-fold increase in illicit drug use in pregnancy, relative to women with 0-1 ACEs after adjustment for confounders. Exposure to child abuse was more consistently associated with illicit drug use in pregnancy than exposure to household dysfunction in childhood. Conclusions: Findings combine with others to speak to the public health significance of maternal ACEs on substance use among expectant mothers across the socioeconomic spectrum; particularly child abuse. This information, can be used by women and the clinicians serving them, to better understand the role that ACEs could play in their decision to use illicit drugs in pregnancy.

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Epidemiology and Effects of Substance Use in Pregnancy

Cited by 61 publications

References 54 publications

Pregnancy complications and premature cardiovascular events among 1.6 million California pregnancies

Pregnancy complications and premature cardiovascular events among 1.6 million California pregnancies

The Efficacy of Technology‐Based Interventions for Alcohol and Illicit Drug Use Among Women of Childbearing Age: A Systematic Review and Meta‐Analysis

Adverse Childhood Experiences are Associated with illicit drug use among pregnant women with middle to high socioeconomic status: Findings from the All Our Families Cohort

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