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Hayer S, Garg B, Wallace J, Prewitt KC, Lo JO, Caughey AB. Prenatal methamphetamine use increases risk of adverse maternal and neonatal outcomes. Am J Obstet Gynecol 2024; 231:356.e1-356.e15. [PMID: 38789069 PMCID: PMC11344678 DOI: 10.1016/j.ajog.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Although methamphetamine use has been increasing in recent years and occurring within new populations and in broader geographical areas, there is limited research on its use and effect in pregnancy. OBJECTIVE This study aimed to examine the association between prenatal methamphetamine use and maternal and neonatal outcomes in a large, contemporary birth cohort. STUDY DESIGN This was a retrospective cohort study using California-linked vital statistics and hospital discharge data from 2008 to 2019. Methamphetamine use was identified using the International Classification of Disease, Ninth Revision and Tenth Revision, codes. Chi-square tests and multivariable Poisson regression models were used to evaluate the associations between methamphetamine use and maternal and neonatal outcomes. RESULTS A total of 4,775,463 pregnancies met the inclusion criteria, of which 18,473 (0.39%) had methamphetamine use. Compared with individuals without methamphetamine use, individuals with methamphetamine use had an increased risk of nonsevere hypertensive disorders (adjusted risk ratio, 1.81; 95% confidence interval, 1.71-1.90), preeclampsia with severe features (adjusted risk ratio, 3.38; 95% confidence interval, 3.14-3.63), placental abruption (adjusted risk ratio, 3.77; 95% confidence interval, 3.51-4.05), cardiovascular morbidity (adjusted risk ratio, 4.30; 95% confidence interval, 3.79-4.88), and severe maternal morbidity (adjusted risk ratio, 3.53; 95% confidence interval, 3.29-3.77). In addition, adverse neonatal outcomes were increased, including preterm birth at <37 weeks of gestation (adjusted risk ratio, 2.85; 95% confidence interval, 2.77-2.94), neonatal intensive care unit admission (adjusted risk ratio, 2.46; 95% confidence interval, 2.39-2.53), and infant death (adjusted risk ratio, 2.73; 95% confidence interval, 2.35-3.16). CONCLUSION Methamphetamine use in pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes that persists after adjustment for confounding variables and sociodemographic factors. Our results can inform prenatal and postpartum care for this high-risk, socioeconomically vulnerable population.
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Affiliation(s)
- Sarena Hayer
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Jessica Wallace
- Department of Family Medicine, University of Colorado, Denver, CO
| | - Kristin C Prewitt
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Department of Internal Medicine, Addiction Medicine Section, Oregon Health & Science University, Portland, OR
| | - Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Blanchot A, Antal MC, Ameline A, Gheddar L, Arbouche N, Raul JS, Kintz P. Pregnancy denial and unplanned home delivery: Considerations about fetal death causes and maternal drug use imputability. Forensic Sci Int 2023; 342:111538. [PMID: 36543017 DOI: 10.1016/j.forsciint.2022.111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
Determining fetal death causes is a complex problem for the forensic pathologist. Beyond the medico-legal context, the expert must be able to evaluate the viability of the fetus at the time of death, to eliminate in-utero fetal death and to determine if the death is related to a fetal, a maternal, a placental cause, or simply related to obstetrical complications. The authors present the case of a 21-year-old woman who unexpectedly gave birth to a fetus during a party. As pregnancy was not acknowledged by the mother (regular menstrual cycles and use of hormonal contraception), no obstetrical check-up had been performed. She would have presented violent abdominal pain and expelled a mass in the toilet. The fetus body, enclosed in the amniotic pouch, and the placenta were found in the toilet. A forensic autopsy was performed jointly by a forensic pathologist and a specialist in fetal pathology. Histological, toxicological and genetic samples were collected. Body morphometry and bone maturation indicated a gestational age of 31-32 weeks of amenorrhea. A significant asphyxia syndrome and non-specific multi-visceral congestion were noted at autopsy. Histological analysis of the fetal tissues revealed a lung and skeletal muscle maturation in accordance with the estimated term. At the brain level, there were signs of anoxia and abnormal cortical development with periventricular nodular heterotopia areas. The placenta microscopic analysis revealed acute chorioamniotitis, the probable cause of the premature fetal expulsion. Toxicological analyses revealed the presence of ecstasy (48 ng/mL) and its metabolite MDA (2 ng/mL) in fetal blood. Although negative in blood, THC-COOH tested positive in urine (9 ng/mL). The fetus was repetitively exposed to cannabis, as Δ9-THC tested positive in hair (51 pg/mg). Maternal hair analysis on 4 × 3 cm evidenced a long-term use of cannabis, while results support single massive exposure to ecstasy. In this article, the authors try to explain the reflexive pathway carried out to establish death causes and the maternal toxic consumption imputability on the cerebral malformations and fetal death. This case illustrates both the interest of toxicological analyses in cases of fetal death and the importance of a collaborative work between forensic and fetal pathologists and toxicologists, which appeared critical to answer in the best conditions to the magistrates questions, as well as to the bereaved families.
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Affiliation(s)
- Adeline Blanchot
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France.
| | - Maria Cristina Antal
- UF6349 Fœtopathologie, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Alice Ameline
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | - Laurie Gheddar
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | - Nadia Arbouche
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | | | - Pascal Kintz
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
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Courchesne-Krak NS, Kepner W, Rubano A, Marienfeld C. Differences in outpatient, emergency, and inpatient use among pregnant women with a substance-related diagnosis. Am J Obstet Gynecol MFM 2022; 4:100559. [PMID: 34990875 PMCID: PMC8891059 DOI: 10.1016/j.ajogmf.2021.100559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND As a vulnerable population, pregnant women with a substance-related diagnosis (ie, substance use, misuse, or dependence) may use healthcare disproportionately. OBJECTIVE The primary goal of this study was to evaluate the differences in the use of outpatient clinical visits, emergency department visits, and inpatient days in the hospital among women with and without a substance-related diagnosis during the antepartum period. STUDY DESIGN This retrospective study retrieved electronic health record data on women (age, 18-44 years) who delivered a single live birth or stillbirth at ≥20 weeks of gestation from April 1, 2012, to September 30, 2019. Imbalance in measured maternal sociodemographic and obstetrical characteristics between women with and without a substance-related diagnosis was attenuated using propensity score matching on key demographic characteristics (eg, age), yielding a matched 1:1 sample. Unadjusted and adjusted logistic regressions models were used to determine the association between a substance-related diagnosis and outpatient visits, emergency visits, and inpatient days. RESULTS From the total sample (n=16,770), the matched cohort consisted of 1986 deliveries. Of these, most were White (51.0%), or mixed or of some other race (31.1%). The mean age was 29.8 (standard deviation, 5.6). A substance-related diagnosis was identified in 993 women (50%) because of matching. Women with a substance-related diagnosis were more likely to have ≤10 outpatient visits than women without a substance-related diagnosis (adjusted odds ratio, 1.81 [95% confidence interval, 1.44-2.28]; P<.0001). Alcohol-, opioid-, and stimulant-related diagnoses were independently associated with ≤10 outpatient visits (adjusted odds ratio, 3.16 [95% confidence interval, 1.67-6.04]; P=.0005; adjusted odds ratio, 3.02 [95% confidence interval, 1.79-5.09]; P<.0001; adjusted odds ratio, 2.18 [95% confidence interval, 1.39-3.41]; P=.0007, respectively). Women with a substance-related diagnosis were more likely to have ≥1 emergency visit than women without a substance-related diagnosis (adjusted odds ratio, 1.36 [95% confidence interval, 1.00-1.85]; P<.0001). Opioid-, stimulant-, and nicotine-related diagnoses were independently associated with ≥1 emergency visit (adjusted odds ratio, 2.28 [95% confidence interval, 1.09-4.77]; P=.0287; adjusted odds ratio, 2.01 [95% confidence interval, 1.07-3.78]; P=.0301; adjusted odds ratio, 3.38 [95% confidence interval, 1.90-6.02]; P<.0001, respectively). Women with a substance-related diagnosis were more likely to have ≥3 inpatient days than women without a substance-related diagnosis (adjusted odds ratio, 1.69 [95% confidence interval, 1.07-2.67]; P=.0256). Opioid-, stimulant-, and nicotine-related diagnosis were independently associated with ≥3 inpatient days (adjusted odds ratio, 3.52 [95% confidence interval, 1.42-8.75]; P=.0067; adjusted odds ratio, 3.51 [95% confidence interval, 1.31-9.34]; P=.0123; adjusted odds ratio, 2.74 [95% confidence interval, 1.11-6.73]; P=.0285, respectively). CONCLUSION Women with a substance-related diagnosis during the antepartum period who delivered a single live birth or stillbirth at ≥20 weeks of gestation were experiencing fewer outpatient visits, more emergency department visits, and more inpatient days than women without a substance-related diagnosis. The type of substance-related diagnosis (eg, alcohol, opioids, stimulants, or nicotine) was associated with different patterns of healthcare use. The results from this study have reinforced the need to identify substance-related diagnoses in pregnant women early to minimize disproportionate healthcare service utilization through intervention and treatment.
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Affiliation(s)
- Natasia S Courchesne-Krak
- Department of Psychiatry, University of California San Diego, La Jolla, CA (Dr Courchesne-Krak, Mr Kepner, and Dr Marienfeld).
| | - Wayne Kepner
- Department of Psychiatry, University of California San Diego, La Jolla, CA (Dr Courchesne-Krak, Mr Kepner, and Dr Marienfeld)
| | - Amanda Rubano
- University of Rochester School of Medicine and Dentistry, Rochester, NY (Ms Rubano)
| | - Carla Marienfeld
- Department of Psychiatry, University of California San Diego, La Jolla, CA (Dr Courchesne-Krak, Mr Kepner, and Dr Marienfeld)
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4
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Perez FA, Blythe S, Wouldes T, McNamara K, Black KI, Oei JL. Prenatal methamphetamine-impact on the mother and child-a review. Addiction 2022; 117:250-260. [PMID: 33830539 DOI: 10.1111/add.15509] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/02/2021] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Abstract
Methamphetamine (MA) is the second most commonly used illicit drug in the world, after cannabis. There are limited data on the outcomes of pregnant MA users but there is rapidly emerging evidence to suggest that they are more vulnerable, marginalized and impoverished compared with other drug-using mothers. MA use during pregnancy is associated with worse pregnancy outcomes and significantly higher rates of co-existing health and psychosocial problems. Newborn infants exposed to MA are at increased risk of perinatal complications, present differently at birth to infants exposed to other drugs of dependency such as opioids and have poorer neurological adaptation and feeding difficulties. Sparse literature from neuroimaging and cohort studies suggests that the neurocognitive deficits in MA exposed children persist, even into adulthood. Current clinical practice guidelines for the care of substance exposed pregnant women are opioid-centric with little attention paid to the consequences of prenatal MA exposure.
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Affiliation(s)
- Fatima Anne Perez
- Department of Newborn Care, The Royal Hospital for Women, Randwick, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University.,Ingham Institute, Liverpool, Australia
| | - Trecia Wouldes
- School of Medicine, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kelly McNamara
- Faculty of Medicine and Health, University of Sydney, Sidney, Australia.,School of Women's and Children's Health, University of New SouthWales, Sidney, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, University of Sydney, Sidney, Australia
| | - Ju Lee Oei
- Department of Newborn Care, The Royal Hospital for Women, Randwick, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia
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5
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Gabrhelík R, Skurtveit S, Nechanská B, Handal M, Mahic M, Mravčík V. Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study. Eur Addict Res 2021; 27:97-106. [PMID: 32702698 DOI: 10.1159/000509048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy. OBJECTIVES To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP). METHOD A cohort study using nationwide registries in Czechia (2000-2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (n = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (n = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (n = 1,511,310) with no substance use disorder diagnosis (GP). The neonatal outcomes studied were growth parameters, gestational age, preterm birth, and Apgar score. To explore the associations between MA exposure and neonatal outcomes, regression coefficients (b) and odds ratios from multivariable linear and binary logistic regression were estimated. RESULTS MA-exposed women had similar socio-economic characteristics to opioid-exposed, both of which were worse than in the GP. After adjustment, MA exposure was associated with a more favourable birthweight when compared to the opioid-exposed (adjusted mean differences [aMD] b = 122.3 g, 95% CI: 26.0-218.5) and length (aMD b = 0.6 cm, 0.0-1.1). Unadjusted results from the comparison with the GP showed that the MA group had poorer neonatal outcomes, especially in the growth parameters. Adjustment for background characteristics had a profound effect on the comparison with the GP. After adjustment, MA exposure was associated only with a slightly reduced birthweight (aMD b = -63.0 g, -123.0 to -3.1) and birth length (aMD b = -0.3 cm, -0.6 to 0.0). CONCLUSIONS Although the observed negative outcomes were large in the MA-exposed newborns, the adjustment had a profound effect on the comparison with the GP, indicating the large influence of lifestyle and socio-economic factors in these high-risk pregnancies. MA-exposed newborns had better neonatal outcomes compared to opioids-exposed.
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Affiliation(s)
- Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia, .,Department of Addictology, General University Hospital in Prague, Prague, Czechia,
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Centre for Addiction Research at the University of Oslo, Oslo, Norway
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Marte Handal
- Norwegian Institute of Public Health, Oslo, Norway
| | - Milada Mahic
- Norwegian Institute of Public Health, Oslo, Norway
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czechia.,National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech Republic, Prague, Czechia
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6
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Garey JD, Lusskin SI, Scialli AR. Teratogen update: Amphetamines. Birth Defects Res 2020; 112:1171-1182. [PMID: 32755038 DOI: 10.1002/bdr2.1774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/19/2020] [Accepted: 07/06/2020] [Indexed: 01/09/2023]
Abstract
Amphetamines are synthetic noncatecholamine sympathomimetic amines that act as psychostimulants. They have been prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD), narcolepsy, and additional health conditions. Amphetamines are also drugs of abuse. Some experimental animal studies suggested adverse developmental effects of amphetamines, including structural malformations. These effects were most often observed in experimental animals at higher dose levels than those used for treatment or abuse and at dose levels that produce maternal toxicity. Controlled studies of amphetamine use for the treatment of ADHD and other indications did not suggest that amphetamines are likely to cause structural malformations, although there are three studies associating medication for ADHD or methamphetamine abuse with gastroschisis. We did not locate studies on the neurobehavioral effects of prenatal exposures to therapeutic amphetamine use. Amphetamine abuse was associated with offspring neurobehavioral abnormalities, but lack of adequate adjustment for confounding interferes with interpretation of the associations. Adverse effects of methamphetamine abuse during pregnancy may be due to factors associated with drug abuse rather than methamphetamine itself. The adverse effects observed in methamphetamine abuse studies may not be extrapolatable to amphetamine medication use.
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Affiliation(s)
- Joan D Garey
- Reproductive Toxicology Center, A Non-Profit Foundation, Washington, District of Columbia, USA
| | - Shari I Lusskin
- Reproductive Toxicology Center, A Non-Profit Foundation, Washington, District of Columbia, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anthony R Scialli
- Reproductive Toxicology Center, A Non-Profit Foundation, Washington, District of Columbia, USA
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Pham T, Tinajero Y, Mo L, Schulkin J, Schmidt L, Wakeman B, Kremer M. Obstetrical and perinatal outcomes of patients with methamphetamine-positive drug screen on labor and delivery. Am J Obstet Gynecol MFM 2020; 2:100195. [PMID: 33345915 DOI: 10.1016/j.ajogmf.2020.100195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The incidence of methamphetamine use in reproductive-age women across the United States is increasing. The existing literature on methamphetamine use in pregnancy has indicated an elevated risk of adverse maternal and neonatal health outcomes. OBJECTIVE This study aimed to investigate pregnancy outcomes in patients with recent methamphetamine use compared with patients who received negative test results for methamphetamine at the time of delivery. STUDY DESIGN A single-site retrospective cohort study from January to December 2015 was performed. Patients with a documented urine drug screen during the delivery encounter were identified from the electronic medical records. The outcomes of patients with methamphetamine-positive urine drug screens were compared with controls with urine drug screens negative for methamphetamine. Maternal outcomes of interest included placental abruption, hypertensive disorders, premature preterm rupture of membranes, postpartum hemorrhage, and preterm birth. Utilization of prenatal care, social work consults, and child protective services referrals were also recorded. Neonatal outcomes included birthweight, neonatal intensive care unit length of stay, Apgar scores, and perinatal mortality. RESULTS The 2 groups had similar demographic characteristics (age, multiparity, ethnicity), with the methamphetamine-positive group more likely to have no or limited prenatal care. Both groups engaged in polysubstance use. A methamphetamine-positive urine drug screen at the time of delivery carries an increased risk of abruption (odds ratio, 5.63; confidence interval, 1.21-26.21) but indicated no increased risk of maternal hypertensive disorders. Additional associated risks include preterm birth (odds ratio, 3.10; confidence interval, 1.44-6.68), lower Apgar scores at 1 and 5 minutes (P=.012 and P=.02, respectively), and increased perinatal mortality (odds ratio, 6.9; confidence interval, 1.01-47.4). CONCLUSION Positive urine drug testing for methamphetamines during labor admission confers considerable maternal and perinatal morbidity and mortality including an increased risk of placental abruption, preterm birth, and perinatal demise. Given the limited treatments for methamphetamine addiction, further research is urgently needed.
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Affiliation(s)
- Tiffany Pham
- Los Olivos Women's Medical Group, Stanford Health Care, Los Gatos, CA
| | - Yolanda Tinajero
- Department of Obstetrics and Gynecology, University of California, San Francisco, CA
| | - Lihong Mo
- Department of Obstetrics and Gynecology, University of California, San Francisco-Fresno, Fresno, CA
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Loren Schmidt
- Department of Biology, Seattle University, Seattle, WA
| | - Brooke Wakeman
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Mallory Kremer
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
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8
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Smid MC, Metz TD, Gordon AJ. Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women. Clin Obstet Gynecol 2019; 62:168-184. [PMID: 30601144 PMCID: PMC6438363 DOI: 10.1097/grf.0000000000000418] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Stimulant use, including cocaine, methamphetamines, ecstasy, and prescription stimulants, in pregnancy is increasingly common. In the United States, stimulants are the second most widely used and abused substances during pregnancy and pregnant women using stimulants in pregnancy are at increased risk of adverse perinatal, neonatal, and childhood outcomes. In this review, we describe the pharmacology, pathophysiology, and epidemiology of stimulants, summarize the maternal and neonatal effects of perinatal stimulant use, and outline treatment options for stimulant use disorders among pregnant women. Development of effective treatment strategies for stimulant use disorders identified among pregnant women are urgently needed.
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Affiliation(s)
- Marcela C Smid
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine
- Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), Salt Lake City VA Health Care System, Salt Lake City, Utah
| | - Torri D Metz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine
- Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), Salt Lake City VA Health Care System, Salt Lake City, Utah
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9
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Admon LK, Bart G, Kozhimannil KB, Richardson CR, Dalton VK, Winkelman TNA. Amphetamine- and Opioid-Affected Births: Incidence, Outcomes, and Costs, United States, 2004-2015. Am J Public Health 2018; 109:148-154. [PMID: 30496001 DOI: 10.2105/ajph.2018.304771] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives. To estimate trends in incidence, outcomes, and costs among hospital deliveries related to amphetamines and opioids.Methods. We analyzed 2004-to-2015 data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States compiled by the Healthcare Cost and Utilization Project, by using a repeated cross-sectional design. We estimated the incidence of hospital deliveries related to maternal amphetamine or opioid use with weighted logistic regression. We measured clinical outcomes and costs with weighted multivariable logistic regression and generalized linear models.Results. Amphetamine- and opioid-related deliveries increased disproportionately across rural compared with urban counties in 3 of 4 census regions between 2008 to 2009 and 2014 to 2015. By 2014 to 2015, amphetamine use was identified among approximately 1% of deliveries in the rural West, which was higher than the opioid-use incidence in most regions. Compared with opioid-related and other hospital deliveries, amphetamine-related deliveries were associated with higher incidence of preeclampsia, preterm delivery, and severe maternal morbidity and mortality.Conclusions. Increasing incidence of amphetamine and opioid use among delivering women and associated adverse gestational outcomes indicate that amphetamine and opioid use affecting birth represent worsening public health crises.
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Affiliation(s)
- Lindsay K Admon
- Lindsay K. Admon and Vanessa K. Dalton are with the Department of Obstetrics and Gynecology at the University of Michigan, Ann Arbor. L. K. Admon was also with the US Department of Veterans Affairs, Ann Arbor, at the time this work was completed. Caroline R. Richardson is with the Department of Family Medicine at the University of Michigan. Katy B. Kozhimannil is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Gavin Bart is with the Division of Addiction Medicine, Department of Medicine at Hennepin Healthcare, Minneapolis. Tyler N. A. Winkelman is in the Division of General Internal Medicine and the Hennepin Healthcare Research Institute, Hennepin Healthcare
| | - Gavin Bart
- Lindsay K. Admon and Vanessa K. Dalton are with the Department of Obstetrics and Gynecology at the University of Michigan, Ann Arbor. L. K. Admon was also with the US Department of Veterans Affairs, Ann Arbor, at the time this work was completed. Caroline R. Richardson is with the Department of Family Medicine at the University of Michigan. Katy B. Kozhimannil is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Gavin Bart is with the Division of Addiction Medicine, Department of Medicine at Hennepin Healthcare, Minneapolis. Tyler N. A. Winkelman is in the Division of General Internal Medicine and the Hennepin Healthcare Research Institute, Hennepin Healthcare
| | - Katy B Kozhimannil
- Lindsay K. Admon and Vanessa K. Dalton are with the Department of Obstetrics and Gynecology at the University of Michigan, Ann Arbor. L. K. Admon was also with the US Department of Veterans Affairs, Ann Arbor, at the time this work was completed. Caroline R. Richardson is with the Department of Family Medicine at the University of Michigan. Katy B. Kozhimannil is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Gavin Bart is with the Division of Addiction Medicine, Department of Medicine at Hennepin Healthcare, Minneapolis. Tyler N. A. Winkelman is in the Division of General Internal Medicine and the Hennepin Healthcare Research Institute, Hennepin Healthcare
| | - Caroline R Richardson
- Lindsay K. Admon and Vanessa K. Dalton are with the Department of Obstetrics and Gynecology at the University of Michigan, Ann Arbor. L. K. Admon was also with the US Department of Veterans Affairs, Ann Arbor, at the time this work was completed. Caroline R. Richardson is with the Department of Family Medicine at the University of Michigan. Katy B. Kozhimannil is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Gavin Bart is with the Division of Addiction Medicine, Department of Medicine at Hennepin Healthcare, Minneapolis. Tyler N. A. Winkelman is in the Division of General Internal Medicine and the Hennepin Healthcare Research Institute, Hennepin Healthcare
| | - Vanessa K Dalton
- Lindsay K. Admon and Vanessa K. Dalton are with the Department of Obstetrics and Gynecology at the University of Michigan, Ann Arbor. L. K. Admon was also with the US Department of Veterans Affairs, Ann Arbor, at the time this work was completed. Caroline R. Richardson is with the Department of Family Medicine at the University of Michigan. Katy B. Kozhimannil is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Gavin Bart is with the Division of Addiction Medicine, Department of Medicine at Hennepin Healthcare, Minneapolis. Tyler N. A. Winkelman is in the Division of General Internal Medicine and the Hennepin Healthcare Research Institute, Hennepin Healthcare
| | - Tyler N A Winkelman
- Lindsay K. Admon and Vanessa K. Dalton are with the Department of Obstetrics and Gynecology at the University of Michigan, Ann Arbor. L. K. Admon was also with the US Department of Veterans Affairs, Ann Arbor, at the time this work was completed. Caroline R. Richardson is with the Department of Family Medicine at the University of Michigan. Katy B. Kozhimannil is with the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis. Gavin Bart is with the Division of Addiction Medicine, Department of Medicine at Hennepin Healthcare, Minneapolis. Tyler N. A. Winkelman is in the Division of General Internal Medicine and the Hennepin Healthcare Research Institute, Hennepin Healthcare
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Winkelman TNA, Admon LK, Jennings L, Shippee ND, Richardson CR, Bart G. Evaluation of Amphetamine-Related Hospitalizations and Associated Clinical Outcomes and Costs in the United States. JAMA Netw Open 2018; 1:e183758. [PMID: 30646256 PMCID: PMC6324446 DOI: 10.1001/jamanetworkopen.2018.3758] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Despite indications of increasing amphetamine availability and psychostimulant deaths in the United States, evidence across data sources is mixed, and data on amphetamine-related hospitalizations are lacking. OBJECTIVE To clarify trends in amphetamine-related hospitalizations and their clinical outcomes and costs in the United States. DESIGN, SETTING, AND PARTICIPANTS This repeated, cross-sectional study used hospital discharge data from the Healthcare Cost and Utilization Project National Inpatient Sample. The nationally representative sample included US adults (n = 1 292 300) who had amphetamine-related hospitalizations between January 1, 2003, and December 31, 2015. Multivariable logistic and Poisson regression models were used to examine in-hospital mortality and length of stay. Analysis of these data was conducted from November 2017 to August 2018. EXPOSURE Amphetamine dependence or abuse or amphetamine poisoning. MAIN OUTCOMES AND MEASURES Annual hospitalizations, in-hospital mortality, length of stay, transfer to another facility, and costs. RESULTS Over the 2003 to 2015 study period, there were 1 292 300 weighted amphetamine-related hospitalizations. Of this population, 541 199 (41.9%) were female and 749 392 (58.1%) were male, with a mean age of 37.5 years (95% CI, 37.4-37.7 years). Amphetamine-related hospitalizations, compared with other hospitalizations, were associated with age younger than 65 years (98.0% vs 58.0%; P < .001), male sex (60.3% [95% CI, 59.7%-60.8%] vs 41.1% [95% CI, 40.9%-41.3%]), Medicaid coverage (51.2% [95% CI, 49.8%-52.7%] vs 17.8% [95% CI, 17.5%-18.1%]), and residence in the western United States (58.5% [95% CI, 55.9%-61.0%] vs 18.9% [95% CI, 18.0%-19.8%]). Amphetamine-related hospitalizations declined between 2005 and 2008, and then increased from 55 447 hospitalizations (95% CI, 44 936-65 959) in 2008 to 206 180 hospitalizations (95% CI, 95% CI, 189 188-223 172) in 2015. Amphetamine-related hospitalizations increased to a greater degree than hospitalizations associated with other substances. Adjusted mean length of stay (5.9 [95% CI, 5.8-6.0] vs 4.7 [95% CI, 4.7-4.8] days; P < .001), transfer to another facility (26.0% [95% CI, 25.3%-26.8%] vs 18.5% [95% CI, 18.3%-18.6%]; P < .001), and mean in-hospital mortality (28.3 [95% CI, 26.2-30.4] vs 21.9 [95% CI, 21.6-22.1] deaths per 1000 hospitalizations; P < .001) were higher for amphetamine-related than other hospitalizations. Annual hospital costs related to amphetamines increased from $436 million (95% CI, $312 million-$559 million) in 2003 to $2.17 billion (95% CI, $1.95 billion-$2.39 billion) by 2015. CONCLUSIONS AND RELEVANCE Given that amphetamine-related hospitalizations and costs substantially increased between 2003 and 2015, pharmacologic and nonpharmacologic therapies for amphetamine use disorders and a coordinated public health response are needed to curb these rising rates.
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Affiliation(s)
- Tyler N A Winkelman
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Lindsay K Admon
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Nathan D Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
| | - Caroline R Richardson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Gavin Bart
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Division of Addiction Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
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Homsup P, Phaloprakarn C, Tangjitgamol S, Manusirivithaya S. Maternal characteristics and pregnancy outcomes among illicit drug-using women in an urban setting. Taiwan J Obstet Gynecol 2018; 57:83-88. [PMID: 29458910 DOI: 10.1016/j.tjog.2017.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify characteristics and pregnancy outcomes among pregnant illicit drug users living in an urban area, and to describe trends in drug use over an 8-year period. MATERIALS AND METHODS Data on pregnant women living in the Bangkok Metropolitan Region who delivered at our institution during 2008-2015 were studied. Women with drug use (n = 197) and women without drug use (n = 787) were compared in terms of maternal characteristics and pregnancy outcomes. RESULTS The pregnant drug user rate markedly rose from 0.46% in 2008 to 1.28% in 2015. All pregnant drug users consumed amphetamine-type stimulants (ATS). The most important factor related to drug use was smoking (adjusted odds ratio [aOR] 41.03, 95% confidence interval [CI] 18.90-89.04). Other significant characteristics were teenage pregnancy (aOR 1.78, 95% CI 1.01-3.18), low level of education (aOR 4.97, 95% CI 1.18-20.90 for secondary school and aOR 5.61, 95% CI 1.28-24.49 for primary school or lower), and inadequate number of antenatal visits (aOR 2.20, 95% CI 1.16-4.17 for 1-3 visits and aOR 14.05, 95% CI 7.54-26.16 for no visit). Women of non-Thai ethnicity were less likely to use drugs (aOR 0.15, 95% CI 0.04-0.54). Pregnant drug users had a significantly higher risk of anemia (aOR 1.73, 95% CI 1.05-2.85), preterm delivery (aOR 2.35, 95% CI 1.29-4.29), low birth weight (aOR 2.26, 95% CI 1.23-4.17) and small for gestational age infants (aOR 3.19, 95% CI 1.39-7.33), but lower risk of cesarean section (aOR 0.43, 95% CI 0.21-0.86) than non-drug users. CONCLUSION Compared to urban pregnant women without drug use, women who consumed drugs were younger, had lower level of education, poorer self-care and poorer pregnancy outcomes. ATS was the single most commonly used drug.
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Affiliation(s)
- Pitchaya Homsup
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chadakarn Phaloprakarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
| | - Siriwan Tangjitgamol
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sumonmal Manusirivithaya
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Nörby U, Winbladh B, Källén K. Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy. Pediatrics 2017; 140:peds.2017-0747. [PMID: 29127207 DOI: 10.1542/peds.2017-0747] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To analyze perinatal outcomes after maternal use of attention-deficit/hyperactivity disorder (ADHD) medication during pregnancy. METHODS The study included singletons born between 2006 and 2014 in Sweden. Data on prescription drug use, pregnancies, deliveries, and the newborn infants' health were obtained from the Swedish Medical Birth Register, the Prescribed Drug Register, and the Swedish Neonatal Quality Register. We compared infants exposed to ADHD medication during pregnancy with infants whose mothers never used these drugs and infants whose mothers used ADHD medication before or after pregnancy. Analyses were performed with logistic regression. RESULTS Among 964 734 infants, 1591 (0.2%) were exposed to ADHD medication during pregnancy and 9475 (1.0%) had mothers treated before or after pregnancy. Exposure during pregnancy increased the risk for admission to a NICU compared with both no use and use before or after pregnancy (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.3-1.7; and aOR, 1.2; 95% CI, 1.1-1.4, respectively). Infants exposed during pregnancy had more often central nervous system-related disorders (aOR, 1.9; 95% CI, 1.1-3.1) and were more often moderately preterm (aOR, 1.3; 95% CI, 1.1-1.6) than nonexposed infants. There was no increased risk for congenital malformations or perinatal death. CONCLUSIONS Treatment with ADHD medication during pregnancy was associated with a higher risk for neonatal morbidity, especially central nervous system-related disorders such as seizures. Because of large differences in background characteristics between treated women and controls, it is uncertain to what extent this can be explained by the ADHD medication per se.
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Affiliation(s)
- Ulrika Nörby
- Centre of Reproduction Epidemiology, Tornblad Institute, Department of Clinical Sciences, Lund University, Lund, Sweden; .,Department of E-health and Strategic IT, Health and Medical Care Administration, Stockholm County Council, Stockholm, Sweden; and
| | - Birger Winbladh
- Department of Clinical Sciences and Education, Karolinska Institutet and Sachs' Children's and Youth Hospital, Stockholm, Sweden
| | - Karin Källén
- Centre of Reproduction Epidemiology, Tornblad Institute, Department of Clinical Sciences, Lund University, Lund, Sweden
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Dills AK, Grecu AM. Effects of state contraceptive insurance mandates. ECONOMICS AND HUMAN BIOLOGY 2017; 24:30-42. [PMID: 27889633 DOI: 10.1016/j.ehb.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
Using U.S. Natality data for 1996 through 2009 and an event analysis specification, we investigate the dynamics of the effects of state insurance contraceptive mandates on births and measures of parental investment: prenatal visits, non-marital childbearing, and risky behaviors during pregnancy. We analyze outcomes separately by age, race, and ethnicity. Among young Hispanic women, we find a 4% decline in the birth rate. There is evidence of a decrease in births to single mothers, consistent with increased wantedness. We also find evidence of selection into motherhood, which could explain the lack of a significant effect on birth outcomes.
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Affiliation(s)
- Angela K Dills
- Western Carolina University, Forsyth 224A, Cullowhee, NC 28723, United States.
| | - Anca M Grecu
- Seton Hall University, JH 621 Department of Economics and Legal Studies, Stillman School of Business, Seton Hall University, 400 South Orange Ave, South Orange, NJ, 07079, United States.
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Parolin M, Simonelli A. Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions. Front Psychiatry 2016; 7:152. [PMID: 27625612 PMCID: PMC5004230 DOI: 10.3389/fpsyt.2016.00152] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022] Open
Abstract
Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.
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Affiliation(s)
- Micol Parolin
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
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Clemow DB, Walker DJ. The Potential for Misuse and Abuse of Medications in ADHD: A Review. Postgrad Med 2015; 126:64-81. [DOI: 10.3810/pgm.2014.09.2801] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
INTRODUCTION Methamphetamine (MA) is one of the most commonly used illicit drugs in pregnancy, yet studies on MA-exposed pregnancy outcomes have been limited because of retrospective measures of drug use; lack of control for confounding factors; other drug use, including tobacco; poverty; poor diet; and lack of prenatal care. This study presents prospective collected data on MA use and birth outcomes, controlling for most confounders. MATERIALS AND METHODS This is a retrospective cohort study of women obtaining prenatal care from a clinic treating women with substance use disorders, on whom there are prospectively obtained data on MA and other drug use, including tobacco. Methamphetamine-exposed pregnancies were compared with non-MA exposed pregnancies and non-drug-exposed pregnancies, using univariate and multivariate analysis to control for confounders. RESULTS One hundred forty-four infants were exposed to MA during pregnancy, 50 had first trimester exposure only, 45 had continuous use until the second trimester, 29 had continuous use until the third trimester, but were negative at delivery, and 20 had positive toxicology at delivery. There were 107 non-MA-exposed infants and 59 infants with no drug exposure. Mean birth weights were the same for MA-exposed and nonexposed infants (3159 g vs 3168 g; P = 0.9), although smaller than those without any drug exposure (3159 vs 3321; P = 0.04), infants with positive toxicology at birth (meconium or urine) were smaller than infants with first trimester exposure only (2932 g vs 3300 g; P = 0.01). Gestation was significantly shorter among the MA-exposed infants than that among nonexposed infants (38.5 vs 39.1 weeks; P = 0.045), and those with no drug exposure (38.5 vs 39.5; P = 0.0011), the infants with positive toxicology at birth had a clinically relevant shortening of gestation (37.3 weeks vs 39.1; P = 0.0002). CONCLUSIONS Methamphetamine use during pregnancy is associated with shorter gestational ages and lower birth weight, especially if used continuously during pregnancy. Stopping MA use at any time during pregnancy improves birth outcomes, thus resources should be directed toward providing treatment and prenatal care.
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Affiliation(s)
- Tricia E. Wright
- Department of Obstetrics, Gynecology and Women’s Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou St. Ste 824, Honolulu, HI 96826, 808-203-6540, 808-955-2174 fax
| | - Renee Schuetter
- Path Clinic, Waikiki Health, Honolulu, Hawaii, 845 22nd Ave., Honolulu, HI 96816
| | - Jacqueline Tellei
- Path Clinic, Waikiki Health, Honolulu, Hawaii, 845 22nd Ave., Honolulu, HI 96816
| | - Lynnae Sauvage
- Department of Obstetrics, Gynecology and Women’s Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou St. Ste 824, Honolulu, HI 96826, 808-203-6540, 808-955-2174 fax
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Himes SK, LaGasse LL, Derauf C, Newman E, Smith LM, Arria AM, Grotta SAD, Dansereau LM, Abar B, Neal CR, Lester BM, Huestis MA. Risk of neurobehavioral disinhibition in prenatal methamphetamine-exposed young children with positive hair toxicology results. Ther Drug Monit 2014; 36:535-43. [PMID: 24518561 PMCID: PMC4101149 DOI: 10.1097/ftd.0000000000000049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective was to evaluate the effects of prenatal methamphetamine exposure (PME) and postnatal drug exposures identified by child hair analysis on neurobehavioral disinhibition at 6.5 years of age. METHODS Mother-infant pairs were enrolled in the Infant Development, Environment, and Lifestyle (IDEAL) Study in Los Angeles, Honolulu, Tulsa, and Des Moines. PME was determined by maternal self-report and/or positive meconium results. At the 6.5-year follow-up visit, hair was collected and analyzed for methamphetamine, tobacco, cocaine, and cannabinoid markers. Child behavioral and executive function test scores were aggregated to evaluate child neurobehavioral disinhibition. Hierarchical linear regression models assessed the impact of PME, postnatal substances, and combined PME with postnatal drug exposures on the child's neurobehavioral disinhibition aggregate score. Past year caregiver substance use was compared with child hair results. RESULTS A total of 264 children were evaluated. Significantly more PME children (n = 133) had hair positive for methamphetamine/amphetamine (27.1% versus 8.4%) and nicotine/cotinine (38.3% versus 25.2%) than children without PME (n = 131). Overall, no significant differences in analyte hair concentrations were noted between groups. Significant differences in behavioral and executive function were observed between children with and without PME. No independent effects of postnatal methamphetamine or tobacco exposure, identified by positive hair test, were noted and no additional neurobehavioral disinhibition was observed in PME children with postnatal drug exposures, as compared with PME children without postnatal exposure. CONCLUSIONS Child hair testing offered a noninvasive means to evaluate postnatal environmental drug exposure, although no effects from postnatal drug exposure alone were seen. PME, alone and in combination with postnatal drug exposures, was associated with behavioral and executive function deficits at 6.5 years.
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Affiliation(s)
- Sarah K. Himes
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
| | - Linda L. LaGasse
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, RI
| | - Chris Derauf
- Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Elana Newman
- Department of Psychology, The University of Tulsa, Tulsa, OK
| | - Lynne M. Smith
- Department of Pediatrics, LABioMed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Torrance, CA
| | - Amelia M. Arria
- Family Science Department, Center on Young Adult Health and Development, University of Maryland School of Public Health, College Park, MD
| | - Sheri A. Della Grotta
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, RI
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, RI
| | - Beau Abar
- Department of Emergency Medicine and Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Charles R. Neal
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Barry M. Lester
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women & Infants Hospital, Providence, RI
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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McLaurin R, Geraghty S. Placenta praevia, placental abruption and amphetamine use in pregnancy: A case study. Women Birth 2013; 26:138-42. [DOI: 10.1016/j.wombi.2012.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/25/2012] [Accepted: 11/12/2012] [Indexed: 11/26/2022]
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Pan IJ, Yi HY. Prevalence of hospitalized live births affected by alcohol and drugs and parturient women diagnosed with substance abuse at liveborn delivery: United States, 1999-2008. Matern Child Health J 2013; 17:667-76. [PMID: 22688539 PMCID: PMC4521396 DOI: 10.1007/s10995-012-1046-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.
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Affiliation(s)
- I-Jen Pan
- CSR Incorporated, Arlington, Virginia
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Maternal drug use and its effect on neonates: a population-based study in Washington State. Obstet Gynecol 2012; 119:924-33. [PMID: 22525903 DOI: 10.1097/aog.0b013e31824ea276] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the effect of maternal illicit and prescription drug use on neonates in Washington State between 2000 and 2008. METHODS We used state-linked birth certificate and hospital discharge (mother and neonate) data to calculate prenatal drug exposure and neonatal abstinence syndrome rates, and compared state neonatal abstinence syndrome rates with national-level data from the Nationwide Inpatient Sample. We identified the drugs of exposure, examined predictors of drug exposure and neonatal abstinence syndrome, and assessed perinatal outcomes among drug-exposed and neonatal abstinence syndrome-diagnosed neonates compared with unexposed neonates. RESULTS Drug exposure and neonatal abstinence syndrome rates increased significantly between 2000 and 2008, neonatal abstinence syndrome rates being consistently higher than national figures (3.3 compared with 2.8 per 1,000 births in 2008; P<.05). The proportion of neonatal abstinence syndrome-diagnosed neonates exposed prenatally to opioids increased from 26.4% in 2000 to 41.7% in 2008 (P<.05). Compared with unexposed neonates, drug-exposed and neonatal abstinence syndrome-diagnosed neonates had a lower mean birth weight, longer birth hospitalization, were more likely to be born preterm, experience feeding problems, and have respiratory conditions (all P<.001). CONCLUSION Maternal use of illicit and prescription drugs was associated with considerable neonatal morbidity and significantly higher rates of drug exposure and neonatal abstinence syndrome in recent years. Data suggest that opioid analgesics contributed to the increase in prenatal drug exposure and neonatal abstinence syndrome in Washington State. In accordance with current guidelines, our findings emphasize the need for clinicians to screen pregnant women for illicit and prescription drug use and minimize use of opioid analgesics during pregnancy. LEVEL OF EVIDENCE II.
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Wright TE, Schuetter R, Fombonne E, Stephenson J, Haning WF. Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women. Harm Reduct J 2012; 9:5. [PMID: 22260315 PMCID: PMC3292917 DOI: 10.1186/1477-7517-9-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 01/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methamphetamine (MA) use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103) seen over 3 years of operation of the program. METHODS Referrals came from community health centers, hospitals, addiction treatment facilities, private physician offices, homeless outreach services and self-referral through word-of-mouth and bus ads. Data to describe sample characteristics and outcome was obtained prospectively and retrospectively from chart abstraction and delivery data. Drug use data was obtained from the women's self-report and random urine toxicology during the pregnancy, as well as urine toxicology at the time of birth on mothers, and urine and meconium toxicology on the infants. Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale. Data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame, who were enrolled in another study of pregnancy outcomes. Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies. RESULTS Between April 2007 and August 2010, 213 women with a past or present history of addiction were seen, 132 were pregnant and 97 delivered during that time. 103 live-born infants were delivered. There were 3 first-trimester Spontaneous Abortions, two 28-week intrauterine fetal deaths, and two sets of twins and 4 repeat pregnancies. Over 50% of the women had lost custody of previous children due to substance use. The majority of women who delivered used methamphetamine (86%), either in the year before pregnancy or during pregnancy. Other drugs include marijuana (59.8%), cocaine (33%), opiates (9.6%), and alcohol (15.2%). Of the women served, 85% smoked cigarettes upon enrollment. Of the 97 women delivered during this period, all but 4 (96%) had negative urine toxicology at the time of delivery. Of the 103 infants, 13 (12.6%) were born preterm, equal to the state and national average, despite having many risk factors for prematurity, including poverty, poor diet, smoking and polysubstance use. Overwhelmingly, the women are parenting their children, > 90% retained custody at 8 weeks. Long-term follow-up showed that women who maintained custody chose long-acting contraceptive methods; while those who lost custody had a very high (> 50%) repeat pregnancy rate at 9 months post delivery. CONCLUSION Methamphetamine use during pregnancy doesn't exist is isolation. It is often combined with a multitude of other adverse circumstances, including poverty, interpersonal violence, psychiatric comorbidity, polysubstance use, nutritional deficiencies, inadequate health care and stressful life experiences. A comprehensive harm reduction model of perinatal care, which aims to ameliorate some of these difficulties for substance-using women without mandating abstinence, provides exceptional birth outcomes and can be implemented with limited resources.
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Affiliation(s)
- Tricia E Wright
- Department of Obstetrics, Gynecology and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou St., Ste. 824, Honolulu, HI 96826 USA
| | - Renee Schuetter
- Perinatal Addiction Treatment of Hawaii, 845 22nd. Ave., Honolulu, HI 96816. USA
| | - Eric Fombonne
- Department of Child Psychiatry, McGill University, 845 Sherbrooke Street West, Montreal, Quebec, H3A 2T5, Canada
| | - Jessica Stephenson
- Perinatal Addiction Treatment of Hawaii, 845 22nd. Ave., Honolulu, HI 96816. USA
| | - William F Haning
- Department of Psychiatry, University of Hawaii John A. Burns School of Medicine, 1356 Lusitana St., 4th Floor, Honolulu, HI 96813 USA
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Lindsay B, Albrecht J, Terplan M. Against professional advice: treatment attrition among pregnant methamphetamine users. Subst Abuse Rehabil 2011; 2:189-95. [PMID: 24474856 PMCID: PMC3846313 DOI: 10.2147/sar.s25083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pregnant methamphetamine users who leave substance use treatment against professional advice may be at risk of poorer health outcomes. To examine the hypothesis that methamphetamine use during pregnancy may be associated with leaving substance use treatment against professional advice, the 2006 Treatment Episode Data Set was analyzed. A logistic regression adjusting for age, race, service setting, prior substance abuse treatment, criminal justice referral, and education was conducted. Inclusion criteria were met by 18,688 pregnant admissions; 26.4% identified methamphetamines as their primary substance of use. Frequency of use was identified as an effect modifier, therefore results were stratified by less than weekly use and weekly or more use. Methamphetamine use was significantly associated with leaving treatment against professional advice regardless of usage level. However, the odds of leaving treatment were greater among women using methamphetamine less than weekly. Further investigation into this association may be warranted due to the complications that may result from methamphetamine use during pregnancy.
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Affiliation(s)
- Brianna Lindsay
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Jennifer Albrecht
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Mishka Terplan
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA ; Department of Obstetrics, Gynecology, and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
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Prenatal amphetamine exposure and birth outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2011; 205:219.e1-7. [PMID: 21658669 DOI: 10.1016/j.ajog.2011.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/22/2011] [Accepted: 04/11/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review the relationship between amphetamine exposure in pregnancy and birth outcomes. STUDY DESIGN Electronic databases were searched to identify relevant studies. Data from included studies were extracted by 2 reviewers. Summary odds ratio (OR) and confidence intervals (CIs) were calculated using the random effects model. RESULTS Ten studies were included. Significant increases in unadjusted risks of preterm birth (OR, 4.11; 95% CI, 3.05-5.55), low birthweight (OR, 3.97; 95% CI, 2.45-6.43), and small for gestational age (OR, 5.79; 95% CI, 1.39-24.06) were identified among women exposed to amphetamines in pregnancy. The mean birthweight was significantly lower among amphetamine-exposed pregnancies (mean difference, -279 g; 95% CI, -485 to -74 g). Two studies provided adjusted estimates on different outcomes, and their results were consistent with the findings from the unadjusted data. CONCLUSION Amphetamine exposure in pregnancy is associated with adverse birth outcomes and should be identified by physicians providing antenatal care.
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Merkel RL. Safety of stimulant treatment in attention deficit hyperactivity disorder: part II. Expert Opin Drug Saf 2011; 9:917-35. [PMID: 20615078 DOI: 10.1517/14740338.2010.503238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Attention deficit hyperactivity disorder (ADHD) is the most common childhood psychiatric disorder and in at least 50% of cases persists into adulthood. Treatment of ADHD with stimulants is one of the oldest and most effective pharmacological treatments in psychiatry. Yet, there continues to be controversy over the safety of stimulant medications in the treatment of ADHD. AREAS COVERED IN THIS REVIEW This paper is a continuation of an earlier paper that reviewed the safety profile of newer stimulant agents, especially in relation to special populations. This part II reviews, through essentially an organ-system approach, the various clinical concerns that have been raised over the safety of stimulant medications. This includes neuropsychiatric, cardiovascular effects on growth and development, and a number of other less common concerns. WHAT THE READER WILL GAIN A thorough review of safety concerns in stimulants that emphasizes clinical information, case reports, open series or controlled trials relating to stimulant use in the treatment of ADHD. TAKE HOME MESSAGE While many safety concerns have been raised in the use of stimulants, the vast majority of treatment complications are either quickly reversible or easily manageable with appropriate clinical care. The negative consequences of untreated ADHD clearly outweigh the risks of the stimulant medicines when used in an appropriate and careful manner.
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Affiliation(s)
- Richard Lawrence Merkel
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908, USA.
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25
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Scott K, Fagermo N, Callaway L, Lust K. Illicit drug use in late pregnancy associated with stillbirth and eclampsia. Obstet Med 2010; 3:113-4. [PMID: 27579073 DOI: 10.1258/om.2010.090061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2010] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 20-year-old student with an undiagnosed pregnancy who had taken ecstasy and LSD (lysergic acid diethylamide). Twenty-four hours later she delivered a stillborn term infant, and subsequently developed eclampsia with seizures, hypertension and proteinuria. Illicit drug use is relatively common in women of child-bearing age in Australia, and is a risk factor for adverse obstetric outcomes. Ecstasy (MDMA [3,4-methylenedioxymethamphetamine]) is a sympathomimetic amine, similar to amphetamine in its cardiovascular effects. LSD is a hallucinogen with complex pharmacology and has potential for significant compromise of placental blood flow. We propose that the combined vasoconstrictive effects of MDMA and LSD caused placental ischaemia, contributing to the fetal death and precipitating a cascade of endothelial dysfunction which resulted in an eclamptic syndrome.
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Affiliation(s)
- Katherine Scott
- Obstetric Medicine Unit, Royal Brisbane and Women's Hospital , Brisbane, Queensland , Australia
| | - Narelle Fagermo
- Obstetric Medicine Unit, Royal Brisbane and Women's Hospital , Brisbane, Queensland , Australia
| | - Leonie Callaway
- Obstetric Medicine Unit, Royal Brisbane and Women's Hospital , Brisbane, Queensland , Australia
| | - Karin Lust
- Obstetric Medicine Unit, Royal Brisbane and Women's Hospital , Brisbane, Queensland , Australia
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26
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Abstract
Illicit substance use is not uncommon in women of childbearing age. The direct effects of illicit substance use on the mother, pregnancy and the fetus are not well understood, in contrast to the indirect effects of social disadvantage and intercurrent medical and psychiatric illness, which are well documented. We have undertaken a review of the current literature regarding the effects of illicit substance use in pregnancy and include a suggested approach to identification and management of at-risk women.
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Affiliation(s)
- Katherine Scott
- Department of Internal Medicine and Aged Care, Obstetric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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27
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Abstract
Substance abuse in pregnancy has increased over the past three decades in the United States, resulting in approximately 225,000 infants yearly with prenatal exposure to illicit substances. Routine screening and the education of women of child bearing age remain the most important ways to reduce addiction in pregnancy. Legal and illegal substances and their effect on pregnancy discussed in this review include opiates, cocaine, alcohol, tobacco, marijuana, and amphetamines. Most literature regarding opiate abuse is derived from clinical experience with heroin and methadone. Poor obstetric outcomes can be up to six times higher in patients abusing opiates. Neonatal care must be specialized to treat symptoms of withdrawal. Cocaine use in pregnancy can lead to spontaneous abortion, preterm births, placental abruption, and congenital anomalies. Neonatal issues include poor feeding, lethargy, and seizures. Mothers using cocaine require specialized prenatal care and the neonate may require extra supportive care. More than 50% of women in their reproductive years use alcohol. Alcohol is a teratogen and its effects can include spontaneous abortion, growth restriction, birth defects, and mental retardation. Fetal alcohol spectrum disorder can have long-term sequelae for the infant. Tobacco use is high among pregnant women, but this can be a time of great motivation to begin cessation efforts. Long-term effects of prenatal tobacco exposure include spontaneous abortion, ectopic pregnancy, placental insufficiency, low birth weight, fetal growth restriction, preterm delivery, childhood respiratory disease, and behavioral issues. Marijuana use can lead to fetal growth restriction, as well as withdrawal symptoms in the neonate. Lastly, amphetamines can lead to congenital anomalies and other poor obstetric outcomes. Once recognized, a multidisciplinary approach can lead to improved maternal and neonatal outcomes.
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Affiliation(s)
- Joan Keegan
- Lankenau Hospital, Department of Obstetrics and Gynecology, Wynnewood, PA 19096, USA.
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Abstract
OBJECTIVE To estimate trends in the prevalence of methamphetamine treatment during pregnancy in the United States. METHODS Data were obtained from the Treatment Episode Data Set, an administrative data set that captures admissions to federally funded treatment centers in the United States. Demographic and treatment-related measures were examined among women admitted for methamphetamine use and stratified by year of admission to assess trends over time. RESULTS From 1994 to 2006 there were 245,970 pregnant women admitted. In 1994, methamphetamine accounted for 8% of admitted pregnant women, rising to 24% by 2006. This proportion was higher than methamphetamine admissions among both nonpregnant women (12%) and men (7%). The majority of methamphetamine admissions occurred in the West (73%) among white (64%) unemployed (88%) women. Over the time of analysis, women admitted for methamphetamine treatment became sicker (measured by increasing co-occurring psychiatric disorders) and more marginalized (measured by increasing dependent-living situations and criminal justice involvement). CONCLUSION Methamphetamine has become the primary substance compelling treatment during pregnancy. Our findings suggest a need for more effective drug and alcohol screening by clinicians who are positioned to identify and address such concerns outside the criminal justice system. LEVEL OF EVIDENCE III.
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Kuczkowski KM. Postpartum convulsions and acute hemodynamic instability in the parturient with recent amphetamine intake. Arch Gynecol Obstet 2009; 280:1059-61. [PMID: 19340438 DOI: 10.1007/s00404-009-1065-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
Abstract
Amphetamine is one of the most common substances abused in pregnancy and one of the most potent sympathomimetic amines with respect to stimulatory effects on the central nervous system. I present a case of an amphetamine abusing parturient who developed postpartum convulsions and acute hemodynamic instability initially mistaken for eclampsia.
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