Original Article

Journal of Perinatology (2005) 25, 93–100. doi:10.1038/sj.jp.7211214 Published online 21 October 2004

Mortality Risk Associated with Perinatal Drug and Alcohol Use in California

Ellen L Wolfe DrPH, PNP1, Thomas Davis BA2, Joseph Guydish PhD, MPH3 and Kevin L Delucchi PhD4

  1. 1Family Health Care Nursing (E.L.W.), University of California, San Francisco, San Francisco General Hospital, San Francisco, CA, USA
  2. 2Institute for Health Policy Studies (T.D.), University of California, San Francisco, CA, USA
  3. 3Medicine and Policy (J.G.), University of California, San Francisco, CA, USA
  4. 4Department of Psychiatry (K.L.D.), University of California, San Francisco, CA, USA

Correspondence: Ellen L. Wolfe, DrPH, PNP, San Francisco General Hospital, 1001 Potrero Avenue, MS6E, San Francisco, California 94110, USA. E-mail: ewolfe@sfghpeds.ucsf.edu

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Abstract

OBJECTIVE:

 

To analyze the relationship between perinatal drug/alcohol use and maternal, fetal, neonatal, and postneonatal mortality.

STUDY DESIGN:

 

Linked California discharge, birth and death certificate data from 1991–1998 were used to identify drug/alcohol-diagnosed births. Mortality relative risk (RR) ratios were calculated and logistic models were generated for mortality outcomes.

RESULTS:

 

Among 4,536,701 birth records, 1.20% contained drug/alcohol discharge diagnostic codes (n=54,290). The unadjusted RRs for maternal (RR=2.7), fetal (RR=1.3), neonatal (RR=2.4), and postneonatal (RR=4.3) mortality were increased for drug/alcohol-diagnosed births. After controlling for potential confounding, the odds of maternal death for cocaine use (OR=2.15) remained significant as did amphetamine (OR=1.77), cocaine (OR=1.43), polydrug (OR=2.01) and other drug/alcohol use (OR=1.79) for postneonatal mortality.

CONCLUSIONS:

 

The association of cocaine use with maternal mortality and any drug/alcohol use with postneonatal mortality supports screening and identifying women using illicit drugs and alcohol during pregnancy. Increased collaboration with drug treatment programs and closer follow-up for drug-using women and their children may improve mortality outcomes.

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