Cocaine use during pregnancy has been related to physical growth, however effect on BW and HC when controlled for alcohol and smoking has not been reported. A study objective was to quantify history of drug use by a maternal inventory of substance use (MISU) and to assess relationships between use and BW and HC in women with term pregnancies. Women with a history of cocaine/opiate (C/O) use or C/O metabolites in meconium (exposed (EXP) group) were matched to a non-exposed to C/O comparison (COMP) group by race, GA, and infant sex. History of C/O, alcohol and tobacco was assessed on the MISU by 4 time periods; 3 mos prior to, and during each of 3 trimesters of pregnancy. Based on frequency, use was categorized as continuously high, moderate or low, decreasing, increasing, or no use per each time period. Effect on BW and HC was assessed by patterns of use with adjustment for substance use by multivariate analysis.

Results: In the C/O EXP group (n=245), 43% women used C/O continuously throughout 4 time periods at a high rate, 7% at moderate rate, 9% at low rate, 33% of women decreased, and 7% increased use. The COMP group(n=500) did not use C/O. Alcohol and tobacco was used in both EXP and COMP groups. Mean BW and HC was higher in the COMP group than in each of the patterns of C/O EXP (p<.001) by univariate analysis. When impact of C/O on BW and HC was assessed while adjusting for tobacco and alcohol, no differences between C/O EXP and COMP were noted. Compared to non-users, consistent use of tobacco had a deleterious effect on BW (high use) and HC (moderate use) after adjusting for cocaine and alcohol while alcohol use had no impact on BW and HC when adjusting for C/O and tobacco.

Conclusion: During pregnancy smoking appears to have a significant effect on infant BW and HC as compared to cocaine/opiate and alcohol.