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01-02-2012

Infant Birth Outcomes Among Substance Using Women: Why Quitting Smoking During Pregnancy is Just as Important as Quitting Illicit Drug Use

Authors: Beth A. Bailey, Judy G. McCook, Alexis Hodge, Lana McGrady

Published in: Maternal and Child Health Journal | Issue 2/2012

Abstract

Poor birth outcomes are associated with illicit drug use during pregnancy. While prenatal cigarette exposure has similar effects, cessation of illicit drug use during pregnancy is often prioritized over cessation of smoking. The study goal was to examine the impact of pregnancy tobacco use, relative to use of illicit drugs, on birth outcomes. Women were recruited at entry to prenatal care, with background and substance use information collected during pregnancy. Urine drug screens were performed during pregnancy, and the final sample (n = 265) was restricted to infants who also had biologic drug testing at delivery. Participants were classified by pregnancy drug use: no drugs/no cigarettes, no drugs/cigarette use, illicit drugs/no cigarettes, and illicit drugs/cigarette use. Groups differed significantly on infant birthweight, but not gestational age at delivery after control for confounders including background and medical factors. Among women who smoked, the adjusted mean birthweight gain was 163 g for those not using hard illicit drugs, while marijuana use had no effect on birth weight beyond the effect of smoking cigarettes. Women who used hard illicit drugs and did not smoke had an adjusted mean birthweight gain of 317 g over smokers. Finally, women who refrained from hard illicit drugs and smoking had a birthweight gain of 352 g. Among substance using pregnant women, smoking cessation may have a greater impact on birthweight than eliminating illicit drug use. Intervention efforts should stress that smoking cessation is at least as important to improving pregnancy outcomes as abstaining from illicit drug use.

Cut-off values for substances of interest for both urinalysis and meconium analysis. Values equal to or greater than the value listed were considered a positive drug screen for that substance. amphetamines, 500 ng/ml; barbiturates, 200 ng/ml; benzodiazepines, 100 ng/ml; cannabinoids; 50 ng/ml; cocaine, 300 ng/ml; opiates, 100 ng/ml.

A value greater than 6 ppm was used to indicate cigarette use [78].

Lester, B. M., & Twomey, J. E. (2008). Treatment of substance abuse during pregnancy. Womens Health, 4, 67–77.CrossRef

Jones, H. E., Martin, P. R., Heil, S. H., et al. (2008). Treatment of opioid-dependent pregnant women: Clinical and research issues. Journal of Substance Abuse Treat, 35(3), 245–259.CrossRef

Winklbaur, B., Kopf, N., Ebner, N., et al. (2008). Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: A knowledge synthesis for better treatment for women and neonates. Addiction, 103(9), 1429–1440.PubMedCrossRef

Howell, E. M., Heiser, N., & Harrington, M. (1999). A review of recent findings on substance abuse treatment for pregnant women. Journal of Substance Abuse Treatment, 16(3), 195–219.PubMedCrossRef

Miles, D. R., Lanni, S., Lansson, L., & Svikis, D. (2006). Smoking and illicit drug use during pregnancy: Impact on neonatal outcome. Journal of Reproductive Medicine, 51, 567–572.PubMed

Jessup, M. A., & Song, Y. (2008). Tobacco-related practices and policies in residential perinatal drug treatment programs. Journal of Psychoactive Drugs, 5((Suppl)), 357–364.PubMedCrossRef

Bailey, B. A., & Jones Cole, L. (2009). Are obstetricians following best practice guidelines for addressing pregnancy smoking? Results from Northeast Tennessee. Southern Medicine Journal, 102, 894–899.CrossRef

Jordan, T. R., Dake, J. R., & Price, J. H. (2006). Best practices for smoking cessation in pregnancy: Do obstetricians/gynecologists use them in practice? Journals of Womens Health, 15(4), 400–441.CrossRef

Finnegan, L. P. (1984). Neonatal abstinence. In: Current Therapy in Neonatal and Perinatal Medicine. St. Louis: CV Mosby.

10.

Pichini, S., & Garcia-Algar, O. (2006). In utero exposure to smoking and newborn neurobehavior: How to assess neonatal withdrawal syndrome? Therapeutic Drug Monitoring, 28, 288–290.PubMedCrossRef

11.

Koren, G., Gladstone, D., Robeson, C., & Robieux, I. (1992). The perception of teratogenic risk of cocaine. Teratol, 46, 567–571.CrossRef

12.

DeVille, K. A., & Kopelman, L. M. (1998). Moral and social issues regarding pregnant women who use and abuse drugs. Obstetrics and Gynecology Clinics of North America, 25(1), 237–254.PubMedCrossRef

13.

Lambert, B., Schneider, M., & Campbell, D. (2010). Ethical issues and addiction. Journal of Addictive Diseases, 29(2), 164–174.PubMedCrossRef

14.

Nutt DJ, King LA, Phillips LD. Drug harms in the UK: A multicriteria decision analysis. Lancet 2010, early online publication, 1 Nov 2010.

15.

Adams, E. K., Miller, V. P., Ernst, C., et al. (2002). Neonatal health care costs related to smoking during pregnancy. Health Economics, 11, 193–206.PubMedCrossRef

16.

Choo, R. E., Heustis, M. A., Schroeder, J. R., Shin, A. S., & Jones, H. E. (2004). Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure. Drug and Alcohol Dependence, 75(3), 253–260.PubMedCrossRef

17.

Winklbaur, B., Baewert, A., Jagsch, R., et al. (2009). Association between prenatal tobacco exposure and outcomes of neonates born to opioid-maintained mothers. Implications for treatment. European Addiction Research, 15(3), 150–156.PubMedCrossRef

18.

Lifshitz, M., Gavrilov, V., Galil, A., & Landau, D. (2001). A four year survey of neonatal narcotic withdrawal: Evaluation and treatment. Israel Medical Association Journal, 3(2), 17–20.PubMed

19.

Burstyn, I., Kapur, N., & Cherry, N. M. (2010). Substance use of pregnant women and early neonatal morbidity: where to focus intervention? Canadian Journal of Public Health, 101(2), 1490153.

20.

Mayes, L. C., Cicchetti, D., Acharyya, S., & Zhang, H. (2003). Developmental trajectories of cocaine-and-other drug-exposed and non-cocaine exposed children. Journal of Developmental and Behavioral Pediatrics, 24(5), 323–335.PubMedCrossRef

21.

Pinto, S. M., Dodd, S., Walkinshaw, S. A., et al. (2010). Substance abuse during pregnancy: Effect on pregnancy outcomes. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 150(2), 137–141.PubMedCrossRef

22.

El-Mohandes, A., Herman, A. A., El-Khorazaty, M. N., et al. (2003). Prenatal care reduces the impact of illicit drug use on perinatal outcomes. Journal of Perinatology, 23, 354–360.PubMedCrossRef

23.

Gray, T. R., Eiden, R. D., Leonard, K. E., et al. (2010). Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth. Clinical Chemistry, 56(9), 1442–1450.PubMedCrossRef

24.

Cornelius, M. D., Taylor, P. M., Geva, D., & Day, N. L. (1005). Prenatal tobacco and marijuana use among adolescents: Effects on offspring gestational age, growth, and morphology. Pediatrics, 95, 738–743.

25.

Shiono, P. H., Klebanoff, M. A., Nugent, R. P., et al. (1995). The impact of cocaine and marijuana use on low birth weight and preterm birth: A multicenter study. American Journal of Obstetrics and Gynecology, 172, 19–27.PubMedCrossRef

26.

English, D. R., Hulse, G. K., Milne, E., Holman, C. D. J., & Bower, C. I. (1997). Maternal cannabis use and birth weight: A meta-analysis. Addiction, 92, 1553–1560.PubMedCrossRef

27.

Fergusson, D. M., Horwood, L. J., & Northstone, K. (2002). Maternal use of cannabis and pregnancy outcome. British Journal of Obstetrics and Gynaecology, 109, 21–27.PubMedCrossRef

28.

vanGelder, M. M. H. J., Reefhuis, J., Caton, A. R., et al. (2010). Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study. Drug Alcohol Dependent, 109, 243–247.CrossRef

29.

Nordstrom-Klee (Bailey), B., Delaney-Black, V., Covington, C., Ager, J., & Sokol, R. J. (2002). Growth from birth onwards of children prenatally exposed to drugs: A literature review. Neurotoxicology and Teratology, 24, 481–488.CrossRef

30.

Zuckerman, B., Frank, D. A., Hingson, R., et al. (1989). Effects of maternal marijuana and cocaine use on fetal growth. New England Journal of Medicine, 320(12), 762–768.PubMedCrossRef

31.

Chasnoff, I. J., Griffith, D. R., Freier, C., & Murray, J. (1992). Cocaine/polydrug use in pregnancy: Two-year follow-up. Pediatrics, 89(2), 284–289.PubMed

32.

Eyler, F. D., Behnke, M., Conlon, M., Woods, N. S., & Wobie, K. (1998). Birth outcome from a prospective, matched study of prenatal crack/cocaine use: I. Interactive and dose effects on health and growth. Pediatrics, 101(2), 229–237.PubMedCrossRef

33.

Covington, C., Nordstrom-Klee, B., Ager, J., Sokol, R. J., & Delaney-Black, V. (2002). Birth to age 7 growth of children prenatally exposed to drugs: A prospective cohort study. Neurotoxicology and Teratology, 24, 489–496.PubMedCrossRef

34.

Kliegman, R. M., Madura, D., Kiwi, R., Eisenberg, I., & Yamashita, T. (1994). Relation of maternal cocaine use to the risks of prematurity and low birth weight. Journal of Pediatrics, 124(5), 751–756.PubMedCrossRef

35.

Jacobson, J. L., Jacobson, S. W., Sokol, R. J., et al. (1994). Effects of alcohol use, smoking, and illicit drug use on fetal growth in black infants. Journal of Pediatrics, 124, 757–764.PubMedCrossRef

36.

Miller, J. M., Boudreaux, M. C., & Regan, F. A. (1995). A case-controlled study of cocaine use in pregnancy. American Journal of Obstetrics and Gynecology, 172(1), 180–185.PubMedCrossRef

37.

Hulse, G. K., Milne, E., English, D. R., & Holman, C. D. (1997). The relationship between maternal use of heroin and methadone and infant birth weight. Addiction, 92, 1571–1579.PubMedCrossRef

38.

Smith, L. M., LaGasse, L. L., Derauf, C., et al. (2006). The infant development, environment, and lifestyle study: Effects of prenatal methamphetamine exposure, polydrug exposure, and poverty on intrauterine growth. Pediatrics, 118(3), 1149–1156.PubMedCrossRef

39.

Smith, L., Yonekura, M. L., Wallace, T., et al. (2003). Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term. Journal of Developmental and Behavioral Pediatrics, 24(1), 17–23.PubMedCrossRef

40.

Nguyen, D., Smith, L. M., LaGasse, L. L., et al. (2010). Intrauterine growth of infants exposed to prenatal methamphetamine: Results from the infant development, environment, and lifestyle study. Journal of Pediatrics, 157(2), 337–339.PubMedCrossRef

41.

Rogers, J. M. (2008). Tobacco and pregnancy: Overview of exposure and effects. Birth Defects Research, 84, 1–15.PubMedCrossRef

42.

Abel, E. L. (1980). Smoking during pregnancy: A review of effects on growth and development of offspring. Human Biology, 52, 593.PubMed

43.

Zotti, M. E., Replogle, W. H., & Sappenfield, W. M. (2003). Prenatal smoking and birth outcomes among Mississippi residents. Journal of Miss State Medical Association, 44(1), 3–9.

44.

Cliver, S. P., Goldenberg, R. L., & Cutter, G. R. (1995). The effect of cigarette smoking on neonatal anthropometric measurements. Obstetrics and Gynecology, 85(4), 625–630.PubMedCrossRef

45.

Bernstein, I. M., Plociennik, K., Stable, S., Badget, G. J., & Secker-Walker, R. (2000). Impact of maternal cigarette smoking on fetal growth and body composition. American Journal of Obstetrics and Gynecology, 183, 883–886.PubMedCrossRef

46.

Habek, D., Cerkez-Habek, J., Ivanisevic, M., & Djelmis, J. (2002). Fetal tobacco syndrome and perinatal outcome. Fetal Diagonsis Therapy, 17, 367–371.CrossRef

47.

Wang, X., Zuckerman, B., Pearson, C., et al. (2002). Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight. The Journal of the American Medical Association, 287, 195–202.CrossRef

48.

Mehaffey, K., Higginson, A., Cowan, J., Obsourne, G. M., & Arbour, L. T. (2010). Maternal smoking at first prenatal visit as a marker of risk for adverse pregnancy outcomes in the Qikiqtaaluk (Baffin) Region. Rural and Remote Health, 10, 1484.PubMed

49.

Espy, K. A., Fang, H., Johnson, C., et al. (2010). Prenatal tobacco exposure: Developmental outcomes in the neonatal period. Developmental Psychology ; Online first publication not yet in print.

50.

Secker-Walker, R. H., & Vacek, P. M. (2003). Relationships between cigarette smoking during pregnancy, gestational age, maternal weight gain, and infant birth weight. Addictive Behaviors, 28, 55–66.PubMedCrossRef

51.

Bailey, B. A., & Byrom, A. R. (2007). Factors predicting birth weight in a low-risk sample: The role of modifiable pregnancy health behaviors. Maternal and Child Health Journal, 11, 173–179.PubMedCrossRef

52.

Hack, M., Klein, N. K., & Taylor, H. G. (1995). Long-term developmental outcomes of low birth weight infants. The Future of Children, 5, 176–196.PubMedCrossRef

53.

McIntire, D. D., Bloom, S. L., Casey, B. M., & Leveno, K. J. (1999). Birth weight in relation to morbidity and mortality among newborn infants. New England Journal of Medicine, 340(16), 1234–1238.PubMedCrossRef

54.

Pryor, J., Silva, P. A., & Brooke, M. (1995). Growth, development and behavior in adolescents born small-for-gestational-age. Journal of Paediatric Health, 31(5), 403–407.CrossRef

55.

Nagy, Z., Westerberg, H., Skare, S., Andersson, J. L., Lilja, A., Flodmark, O., et al. (2003). Pretern children have disturbances of white matter at 11 years of age as shown by diffusion tensor imaging. Pediatric Research, 54(5), 672–679.PubMedCrossRef

56.

Peterson, B. S., Vohr, B., Staib, L. H., Cannistraci, C. J., Dolberg, A., Schneider, K. C., et al. (2000). Regional brain volume abnormalities and long-term cognitive outcome in preterm infants. The Journal of the American Medical Association, 284, 1939–1947.CrossRef

57.

Black, L., David, R. J., Brouillette, R. T., & Hunt, C. E. (1986). Effects of birthweight and ethnicity on incidence of sudden infant death syndrome. Journal of Pediatrics, 108, 209–214.PubMedCrossRef

58.

Welliver, R. C. (2003). Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection. Journal of Pediatrics, 143, S112–S117.PubMedCrossRef

59.

Villar, J., Smeriglio, V., Martorell, R., Brown, C. H., & Klein, R. E. (1984). Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life. Pediatrics, 74(5), 783–791.PubMed

60.

Luciana, M., Lindeke, L., Georgieff, M. K., Mills, M. M., & Nelson, C. A. (1999). Neurobehavioral evidence for working memory deficits in school-aged children with histories of prematurity. Development of Medical Child Neurology, 41, 521–533.CrossRef

61.

O’Keeffe, M. J., O’Callaghan, M., Williams, G. M., Najman, J. M., & Bor, W. (2003). Learning, cognitive, and attentional problems in adolescents born small for gestational age. Pediatrics, 112(2), 301–307.PubMedCrossRef

62.

Clements, K. M., Barfield, W. D., Ayadi, M. F., & Wilber, N. (2007). Preterm birth–associated cost of early intervention services: An analysis by gestational age. Pediatrics, 119(4), 866–874.CrossRef

63.

Chiriboga, C. A. (2003). Fetal alcohol and drug effects. Neurologist, 9(6), 267–279.PubMedCrossRef

64.

Slotkin, T. A. (1998). Fetal nicotine or cocaine exposure: Which one is worse? Journal of Pharmacology and Experimental Therapy, 285(3), 931–945.

65.

Savitz, D. A., & Murnane, P. (2010). Behavioral influences on preterm birth: A review. Epidemiology, 21(3), 291–299.PubMedCrossRef

66.

Schempf, A. (2007). Illicit drug use and neonatal outcomes: A critical review. Obstetrical and Gynecological Survey, 62(11), 749–757.PubMedCrossRef

67.

Schempf, A., & Strobino, D. (2008). Illicit drug use and adverse birth outcomes: Is it drugs or context? Journal of Urban Health, 85(6), 858–873.PubMedCrossRef

68.

Rogowski, J. (1998). Cost-effectiveness of care for low birth weight infants. Pediatrics, 102(1), 35–43.PubMedCrossRef

69.

United States Department of Health and Human Services: 1994 National Household Survey on Drug Abuse: Substance Abuse and Mental Health Services Administration. Washington, DC, National Institute on Drug Abuse, 1995.

70.

Ebrahim, S. H., & Gfroerer, J. (2003). Pregnancy-related substance use in the United States during 1996–1998. Obstetrics and Gynecology, 101, 374–379.PubMedCrossRef

71.

Budney, A. J., Higgins, S. T., Hughes, J. R., & Bickel, W. K. (1993). Nicotine and caffeine use in cocaine-dependent individuals. Journal of Substance Abuse, 5, 117–130.PubMedCrossRef

72.

Jones, H. E., Heil, S. H., O’Grady, K. E., et al. (2009). Smoking in pregnant women screened for an opioid agonist medication study compared to related pregnant and non-pregnant patient samples. American Journal of Drug and Alcohol Abuse, 35(5), 375–380.PubMedCrossRef

73.

Landry, S. H., & Whitney, J. A. (1996). The impact of prenatal cocaine exposure: Studies of the developing infant. Seminars in Perinatology, 20(2), 99–106.PubMedCrossRef

74.

Bolnick, J. M., & Rayburn, W. F. (2003). Substance use disorders in women: Special considerations during pregnancy. Obstetrics and Gynecology Clinics of North America, 30(3), 545–558.PubMedCrossRef

75.

Bada, H. S., Das, A., Bauer, C. R., et al. (2005). Low birth weight and preterm births: Etiologic fraction attributable to prenatal drug exposure. Journal of Perinatology, 25, 631–637.PubMedCrossRef

76.

Bailey, B. A., & Jones Cole, L. (2009). Rurality and birth outcomes: findings from Southern Appalachia and the potential role of pregnancy smoking. Journal Rural Health, 25, 141–149.CrossRef

77.

Bailey, B. A., & Wright, H. N. (2010). Assessment of pregnancy cigarette smoking and factors that predict denial. American Journal of Health Behaviour, 34, 166–176.

78.

SRNT Subcommittee on Biochemical Verification. (2002). Biochemical verification of tobacco use and cessation. Nicotine & Tobacco Research, 4(2), 149–159.CrossRef

79.

Abel E. L, Sokol R. J, Hannigan J. H, Nordstrom (Bailey) B. The effects of maternal drinking during pregnancy. In: Prenatal Diagnosis: Genetics, Reproductive Risks, Testing, and Management. Evans, M. I (ed); New York: McGraw-Hill, 123–129, 2006.

80.

Bailey, B., & Sokol, R. J. (2008). Is prematurity a part of the fetal alcohol spectrum disorders? Expert Review of Obstetircs and Gynecology, 3(2), 245–255.CrossRef

81.

Kotelchuck, M. (1994). An evaluation of the kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. American Journal of Public Health, 84, 1414–1420.PubMedCrossRef

Title: Infant Birth Outcomes Among Substance Using Women: Why Quitting Smoking During Pregnancy is Just as Important as Quitting Illicit Drug Use
Authors: Beth A. Bailey
Judy G. McCook
Alexis Hodge
Lana McGrady
Publication date: 01-02-2012
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue 2/2012
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-011-0776-y

At a glance: The STEP trials

Springer Medicine

Infant Birth Outcomes Among Substance Using Women: Why Quitting Smoking During Pregnancy is Just as Important as Quitting Illicit Drug Use

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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