708 The relationship between toxicology-confirmed illicit drug use close to delivery and placental pathology

Abstract

Illicit drug use continues to rise among women of reproductive age. Tobacco and alcohol demonstrated a strong association with placental insufficiency in prior studies. Less is known about the impact illicit drugs of abuse may have on the placenta. We aim to evaluate the association between toxicology-confirmed illicit drug use within 72 hours of delivery and placental pathology. This is a retrospective study of patients delivered between January 2016 and December 2019. Singleton pregnancies with urine drug screen performed within 72 hours of delivery and placenta sent to pathology at time of delivery were included. Current tobacco and alcohol users were excluded. Placental pathology (PP) findings (divided into vascular malperfusion and inflammation) and neonatal outcomes were compared between women that tested negative for drugs (NDS) and positive for one or more illicit drugs (IDU). Independent t-tests were used to calculate differences in demographics and outcomes. 466 NDS and 52 IDU patients were identified. IDU were likely to be younger (p=.024), white, non-Hispanic (p=.001) and to have a psychiatric history (p=.003). There was no difference in BMI, parity and preexisting conditions among the groups except for thrombophilia, which only occurred in NDS. Gestational age at delivery and antepartum complications were similar among the groups except for gestational diabetes, which only occurred in NDS. IDU were more likely to have placental inflammation (Table-1) however rates of vascular malperfusion were similar among the groups. IDU had lower birth weight (p=.006) and higher composite neonatal morbidity (p=.043) (Table-2). Rates of NICU admission (p=.026), Respiratory Distress Syndrome (p=.026) and Neonatal Abstinence Syndrome (p=.015) were higher among IDU. Vascular malperfusion was similar among the two groups, which may be accounted for by the higher rate of GDM and Thrombophilia in the NDS group. Inflammation was more frequent in the IDU group. Illicit drug use demonstrates a significant relationship with adverse PP and adverse neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)