To analyze the relationship between perinatal drug/alcohol use and maternal, fetal, neonatal, and postneonatal mortality.
Linked California discharge, birth and death certificate data from 1991-1998 were used to identify drug/alcohol-diagnosed births. Mortality relative risk (RR) ratios were calculated and logistic models were generated for mortality outcomes.
Among 4,536,701 birth records, 1.20% contained drug/alcohol discharge diagnostic codes (n=54,290). The unadjusted RRs for maternal (RR=2.7), fetal (RR=1.3), neonatal (RR=2.4), and postneonatal (RR=4.3) mortality were increased for drug/alcohol-diagnosed births. After controlling for potential confounding, the odds of maternal death for cocaine use (OR=2.15) remained significant as did amphetamine (OR=1.77), cocaine (OR=1.43), polydrug (OR=2.01) and other drug/alcohol use (OR=1.79) for postneonatal mortality.
The association of cocaine use with maternal mortality and any drug/alcohol use with postneonatal mortality supports screening and identifying women using illicit drugs and alcohol during pregnancy. Increased collaboration with drug treatment programs and closer follow-up for drug-using women and their children may improve mortality outcomes.
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"Access to reproductive health services, including contraceptives, prenatal care and mothering services , are a basic human right [5,6], and are particularly important for marginalized, drug-using women who may experience higher rates of maternal morbidity, mortality and negative obstetric, fetal and child outcomes as a result of drug use during pregnancy [7-10]. While research about access to reproductive health services among drug-using FSWs is scarce, a number of studies report that substance-using mothers experience limited or no access to prenatal care because of the stigma attached to maternal substance use during pregnancy [11-13]. "
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to describe levels of pregnancy and contraceptive usage among a cohort of street-based female sex workers (FSWs) in Vancouver.
The study sample was obtained from a community-based prospective cohort study (2006-2008) of 211 women in street-based sex work who use drugs, 176 of whom had reported at least one prior pregnancy. Descriptive statistics were used to estimate lifetime pregnancy prevalence, pregnancy outcomes (miscarriage, abortion, adoption, child apprehension, child custody), and contraceptive usage. In secondary analyses, associations between contraceptive usage, individual and interpersonal risk factors and high number of lifetime pregnancies (defined as greater than the sample mean of 4) were examined.
Among our sample, 84% reported a prior pregnancy, with a mean of 4 lifetime pregnancies (median = 3; IQR: 2-5). The median age of women reporting 5+ pregnancies was 38 years old [interquartile range (IQR): 25.0-39.0] compared to 34 years [IQR: 25.0-39.0] among women reporting 4 or fewer prior pregnancies. 45% were Caucasian and 47% were of Aboriginal ancestry. We observed high rates of previous abortion (median = 1;IQR:1-3), apprehension (median = 2; IQR:1-4) and adoption (median = 1; IQR:1-2) among FSWs who reported prior pregnancy. The use of hormonal and insertive contraceptives was limited. In bivariate analysis, tubal ligation (OR = 2.49; [95%CI = 1.14-5.45]), and permanent contraceptives (e.g., tubal ligation and hysterectomy) (OR = 2.76; [95%CI = 1.36-5.59]) were both significantly associated with having five or more pregnancies.
These findings demonstrate high levels of unwanted pregnancy in the context of low utilization of effective contraceptives and suggest a need to improve the accessibility and utilization of reproductive health services, including family planning, which are appropriately targeted and tailored for FSWs in Vancouver.
Full-text · Article · Aug 2011 · BMC Pregnancy and Childbirth
[Show abstract][Hide abstract] ABSTRACT: ntroduction: The use of drugs by pregnat adolescents is a serious problem of public health because it can harm the mother and the newborn. So, the correct identification of the cases and the correlates of use of drugs in this population are important for the comprehension of this condition, for the identification of adolescents in high risk for this situation and for helping the development of public politics of prevention and correct treatment of these cases. Aims: 1) To check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair. 2) To investigate the association of cocaine and marijuana use during adolescent pregnancy in São Paulo, Brazil, with psychiatric disorders, social status and sexual history. Method: One thousand pregnant adolescents were evaluated using the Composite International Diagnostic Interview, and sociodemographic and socio-economic questionnaire at the obstetric center of a public hospital in São Paulo, Brazil. Hair sample was collected for analysis. Results: Hair analysis detected the use of cocaine and/or marijuana in the third trimester of pregnancy in 60 (6%) patients. 40 (4%) patients used only marijuana, 17 (1.7%) used only cocaine, and 3 (0.3%) used both drugs. None of the patients had reported the use of these substances in their interviews with healthcare professionals. The following are associated with cocaine and/or marijuana use during the third trimester of the pregnancy: Being younger than 14 years of age, having a history of more than 3 sexual partners, and having psychiatric disorders, specifically, bipolar disorder, post-traumatic stress disorder, and somatoform disorder. Conclusion: Although the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drug use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions can be implemented for the mothers as well as for their children. In early adolescence pregnancy, having 3 or more sexual partners in life for this population is significantly associated with the use of cocaine or marijuana during gestation. This association suggests that specific intervention programs should target these young women. Introdução: O uso de drogas por adolescentes grávidas é um grave problema de saúde pública, tanto pelas conseqüências provocadas na saúde da mãe quanto na do recémnato. Por isso a identificação correta dos casos e dos fatores correlacionados ao uso de drogas nessa população são importantes para o entendimento desse fenômeno, para a identificação das adolescentes em alto risco para essa condição e para o auxílio do desenvolvimento de possíveis políticas públicas de prevenção e de tratamento adequado desses casos. Objetivos: 1) Verificar a validade do auto-relato do uso de drogas por adolescentes grávidas, através da comparação de suas respostas a uma entrevista estruturada sobre o seu consumo de cocaína e maconha durante a gravidez com o teste de seus fios de cabelo. 2) Investigar, em uma população de gestantes adolescentes de uma maternidade pública de São Paulo, Brasil, a associação entre o consumo de cocaína e maconha durante a gravidez com distúrbios psiquiátricos, status social e história sexual. Métodos: Mil adolescentes grávidas foram entrevistadas por meio do Composite International Diagnostic Interview no centro obstétrico de um hospital público de São Paulo, foram submetidas ao teste de cabelo para identificar o uso de maconha e de cocaína e responderam a um questionário complementar com informações demográficas e socioeconômicas, de comportamento sexual e de exposição à violência. Resultados: Das 1000 pacientes entrevistadas 6% consumiram drogas durante o terceiro trimestre da gravidez (maconha: 4,0%, cocaína: 1,7%, ambos: 0,3%). Quanto aos fatores correlacionados na população de adolescentes grávidas avaliada, ter três ou mais parceiros sexuais na vida está significativamente associado ao uso de maconha ou cocaína durante a gestação. Esta associação sugere que programas de intervenção específicos devem ser dirigidos a essas jovens. As associações com os Transtornos Somatoforme, Bipolar e de Estresse Pós-traumático sugerem que o uso de drogas pode ser uma tentativa de escapar da rude realidade da vida e os transtornos psiquiátricos são mais um tipo de problema que podem ocorrer, agravando essa realidade. Conclusão: Esse estudo, através de dados obtidos a partir de entrevistada estruturada e exames de confirmação biológica aplicados a uma amostra grande contribui para a obtenção de informações sobre o sub-relato de uso de drogas no terceiro trimestre da gestação de adolescentes e dos fatores correlacionados ao uso drogas por adolescentes grávidas, colaborando para o conhecimento que pode orientar a organização de políticas públicas para a prevenção desse grave problema de saúde pública.