Prenatal Drug Use Research Articles

Drug Use during Pregnancy

Prevention and intervention services for pregnant, drug-using women have often developed prior to gaining empirical data on the antecedents of prenatal drug use. These data are important to address some of the underlying factors of drug use during pregnancy. A review of the literature indentified at least six categories of psychosocial risk factors that have been investigated as relevant to drug use among women, including pregnant women. These factors include: (1) history of childhood sexual abuse, (2) family history of alcohol or drug problems, (3) male partner's alcohol or drug use, (4) current depression, (5) social support, and (6) homelessness or transiency. An examination of these psychosocial risk factors indicates that the existing literature on these factors in drug use is limited by a lack of methodological rigor, resulting in large variations in prevalence rates due to factors such as definition. This paper summarizes the existing literature and methodological iussues regarding the relation between psychosocial risk factors and drug use among women, including pregnant women. It also discusses some of the limitations and issues in assessing prenatal drug use with a particular focus on self-report and urine toxicologies.

Frequency of Prenatal Drug Abuse: Assessment, Obstacles, and Policy Implications

The scope of interventions into social problems is based on an accurate assessment of the nature of that problem. An accurate, biased or ambiguous analysis has serious consequences for the efficacy of social interventions. This may indeed be the case with studies on the prevalence of prenatal drug use. This paper examines 23 studies conducted since 1980 and finds that the data have a number of serious methodological issues that compromise their utility in determining the breadth and characteristics of the problem.

THE EFFECT OF MATERNAL DRUG USE ON BIRTH WEIGHT: MEASUREMENT ERROR IN BINARY VARIABLES

We develop a method to correct for non‐random measurement error in a binary indicator of illicit drugs. Our results suggest that estimates of the effect of self‐reported prenatal drug use on birth weight are biased upwards by measurement error—a finding contrary to predictions of a model of random measurement error. More accurate estimates of the true effect of drug use on birth weight can be obtained by using the predicted probability of falsely reporting drug use. Thus out‐of‐sample information on drug use may improve estimates of the effect of reported drug use in other settings.

Association of maternal drug use during pregnancy with maternal HIV culture positivity and perinatal HIV transmission.

To evaluate the relationship of drug use with maternal HIV culture positivity at delivery and perinatal HIV transmission. Multicenter prospective cohort study. Obstetric and pediatric clinics in five cities in the United States. Five hundred and thirty HIV-infected pregnant women and their infants. Multivariate logistic regression was used to evaluate the association of 'hard drug' use (one or more of the following: cocaine, heroin/opiates, methadone, injecting drug use) assessed by self-report and urine toxicology with positive maternal HIV culture at delivery and perinatal HIV transmission. Forty-two per cent of women used hard drugs during pregnancy. Increased probability of a positive maternal delivery HIV culture was significantly associated with prenatal hard drug use [odds ratio (OR), 3.08] and maternal cocaine use (OR, 2.98) among HIV-infected women with > 29% CD4+ lymphocytes. After adjusting for maternal culture positivity at delivery, CD4+ lymphocyte percentage and gestational age, significantly greater transmission risk was observed with hard drug use among women with membrane rupture > 4 h. On the basis of self-report and urine toxicology, overall maternal hard drug use and cocaine use in the WITS cohort were associated with maternal HIV culture positivity at delivery, and maternal hard drug use was associated with perinatal transmission.

Prosecutors as Crime Creators: The Case of Prenatal Drug Use

This article examines prosecutors' adoption of the crime creator role in matters surrounding prenatal drug use. By interpreting substantive criminal statutes expansively, prosecutors attempted to criminalize women's prenatal behavior. Their crime creation activities were carried out against the backdrop of the war on drugs and the contemporary child protection movement. Although the courts rejected prosecutors' attempts to criminalize prenatal drug use, questions remain about whether this social problem should be criminalized. Moreover, prosecutors' crime creation activities raise questions about the appropriate use of discretionary authority and reveal the tensions between the desire to convict and the obligation to seek justice.

Prenatal drug use in Minneapolis-St Paul, Minn. A 4-year trend

To determine the rates of maternal ingestion of cocaine, marijuana, and opiates in women from Minneapolis-St Paul, Minn, in 1993 and compare them with rates observed in 1989; and to compare outcomes of newborns born to those women with and without evidence of prenatal drug ingestion. The meconium from newborns of a representative cluster-based sample of women from Minneapolis-St Paul was analyzed for metabolites of cocaine, marijuana, and opiates. The newborns were consecutive births in four urban and suburban hospitals. Maternal demographic information and newborn outcome data were collected and matched to the meconium samples. The race, age, and socioeconomic status of the mothers whose newborns were screened were the same as the demographic characteristics of all women delivering babies in Minneapolis-St Paul in 1990 and 1991. Metropolitan hospitals of Minneapolis-St Paul. Of the 1333 samples, 27 (2.0%) were cocaine positive, 35 (2.6%) were tetrahydrocannabinol positive, and 16 (1.2%) were opiate positive. There were 168 women (22.6%) reporting that they smoked. Detection of tetrahydrocannabinol and cocaine was more common in newborns of women of color, those receiving medical assistance, and those over age 23 years. Newborns with meconium samples positive for cocaine or tetrahydrocannabinol had slightly lower average birth weights but were no more likely to be premature or to require neonatal intensive care unit admission than newborns with no drugs detected in their meconium. Newborns of mothers who smoked throughout pregnancy had lower average birth weights and higher rates of prematurity and neonatal intensive care unit admissions. Standardized rates of cocaine detection in the four hospitals decreased from 4.0% in 1989 to 2.0% in 1993. Rates of perinatal cocaine detection have declined in the Twin Cities of Minneapolis-St Paul over the past 4 years. In this population, self-reported smoking was associated with more serious adverse outcomes of the newborns than was the detection of cocaine, marijuana, or opiates.

Prenatal care and drug use in pregnant women

This case-control study tested the hypothesis that pregnant inner-city women with low utilization of prenatal care are likely to be frequent drug users. Cases registered consecutively for prenatal care at ≥ 28 weeks gestation or had < 4 prenatal visits. Controls were matched to cases by date of delivery. 24 81 (30%) cases and 16 128 (12%) controls were frequent drug users (adjusted odds ratio = 2.5; 95% CI, 1.2–5.4). Drug use ( P = 0.01) and socioeconomic status ( P = 0.001) were significantly correlated with prenatal care utilization. Self-report alone failed to note as many drug users as toxicology screen alone. Both substance use history and toxicology screen are advisable in women with low utilization of prenatal care.

Recognizing illicit drug use by pregnant women: reports from Oregon birth attendants.

This study was undertaken to determine the prevalence of recognized prenatal illicit substance abuse and the characteristics of women being identified as illicit drug users in a statewide population-based cohort. During a 1-month period, birth attendants of all singleton births in Oregon (n = 3200) were surveyed regarding their knowledge of prenatal illicit drug use by women who gave birth. Birth certificates were linked to surveys after removal of personal identifiers. Illicit drug use was recognized in 5.2% of delivering women. Nearly half had used cocaine, methamphetamine, or heroin. Recognized users were significantly more likely than nonusers to be unwed and to have used tobacco or alcohol, have received inadequate prenatal care, and have public assistance as a source of payment. Drug use was recognized twice as frequently by practitioners who routinely questioned their patients about it compared with those who relied on clinical judgment or the occurrence of complications during pregnancy. Birth certificate reporting identified only 41% of recognized users. Oregon practitioners are identifying seven times as many drug-using women as can be accommodated by available treatment programs for this population. Increased efforts are needed to ensure the adequacy of resources necessary to cope with the problem as already recognized.

Correlates of battering during pregnancy.

Battering during pregnancy affects the health of both pregnant women and their unborn children. The purpose of this retrospective study of 488 primarily Medicaid-eligible postpartum women was to identify the constellation of factors associated with violence. The prevalence of battering during pregnancy was 7%, similar to that found in other studies. Significant correlates of battering included anxiety, depression, housing problems, inadequate prenatal care, and drug and alcohol use. Woman battering by a partner during pregnancy was associated with a greater severity of this constellation of patterns than those experiencing abuse before pregnancy only, or those experiencing physical attack by someone other than their partner. These factors are important to recognize in nursing assessment of pregnant women.

Drug abuse research and HIV/AIDS: a national perspective from the US.

The National Institute on Drug Abuse (NIDA), the lead Federal agency charged with research on reducing the demand for illicit drugs in the US, has actively pursued the associated challenge of reducing drugs-related HIV transmission. Drug abuse-related spread of the virus occurs not only through sharing contaminated needles but also sexually to partners and perinatally from infected mothers to their offspring. Through a national research and demonstration program, NIDA supports primary AIDS risk reduction activities focused on identifying effective drug abuse prevention and treatment strategies. AIDS is increasingly a disease found in women, children, minorities, and people who live in rural areas. NIDA's efforts are clearly responsive to the changing nature of this epidemic. Among the many promising initiatives currently underway are a medications development program to find new pharmacotherapies for treating drug addiction; an array of National AIDS Outreach Demonstration Projects implementing alternative control strategies for drug abusers not attracted to or successful in drug abuse treatment; establishment of several treatment research units for designing and conducting studies on treatment effectiveness; and a variety of programs aimed at identifying and potentially reducing the risks of prenatal drug use to both mother and child. Effective dissemination of our findings is particularly critical to the overall impact of our research efforts. Collaborative activities teaming NIDA with a multitude of organizations also addressing AIDS related issues are designed to provide a synergistic impact on this complex and multifaceted public health crisis.

The Problem of the Drug-Exposed Newborn: A Return to Principled Intervention

A vast and novel predicament confronts the child welfare system. In steadily increasing numbers throughout the nation, infants are born drug-exposed as a result of their mothers' prenatal drug use.' This phenomenon appears novel, for while the child welfare system is accustomed to contending with post-birth parental conduct, today the system must face the implications of prenatal parental conduct for the

Correlates of neonatal morbidity: maternal characteristics and family resources.

The association of mental characteristics, family resources, and receipt of prenatal care with infant birth weight, gestational age, and Apgar scores was assessed in a retrospective review of an extant computerized data base of admissions to a neonatal intensive care unit (NICU; n = 3,818). Prediction variables included mother's age, marital status, health insurance, parity, prenatal health problems, and prenatal drug use. Less favorable infant birth status was associated with prenatal health problems, being single, not having private insurance, obtaining a prior elective abortion, prenatal drug use, and not receiving prenatal care. Stepwise multiple regressions of predictor variables to birth weight and lack of prenatal care were performed. Low birth weight was associated with being single, receiving no prenatal care, and being Black. Lack of prenatal care was associated with mother's age, high parity, prenatal health problems, and prenatal illicit drug use. Pediatric interventions assessing maternal social and behavioral characteristics are proposed.

Correlates of Parenting on a Neonatal Intensive Care Unit: Maternal Characteristics and Family Resources

The association of maternal characteristics, family resources, and receipt of prenatal care with parenting behaviors observed in a neonatal intensive care unit (NICU; n = 383) was assessed. The parenting behavior of mothers not receiving prenatal care (n = 128) was compared to that of mothers of the preceding and subsequent admissions (n = 256) by retrospective chart review. Parenting variables included frequency of visits to the NICU and evaluative ratings of parents' involvement with their infant. Parenting of the no-prenatal-care group was significantly less favorable than the control on all comparisons. Factor analysis supported a priori grouping of parenting variables. A stepwise multiple regression of maternal and family characteristics to the factor-derived variable, parenting, showed significant contributions for prenatal drug use and father involvement. Pediatric interventions assessing maternal social and behavioral characteristics are proposed.