Low Birth Weight and Preterm Births: Etiologic Fraction Attributable to Prenatal Drug Exposure

Department of Pediatrics, College of Medicine and College of Public Health, University of Kentucky, Lexington, KY 40536, USA.
Journal of Perinatology (Impact Factor: 2.07). 11/2005; 25(10):631-7. DOI: 10.1038/
Source: PubMed


To determine the factors that would increase the likelihood of outcomes: low birth weight (LBW), preterm births and intrauterine growth restriction (IUGR).
Secondary data analysis from a multi-center study. Risk factors for each outcome were derived from logistic regression models. Odds ratios (OR), 95% confidence intervals, and population-attributable risk proportions (PAR%) were estimated.
Prenatal cocaine exposure increased the likelihood of LBW (OR: 3.59), prematurity (OR: 1.25), and IUGR (OR: 2.24). Tobacco, but not marijuana, significantly influenced these outcomes. Alcohol had an effect on LBW and IUGR. Etiologic fractions (PAR%) attributable to tobacco for LBW, prematurity, and IUGR were 5.57, 3.66, and 13.79%, respectively. With additional drug exposure including cocaine, estimated summary PAR% increased to 7.20% (LBW), 5.68% (prematurity), and 17.96% (IUGR).
Disease burden for each outcome increases with each added drug exposure; however, etiologic fraction attributable to tobacco is greater than for cocaine.

Download full-text


Available from: Linda Wright, Oct 03, 2015
42 Reads
  • Source
    • "From birth, there were significant neurotoxic effects of cocaine exposure independent of other drugs or confounding factors. Fetal growth deficiencies in head circumference , length, and weight signaled prenatal physiologic effects (Singer et al., 2002b) and are characteristic of the majority of studies of CE infants (Bada et al., 2005; Frank et al., 2001). In a separate sample of very low birthweight (<1500 g) infants, we found CE infants to have a higher incidence of intraventricular hemorrhage (Singer et al., 1994) likely related to maternal cardiovascular effects. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The study aims to describe developmental outcomes from a longitudinal prospective cohort (Cleveland study) of prenatally cocaine-exposed (CE) infants. Two hundred eighteen CE and 197 nonexposed infants were enrolled at birth and followed through mid-adolescence. Birth CE status was determined by interview and biologic measures. Multiple demographic, drug, and environmental correlates were controlled. Standardized, normative, reliable measures of fetal growth, intelligence quotient (IQ), behavior, executive function, and language were given at each age and risk for substance misuse assessed in adolescence. A subset of children received volumetric magnetic resonance imaging (MRI) at 7 years and functional MRI at 14 years. The effect of CE was determined through multiple regression analyses controlling for confounders. Cocaine exposed had significant negative effects on fetal growth, attention, executive function, language, and behavior, while overall IQ was not affected. CE had significant negative effects on perceptual reasoning IQ and visual-motor skills and predicted lower volume of corpus callosum and decreased gray matter in the occipital and parietal lobes. CE children had higher risk for substance misuse. Confounding risk factors had additive effects on developmental outcomes. Prenatal exposure to cocaine was related to poorer perceptual organization IQ, visual-spatial information processing, attention, language, executive function, and behavior regulation through early adolescence. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 07/2015; 30(4):285-9. DOI:10.1002/hup.2454 · 2.19 Impact Factor
  • Source
    • "Cigarette smoking during pregnancy remains the largest modifiable risk factor of pregnancy-related morbidity and mortality (Dempsey & Benowitz, 2001). Maternal smoking increases the risk of impaired fetal growth, preterm birth, and low birth weight, among other poor birth outcomes (D'Onofrio et al., 2003; Bada et al., 2005; Knopik et al., 2005; Salihu et al., 2008; McCowan & Horgan, 2009; Stroud et al., 2009; Thiriez et al., 2009). Despite these well-known pregnancy-related adverse consequences, nearly 21% of reproductive-age women in the United States smoke cigarettes (Centers for Disease Control and Prevention, 2008) and roughly 13% continue to smoke during pregnancy (Tong et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Despite the high prevalence and known morbidity and mortality caused by cigarette smoking, 60% to 70% of substance abuse treatment programs lack smoking cessation counseling or fail to offer pharmacotherapy for smoking cessation, including those programs designed to meet the needs of drug-dependent pregnant patients. Previous studies of staff knowledge, attitudes, and practices (S-KAP) at general substance abuse/HIV treatment programs have suggested that staff may contribute to the deficiency in smoking cessation treatment in these settings. It is not known whether similar deficiencies exist at perinatal substance abuse treatment programs. Methods: This study compared cigarette S-KAP in perinatal substance abuse (n = 41) and general substance abuse/HIV treatment (Veterans Affairs [VA] medical center, hospital-, and community-based) workforce samples (n = 335). Results: Significant differences were seen between the 2 groups on all measures, but perinatal staff compared favorably to general staff only on measures of barriers to smoking cessation services. Perinatal staff compared unfavorably on all other measures: knowledge, beliefs/attitudes, self-efficacy, and smoking cessation practices. Pair-wise comparisons of knowledge and beliefs/attitudes revealed a significant difference between perinatal and VA staff; of self-efficacy, between perinatal and staff at all other settings; and of smoking cessation practices, between perinatal and VA and community-based staff. Conclusions: These results-showing deficiencies of perinatal staff on most S-KAP measures-are concerning and suggest that identifying gaps in and improving S-KAP in perinatal substance abuse programs is urgently needed, for which the VA may provide an efficacious model.
    Journal of Addiction Medicine 09/2014; 8(5). DOI:10.1097/ADM.0000000000000068 · 1.76 Impact Factor
  • Source
    • "Cigarette smoking during pregnancy is the largest modifiable risk factor for pregnancy-related morbidity and mortality (Benowitz & Dempsey, 2004). It is known to increase risk of impaired fetal growth, pre-term birth, and low birth weight, in addition to other adverse pregnancy and neonatal outcomes (Bada et al., 2005; Conter, Cortinovis, Rogari, & Riva, 1995; Knopik et al., 2005; Salihu et al., 2008; Stroud et al., 2009; Thiriez et al., 2009). Although the harmful consequences of cigarette smoking while pregnant are well known, smoking during pregnancy remains a serious public health problem. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined the relationship between pregnancy intention and change in perinatal cigarette smoking from a large national sample of women in the United States, the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS). The study sample consisted of 49,510 female smokers. Smoking rates and quantities were captured prior to pregnancy, the last 3months of pregnancy, and postpartum. Changes in smoking were compared between pregnancies classified as intended, mistimed, and unwanted. Regardless of pregnancy intention status, most behavior change happened before the final 3months of pregnancy. Overall, most women were able to quit or reduce smoking. However women with unwanted pregnancies had 0.86 times the adjusted odds of quitting/reducing cigarette smoking compared to women with intended or mistimed pregnancies (95% CI: 0.78, 0.95). Findings suggest early smoking cessation interventions lead to greater change in smoking, regardless of pregnancy intention, although change is more difficult for women with unwanted pregnancies.
    Journal of substance abuse treatment 08/2013; 46(2). DOI:10.1016/j.jsat.2013.07.010 · 2.90 Impact Factor
Show more