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Delayed prenatal care: meth use in pregnancy may flag more drug abuse.

SAN FRANCISCO -- Women who use methamphetamine during pregnancy face an increased risk of polydrug use, poverty, delayed prenatal care, and out of home placement of their newborns, compared with women who do not use the drug, Dr. Penny Grant reported in a poster session at the annual meeting of the Pediatric Academic Societies.

The preliminary findings come from the first-ever study of demographic and health care characteristics of mothers who use methamphetamine.

"Methamphetamine is the only illicit drug that does not have a lower rate of use for pregnant women than nonpregnant women," said Dr. Grant of the department of pediatrics at the University of Oklahoma, Tulsa. "Most users smoke it. If you live in an area where there is methamphetamine use, you should be aware that half of those babies are going to be under child protective services provision, and about a quarter of those babies are not going to go home with the mother. So they are already at increased risk for adverse events."

Dr. Grant and her associates screened a cohort of 84 women exposed to methamphetamine use during pregnancy and enrolled 92 women to serve as controls. The women were enrolled in the yearlong multicenter, longitudinal Infant Development, Environment, and Lifestyle study (IDEAL).

The researchers questioned respondents about demographics, prenatal drug use, and prenatal health care. Women in the exposed group were identified by self-report and/or gas chromatographymass spectroscopy confirmation of amphetamine and metabolites in infant meconium. Women in the control group were matched by race, neonatal birth weight, level of education, and type of health insurance. They denied methamphetamine use and had a negative meconium screen.

Of the study participants, 44% were white, 19% were Hispanic, 14% were Asian, 12% were Pacific Islander, 8% were black, and 3% were from other ethnic groups. Almost half (45%) did not complete high school, and 85% were on Medicaid.

Compared with controls, women in the methamphetamine group were from lower socioeconomic status, were multiparous, (two vs. one), and lacked a partner (57% vs. 36%).

They also used more alcohol (43% vs. 17%), tobacco (79% vs. 26%), and marijuana (39% vs. 8%) during pregnancy, and had more referrals to child and protective services at discharge (51% vs. 6%), with 26% (vs. 3%) of newborns not placed with their mothers.

"What really surprised me was the high rate of involvement by child and protective services," Dr. Grant said at the meeting, sponsored by the Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association. "One-quarter of those kids not going home [with their mothers] is really frightening. On the other hand, methamphetamine is horrifically addictive. The people who really get on this [drug] progress to a drug-using lifestyle that impairs their ability to cope with anything in their lives. It is an awful drug."

Most methamphetamine users (73%) smoked the drug. Average reported use was 3 days a week in the first trimester and 2 days a week during the second and third trimesters.

The studied groups did not differ in frequency of perinatal hospitalizations or in the prevalence of hepatitis, STDs, chronic hypertension, or psychiatric diagnoses.

The National Institute on Drug Abuse supported the study.

BY DOUG BRUNK

San Diego Bureau
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Title Annotation:Obstetrics
Author:Brunk, Doug
Publication:OB GYN News
Date:Jul 15, 2004
Words:535
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