Original Article
Journal of Perinatology (2003) 23, 354–360. doi:10.1038/sj.jp.7210933
Prenatal Care Reduces the Impact of Illicit Drug use on Perinatal Outcomes
Participating institutions are listed in the acknowledgements.
Ayman El-Mohandes MD, MPH1, Allen A Herman MD, PhD2, M Nabil El-Khorazaty PhD3, Pragathi S Katta MPH1, Davene White RN, NNP4 and Lawrence Grylack MD5
- 1George Washington University Medical Center Washington, DC, USA
- 2NICHD Rockville, MD, USA
- 3The Research Triangle Institute (RTI International) Rockville, MD USA
- 4Howard University Washington, DC, USA
- 5Columbia Hospital for Women Washington, DC, USA
Correspondence: Ayman El-Mohandes, MD, MPH, Community Health and Pediatrics/Obstetrics and Gynecology, George Washington University, School of Public Health and Health Services, Ross Hall, Suite 125, 2300 I Street, N.W. Washington, DC 20037, USA
Abstract
OBJECTIVE: To estimate the extent that prenatal care (PNC) retains its protective influence against prematurity, low birth weight (LBW), and small for gestational age (SGA) status in infants exposed to illicit drug use (IDU) in pregnancy.
STUDY DESIGN: This was a prospective cohort analysis including 6673 women residents of the District of Columbia (Washington, DC, USA) delivering at four city hospitals. Women were screened in the immediate postpartum period. Levels of PNC were established according to American College of Obstetrics and Gynecology guidelines and the Kotelchuck index. PNC and IDU were compared between subgroups. Adjusted relative risks for prematurity, LBW and SGA, controlling for maternal and gestational ages, were calculated in different groups according to IDU and level of PNC.
RESULTS: IDU was identified in 13% of mothers screened. PNC was classified as none (6%), inadequate (10%), intermediate (20%), and adequate (64%). The highest risk for prematurity, LBW, or SGA occurred in infants born to mothers with no PNC and positive IDU in pregnancy (prematurity OR=12.05, 95% CI: 8.99 to 16.16; LBW OR=14.76, 95% CI: 11.03 to 19.75; SGA OR=9.20, 95% CI: 5.32 to 15.92). As PNC levels increased, significant reductions in risk for prematurity and LBW (not for SGA) in IDU-exposed infants were observed. Risk for SGA in IDU-exposed infants reduced significantly when PNC was introduced.
CONCLUSIONS: In infants exposed to IDU, a reduction in risk for prematurity, LBW, and SGA, was consistently demonstrated with improved levels of PNC. In high-risk populations, health care should seek to reach mothers early, especially those identified at risk for IDU, and deliver PNC to them effectively.
