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Prenatal Care Reduces the Impact of Illicit Drug use on Perinatal Outcomes


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.

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This work was Supported by grants (U18-HD30447, U18-HD30458, U18-HD30450, U18-HD30445, U18-HD31919, U18-HD30454, and U18-HD31206) from the NICHD and the NIH ORMH.

A Cooperative Agreement funded by The NIH Office of Research on Minority Health and The National Institute of Child Health and Human Development supported this study. The following institutions and investigators participated in the NIH-DC Initiative to Reduce Infant Mortality in Minority Populations in the District of Columbia: The Children's National Medical Center — P.C. Scheidt (Principal Investigator), The D.C. Department of Public Health — B.J. Hatcher (Principal Investigator), D.C. General Hospital — L. Johnson (Principal Investigator), Georgetown University Medical Center — K.N. Sivasubramanian (Principal Investigator), Howard University — B.D. Wesley (Principal Investigator), The University of the District of Columbia — V. Melnick (Principal Investigator), The Research Triangle Institute — A.V. Rao (Principal Investigator), The NICHD—H.W. Berendes (Program Officer), A.A. Herman (Scientific Coordinator), B.K. Wingrove (Program Coordinator).

Other participating institutions were Columbia Hospital for Women Medical Center and The George Washington University Medical Center.

We thank Dr. Michele Kiely, the NICHD program officer, for her valuable comments and suggestions on an earlier draft of this paper.

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El-Mohandes, A., Herman, A., Nabil El-Khorazaty, M. et al. Prenatal Care Reduces the Impact of Illicit Drug use on Perinatal Outcomes. J Perinatol 23, 354–360 (2003).

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