Drug Use during Pregnancy and its Consequences: A Nested Case Control Study on Severe Maternal Morbidity

Abstract Objective To assess the relationship between the use of psychoactive substances during pregnancy and the occurrence of severe maternal morbidity (SMM), perinatal outcomes and repercussions on the neuropsychomotor development of exposed children. Methods A case-control study nested within a cohort of severe maternal morbidity (COMMAG) was performed. Women with SMM were considered cases. Controls were thosewith low-risk pregnancy,without SMMand admitted during the same time period as the cases. Cohort data were collected retrospectively in hospital records for childbirth. A face-to-face interview was also performed with 638 women (323 without SMM and 315 with SMM) and their children of the index pregnancy between 6 months and 5 years after childbirth. During the interview, substance abuse during pregnancy was assessed by a modified question from the Alcohol, Smoking and Substance Involvement Screening Test 2.0 (ASSIST) and the neuropsychomotor development in the children was assessed by the Denver Developmental Screening Test, 2nd edition. Results The prevalence of licit or illicit drug use during pregnancy was ~ 17%. Among drug users, 63.9% used alcohol, 58.3% used tobacco, 9.2% used cocaine/crack and 4.6% used marijuana. There was no association between drug use during pregnancy and SMM, although tobacco use during pregnancy was associated with bleeding, presence of near-miss clinical criteria (NMCC) and alteration in infant development; alcohol use was associated with neonatal asphyxia; and cocaine/crack use was associated with the occurrence of some clinical complications during pregnancy. Conclusion The use of psychoactive substances during pregnancy is frequent and associated with worse maternal, perinatal and child development outcomes.

摘要 目的 评估妊娠期精神活性物质使用与严重孕产妇发病（severe maternal morbidity, SMM）、围产期结局以及暴露子代神经精神运动发育影响之间的关联。方法 本研究为一项嵌套于严重孕产妇发病队列（COMMAG）的病例对照研究。将发生严重孕产妇发病（SMM）的女性设为病例组；将同期收治、无SMM且妊娠为低风险的女性设为对照组。队列数据通过分娩住院病历进行回顾性收集。此外，在分娩后6个月至5年期间，对638名受试女性（其中323名无SMM、315名有SMM）及其本次妊娠所诞子女开展面对面访谈。访谈过程中，采用经修改的酒精、吸烟与物质使用筛查测试2.0（Alcohol, Smoking and Substance Involvement Screening Test 2.0, ASSIST）相关问题评估妊娠期物质滥用情况，并采用丹佛发育筛查测验第二版（Denver Developmental Screening Test, 2nd edition）评估儿童神经精神运动发育水平。结果 妊娠期合法或非法药物使用的患病率约为17%。在药物使用者中，63.9%使用酒精、58.3%使用烟草、9.2%使用可卡因/快克，4.6%使用大麻。尽管妊娠期整体药物使用与SMM无显著关联，但妊娠期烟草使用与出血、濒死临床标准（near-miss clinical criteria, NMCC）阳性以及婴儿发育异常存在关联，酒精使用与新生儿窒息存在关联，可卡因/快克使用与妊娠期部分临床并发症存在关联。结论 妊娠期精神活性物质使用较为普遍，且与不良的孕产妇、围产期及儿童发育结局相关。