ABSTRACT: To examine the health care and hospitalizations of young children (birth to age 2 years) born to cocaine-using women and to assess the extent to which premature births account for differences between these children and comparison children.
A retrospective cohort design using a repeat-matching method: comparison children were matched to subjects with exposure to cocaine on 6 sociodemographic variables, first, without attention to gestational age and then using the gestational age as additional matching variable.
City hospitals and primary care clinics.
Children of women giving birth at a single hospital.
Hospital admission and indexes of health care use for children from birth to age 2 years.
Of the 139 subjects with exposure to cocaine, 23% were born prematurely compared with only 6% in the first comparison ( P < .001). At birth, children with exposure to cocaine remained in the hospital longer (P < .01), but this difference was explained by the increased prevalence of prematurity. By age 2 years, these children had significantly fewer visits for health care maintenance (P < .001), were less likely to have completed immunizations (P < .05), and spend more days in the hospital than comparison children. These differences were not related to prematurity, but were explained by differences in sociodemographic characteristics.
Although prematurity is the major reason for lengthier hospital stays at birth of children with exposure to cocaine, adverse social factors contribute most to inadequate preventive health care and increased stays in the hospital in subsequent years.
Archives of Pediatrics and Adolescent Medicine 02/1998; 152(2):177-84. · 4.14 Impact Factor
ABSTRACT: Previous studies of maltreatment of children born to women who used cocaine during pregnancy have relied on either selected samples of infants identified at birth or biased, high-risk samples referred to protective services.
To determine the relative risk of either maltreatment or placement outside the home during the first 2 years of life in children born to women who used cocaine during pregnancy compared with a sociodemographically similar comparison group.
We reviewed the medical records of consecutive deliveries at Yale-New Haven Hospital from August 1, 1989 through September 30, 1990. Of the 1140 women who were eligible for the study, 173 had a positive history and/or a positive urine test for cocaine; 139 of the infants were included in the study. A comparison group of infants was chosen from 526 women whose obstetric records indicated that they had not used cocaine during pregnancy based on at least two separate notations in the record. For each of the 139 cocaine-exposed infants, an infant was chosen from the comparison group based on seven matching characteristics: date of birth, race, method of payment for the hospitalization, gestational age, mother's parity, mother's age at delivery, and timing of the first prenatal visit.
Children's medical records at the only two hospitals in the region, the two neighborhood health centers, and the only health maintenance organization were reviewed from birth to 2 years of age. Each injury was classified by two independent reviewers who used predefined criteria to distinguish maltreatment (physical abuse, neglect, or abandonment) from unintentional injuries. Placements outside the home were categorized according to whether the placement was in foster care or with a relative.
The children were mainly African-Americans (80%), and most were enrolled in Medicaid (96.5%). By 2 years of age, 9.3% of the infants in the cocaine-exposed group versus 1.4% in the comparison group had been maltreated [matched relative risk = 6.5; 95% confidence interval (CI) = 1.47, 28.80], and 25.9% vs 8.6% had spent some time in placement (matched relative risk = 5.0; 95% CI = 2.08, 12.01). After controlling for differences between the groups in baseline clinical and social variables, the adjusted odds ratios for both maltreatment (3.98; 95% CI = .81, 22.80) and placement (1.66; 95% CI = .74, 17. 83) decreased and were no longer statistically significant.
In this population-based study, children born to women who used cocaine during pregnancy were at a substantially increased risk of maltreatment or placement outside the home compared with a sociodemographically similar comparison group. Differences in baseline variables between the two groups, however, partially accounted for this increased risk. Therefore, a mother's use of cocaine is more likely a marker of increased risk rather than a single explanatory variable.
PEDIATRICS 09/1997; 100(2):E7. · 4.47 Impact Factor
ABSTRACT: Previous case-control or cross-sectional studies have provided conflicting results about whether children of teenage mothers are at increased risk of maltreatment compared with children of older mothers. This study is the first to examine this question using a longitudinal, cohort design and the first to address important methodologic issues such as detection bias. Subjects were 219 consecutive index children born to inner-city women who were 18 years or younger and 219 sociodemographically similar comparison children born to women 19 years or older. Data were collected by reviewing the medical records of each child through the fifth birthday. Three outcomes were examined: maltreatment, poor growth, and a change in the child's primary caretaker. Maltreatment was ascertained by having two experts, one of whom was blind to the group status, review each injury documented in the records. Predefined criteria were used to distinguish unintentional injuries from maltreatment (abuse, neglect, or sexual abuse). Maltreatment occurred more frequently in the children of young mothers (12.8%) than in the comparison group (6.4%) (risk ratio [RR] = 2.00; 95% confidence interval [CI] = 1.17, 3.64). Poor growth, defined by growth criteria, occurred in 6.9% of the index group and in 4.1% of comparison children (RR = 1.67; 95% CI = 0.75, 3.73). A change in the child's primary caretaker, either because of placement in foster care or because the mother left the home, occurred in 12.8% of the index group and in 3.2% in comparison children (RR = 4.00; 95% CI = 1.80, 8.87).(ABSTRACT TRUNCATED AT 250 WORDS)
Pediatrics 04/1993; 91(3):642-8. · 5.44 Impact Factor