The effect of substance use during pregnancy on neonatal outcomes in Ethiopia: A systematic review and meta-analysis

Abstract

Background Substance use during pregnancy mainly khat chewing (20%) and alcohol drinking (18.1%) are commonly practiced in Ethiopia. However, the effect of using these substances has not been studied nationally yet. Thus, this study was aimed to examine national evidence about the effect of substance use during pregnancy on birth outcome in the country, 2020. Methods Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size and reported effect of antenatal substance use on birth outcome on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the fixed-effects model due to homogenous primary studies (I 2 = 0.0%). Presence of publication bias was detected from asymmetry of funnel plot and statistically significant Egger's test (p = 0.000). Results In this systematic review and meta-analysis, a total of 5,343 mother-neonate pairs were included from 15 studies. Alcohol, khat, cigarette and narghile were used during pregnancy, and significant adverse birth outcomes attributable to these substances were reported. From the pooled effect of alcohol use, drinking mothers were twice (95%CI: AOR = 2.16; 1.16, 3.17) likely to have newborns with birth defect; 9 times (95% CI: AOR = 9.39; 2.84, 15.94) more prone to own low birth weight neonates; and 1.9 times more prone to deliver preterm neonates (95% CI: AOR = 1.93; 0.52, 3.33) than the nondrinkers. Khat users were 2.4 times (95%CI: AOR = 2.4; 1.11, 5.19) more likely to have congenitally defected neonates; and 3.1 times (95%CI: AOR = 3.19; 1.01, 5.37) more risked to possess low birth weight neonates. Furthermore, antenatal cigarette smokers (95% CI: AOR = 4.36 (1.75, 6.98)) and narghile users (95% CI: AOR = 20.1; 3.94, 103) were at 4 and 20 times more likelihood of having low birth weight neonates as compared to their counterparts. Conclusion Prematurity, low birth weight and congenital malformation were the investigated adverse effects of antenatal substance use in Ethiopia. Therefore, the existing public health efforts should be encouraged to help women stop using these substances completely before pregnancy. Moreover, increasing public awareness about the potential negative impacts of substance use during pregnancy on birth outcome would be of greatest importance for comprehensive prevention of the problem.

Maternal Risk Factors for Low Birthweight Neonates in Sana'a city. Yemen: A Case-Control Study

“…Although khat can lower the appetite and have vasoconstrictive effects on the placental blood vessels [25], no significant association was found between khat chewing and LBW neonates in the present study. This finding is contradictory to that reported earlier for LBW in Yemen [12,14,24,27] and Ethiopia [13,15,30]. Moreover, the frequency, pattern, and length of khat sessions showed no association with LBW in the present study.…”

“…LBW can result from several factors, including antenatal substance use [15]. The WHO Expert Committee on Drug Dependence (ECDD) declared that substance use during pregnancy may have adverse obstetric effects such as LBW and stillbirths [15,16]. The present study revealed that consanguinity was significantly associated with the delivery of LBW neonates by Yemeni pregnant women in Sana'a city, where mothers with LBW neonates were 3.7fold more likely to have consanguineous marriages compared to those with NBW neonates.…”

“…Birth weight is the most sensitive indicator of intrauterine fetal insults resulting from different maternal environmental exposures. LBW can result from several factors, including antenatal substance use [15]. The WHO Expert Committee on Drug Dependence (ECDD) declared that substance use during pregnancy may have adverse obstetric effects such as LBW and stillbirths [15,16].…”

Prenatal maternal alcohol exposure: diagnosis and prevention of fetal alcohol syndrome

“…Investigating the use of other potential teratogens during pregnancy is also important [ 12 , 44 ]. Smoking and drinking are highly correlated; therefore, alcoholics are more likely to be heavy smokers [ 37 ].…”

The effects of khat use during pregnancy on perinatal and maternal outcomes: a meta-analysis

“…Khat chewing during pregnancy has been associated with various obstetric, maternal, and child outcomes. A recent meta-analysis on the effects of various types of substance use on neonatal outcomes has demonstrated an association between prenatal khat use and low birth weight (LBW) and congenital anomalies (Bayih et al 2021). Furthermore, khat use has been reported to increase maternal mental distress and several obstetric complications such as pregnancyinduced hypertension, miscarriage, preterm labor, abruption of the placenta, and postpartum hemorrhage (Abdel-Aleem 2015; Nakajima et al 2017;Pinto et al 2010).…”