General Obstetrics and Gynecology: Obstetrics
The Maternal Lifestyle Study: Drug exposure during pregnancy and short-term maternal outcomes,☆☆

https://doi.org/10.1067/mob.2002.121073Get rights and content

Abstract

OBJECTIVE: Reports of maternal effects resulting from drug exposure during pregnancy are inconsistent. The Maternal Lifestyle Study (MLS) is a multicenter, prospective, observational study that was initiated to better define the effects of exposure to illicit drugs during pregnancy on the mother, fetus, and infant. METHODS: Between May 1993 and May 1995, of 19,079 mother-infant dyads that were screened after delivery for cocaine and opiate exposure at four clinical centers (Brown University, University of Miami, University of Tennessee, Memphis, and Wayne State University), 16,988 (89%) met eligibility criteria and 11,811 (70%) of those eligible agreed to participate in the study. Exposure was defined as an admission of use of cocaine or opiates or both or the presence of cocaine or opiate metabolites in meconium as determined by use of gas chromatography–mass spectroscopy assay. Nonexposure was defined as a negative drug use history by interview and a negative immunoassay screen. When exposure could not be confirmed, such as when meconium was not obtained or was inadequate for confirmatory analysis, the mother-infant dyad was excluded (n = 3184). RESULTS: Of the mothers who consented to participate, 50% were African American, 38% were married, 64% were Medicaid recipients, and 95% had at least one prenatal care visit (median, 10 visits). Significant differences (P <.01) between cocaine-opiate exposed (n = 1185) and nonexposed (n = 7442) mothers included race (African American: 74.6% and 47.0%, respectively), mean age (29.6 and 26.1 years, respectively), and polydrug use including any combination of alcohol, tobacco, and/or marijuana (93% and 42%, respectively). Odds ratios (99% CI) indicate that exposed mothers had a significantly higher risk(P <.001) of medical complications including syphilis 6.7 (4.8-9.6), gonorrhea 1.9 (1.3-3.0), and hepatitis 4.8 (2.6-8.91); psychiatric, nervous, and emotional disorders 4.0 (2.2-7.4); and abruptio placenta 2.3 (1.4-3.9). The odds of a positive test for human immunodeficiency virus were higher (available on 28% of the cohort) in the exposed group 8.2 (14.3-15.4). Seventeen cases of maternal acquired immunodeficiency syndrome (AIDS) were identified. Opiate exposure with its attendant needle use significantly increased the risk of hepatitis and AIDS. The number of hospitalizations during pregnancy did not differ between the exposure groups because 11% of patients in each group were hospitalized at least once. However, violence as a cause of hospitalization was more common in the cocaine-exposed group, 19.6 (2.7-144.7). CONCLUSION: This observational study confirmed many of the reported adverse social and serious medical perinatal complications of mothers exposed to cocaine or opiates during pregnancy. The overall prevalence of these risk outcomes was lower than has been reported previously. (Am J Obstet Gynecol 2002;186:487-95.)

Section snippets

Methods

The entire population of mother-infant dyads who agreed to participate, whether exposed or comparison, constituted the phase I study. This study was reviewed and approved by the institutional review board at each of the four participating institutions. Each of the sites obtained an NIDA Certificate of Confidentiality, which ensured confidentiality of information to be solicited from the participants regarding their drug use, and superseded the mandatory reporting of known drug abuse that was in

Results

Recruitment occurred from May 1993 to May 1995, during which 19,079 mothers were screened at the four sites (Table I).

. Maternal-infant recruitment according to birth weight (in grams) category and clinical center in phase I

Empty CellDetroit (3633)Memphis (4898)Miami (5606)Providence (4942)Total (19,079)
A. Total number screened
501-1500355 (10)479 (10)396 (7)231 (5)1461 (8)
1501-2500849 (23)1190 (24)828 (15)693 (14)3560 (19)
>25002429 (67)3229 (66)4382 (78)4018 (81)14,058 (74)
B. Total number eligible*3208 (88)

Comment

Cocaine or opiate use during pregnancy is part of a spectrum of complex, high-risk behaviors that has been reported to result in significantly increased complications for both the mother and infant. A notable result of this large cohort study, which assessed 8627 postpartum women, was its documentation of the relative low frequency of detrimental acute effects compared with previous reports. Many previous drug abuse studies have relied primarily on maternal report. The protection of

Acknowledgements

We thank Elisabeth Ravelo for preparation of this manuscript and John Langer, Kenneth Poole, and Abik Das of Research Triangle Institute (RTI), Research Triangle Park, NC, for their assistance and their review of this manuscript.

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  • Cited by (0)

    Supported by the National Institute of Child Health and Human Development through cooperative agreements (No. U10 HD 21397),a(No. U10 HD 21385),b(No. U10 HD 27856),c(No. U10 HD 27904),dand (No. U01 HD 19897),fand intra-agency agreements with the National Institute on Drug Abuse, Administration on Children, Youth and Families, and the Center for Substance Abuse Treatment. (CSAT)

    ☆☆

    Reprint requests: Charles R. Bauer, MD, University of Miami, Department of Pediatrics (R-131), PO Box 016960, Miami, FL 33101. E-mail: [email protected]

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