Pregnant women and mothers using alcohol, tobacco and illegal drugs

Czech version

Authors: B. Nechanská ¹; V. Mravčík ^2,3; B. Sopko ³ ; P. Velebil ⁴
Authors‘ workplace: Ústav zdravotnických informací a statistiky ČR, Praha, ředitel Mgr. J. Holub ¹; Klinika adiktologie 1. LF UK a VFN, Praha, přednosta doc. PhDr. M. Miovský, Ph. D. ²; Národní monitorovací středisko pro drogy a drogové závislosti ³; Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc. ⁴
Published in: Ceska Gynekol 2012; 77(5): 457-469

Overview

This analysis is focused on use of addictive substances among women hospitalised during delivery or puerperium. Analysed data come from National Registry of Mothers at Childbirth and from National Registry of Newborns, which are managed by the Institute of Health Information and Statistics.

Goal:
To describe the prevalence of addictive substances use among women during gestation and to study its relation to health complications during pregnancy, delivery or puerperium and to health status of foetus and newborns.

Methods and materials:
The reporting to registries is provided in the Report on mother at childbirth and in the Report on newborn. Both registers provide basic socio-demographic information about mother, information about previous pregnancies and abortions, about current pregnancy, course of delivery, birth and neonatal treatment and health of newborn during hospitalization of mother during delivery or puerperium. Use of addictive substances is monitored in the National Registry of Mothers at Childbirth since 2000. Addictive substances are divided to tobacco, alcohol and drugs. Descriptive analysis of data was performed and binary logistic regression was used to test association of substance use with education and marital status (adjusted for age), analysis of variance was used to test association of substance use with selected health complications of pregnancy, delivery or puerperium and with health status of foetus/newborns (adjusted for age, education, marital status and interaction between addictive substances).

Results:
In 2000–2009, 1,008,821 mothers were reported of whom 60,502 women were registered as cigarette smokers, 1,528 used alcohol and 1,836 used other (illegal) drugs. Total of 1,027,200 newborns were reported. The average age of mothers using addictive substances were about 0.5–3 years lower in comparison with nonusers, in average mothers using illegal drugs were the youngest. Mothers using addictive substances were more often unmarried and had lower education than nonusers – almost 2/3 of mothers using addictive substances were unmarried or didn’t live in permanent partnership and more than 82% of mothers-users have lower education (primary or secondary school without a diploma). The association between substance use and induced and spontaneous abortions was observed only in smokers. Serious complications of pregnancy were associated with all monitored addictive substances – in mothers-smokers, a probability of serious complications were about 40 %, in users of illicit drugs about 13 % and in alcohol users about 5 % higher as compared to nonusers. Substance use showed almost no association with problems during childbirth. Alcohol and illegal drugs use increased probability of complications in puerperium. Health status of foetus/newborn was negatively significantly altered mainly in those born to mothers-smokers in almost all observed characteristics. Mother’s alcohol use during pregnancy was associated primarily with the overall health status of foetus immediately after delivery, congenital anomalies, stillbirth or need for treatment of newborn in the theatre. Infants of mothers using addictive substances had higher probability of consequent hospitalization after discharge from the neonatal department, transfer to infant home and death of infant.

Conclusion:
Association between complications during pregnancy, delivery and puerperium and health status of newborns and substance use of mothers during pregnancy was found mainly in cigarette smoking. Alcohol use was found significant in some (but serious) health problems of mothers and newborns. The association between illegal drugs and monitored indicators wasn’t found. Following the results of this work, criteria for reporting of illegal drug use in mothers during pregnancy should be improved.

Key words:
addictive substances, tobacco smoking, alkohol, drug, mother, newborn.

Sources

1. Almeina, ND., Koren, G., Platt, RW., Kamer, MS. Hair biomarkers as measures of maternal tobacco smoke exposure and predictors of fetal growth. Nicotine Tob Res, 2011, 13 (5), p. 328–335.

2. Alvik, A., Torgersen, AM., Aalen, OO., Lindemann, R. Binge alcohol exposure once a week in early pregnancy predicts temperament and sleeping problems in the infant. Early Hum Dev, 2011, 12.

3. Benedict, MD., Missmer, SA., Vahratian, A., et al. Secondhand tobacco smoke exposure is associated with increased risk of failed implantation and reduced IVF success. Hum Reprod, 2011, 26, 9, p. 2525–2531.

4. Ben-Haroush, A., Ashkenazi, J., Sapir, O., et al. High-quality embryos maintain high pregnancy rates in passive smokers but not in active smokers. Reprod Biomed Online, 2010, 22, 1, p. 44–9.

5. Canon, MJ., Dominique, Y., O’Leary, LA., et al. Characteristics and behaviors of mothers who have a child with fetal alcohol syndrome. Neurotoxicol Teratom, 2011, 7 [Epub ahead of print].

6. Committee on Health Care for Underserved Women. At-risk drinking and alcohol dependence: obstetric and gynecologic implications. American College of Obstetricians and Gynecologists. Obstet Gynecol, 2011, 118 (2 Pt 1), p. 383–388. Committee opinion no. 496.

7. Dott, M., Rasmussen, SA., Hogue, CJ., Reefhuis, J. Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, National Birth Defects Prevention Study, 1997–2002. Matern Child Health J, 2010, 14 (3), p. 373–381.

8. Duncan, JR., Randall, LL., Belliveau, RA., et al. The effect of maternal smoking and drinking during pregnancy upon (3) H-nicotine receptor brainstem binding in infants dying of the sudden infant death syndrome: initial observations in a high risk population. Brain Pathol, 2008, 18 (1), p. 21–31.

9. Dumas, A., Lejeune, C., Simmat-Durand, L., et al. Pregnancy and psychoactives substances: prevalence study based on the declared consumption. J Gynecol Obstet Biol Reprod (Paris), 2008, 37 (8), p. 770–778.

10. Eiden, RD., Leopard, KE., Colder, CR., et al. Anger, hostility, and aggression as predictors of persistent smoking during pregnancy. J Stud Alcohol Druha, 2011, 72 (6), p. 926–932.

11. El-Melegy, NT., Ali, ME. Apoptotic markers in semen of infertile men: Association with cigarette smoking. Int Braz J Urol, 2011, 37 (4), p. 495–506.

12. Gladstone, J., Levy, M., Nulman, I., Koren, G. Characteristics of pregnant women who engage in binge alcohol consumption. CMAJ, 1997, 156 (6), p. 789–794.

13. Gyarmathy, VA., Giraudon, I., Hedrich, D., et al. Drug use and pregnancy – challenges for public health. Euro Surveill, 2009, 14 (9), p. 33–36.

14. Hoell, I., Havemann-Reinecke, U. Pregnant opioid addicted patients and additional drug intake. Part I. Toxic effects and therapeutic consequences. Med Monatsschr Pharm ct, 2011, 34 (10), p. 363–374, quiz 375–6.

15. Hotham, E., Ali, R., White, J., Robinson, J. Pregnancy-related changes in tobacco, alcohol and cannabis use reported by antenatal patients at two public hospitals in South Australia. Aust N Z J Obstet Gynaecol, 2008, 48 (3), p. 248–254.

16. Kakko, J., Heilig, M., Sarman, I. Buprenorphine and methadone treatment of opiate dependence during pregnancy: comparison of fetal growth and neonatal outcomes in two consecutive case series. Drug Alcohol Depend, 2008, 96 (1–2), p. 69–78.

17. Králíková, E., Bajerová, J., Raslová, N., et al. Smoking and pregnancy: prevalence, knowledge, anthropometry, risk communication. Prague Med Rep, 2005, 106 (2), p. 195–200.

18. Kukla, L., Hrubá, D., Tyrlík, M. Alkohol a drogy v těhotenství. Rozdíly mezi kuřačkami a nekuřačkami. Alkoholismus a drogové závislosti, 1999, 34 (4), p. 193–202.

19. Kukla, L., Hrubá, D., Tyrlík, M. Průběh těhotenství a vývoj plodu kouřících a nekouřících žen. Čes Gynek, 1999, 4, s. 271–274.

20. Kukla, L., Hrubá, D., Tyrlík, M. Maternal smoking during pregnancy, behavioral problems and school performances of their school-aged children. Cent Eur J Public Health, 2008, 16 (2), p. 71–76.

21. Lamy, S., Thibaut, F. État des lieux de la consommation de substances psychoactives par les femmes enceintes. Encephale, 2010, 36 (1), p. 33–38.

22. Leonardi-Bee, J., Smyth, A., Britton, J., Coleman, T. Environmental tobacco smoke and fetal health: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 2008, 93 (5), F351–361.

23. Mateja, WA., Nelson, DB., Kroelinger, CD., et al. The association between maternal alcohol use and smoking in early pregnancy and congenital cardiac defects in infants. J Womens Health (Larchmt), 2011, 6 [Epub ahead of print].

24. Minozzi, S., Amato, L., Vecchi, S., Davoli, M. Maintenance agonist treatments for opiate dependent pregnant women. Cochrane Database Syst Rev. 2008, Apr 16;(2).

25. Mravčík, V., Pešek, R., Horáková, M., Nečas, V., et al. Výroční zpráva o stavu ve věcech drog v České republice v roce 2010. Praha: Úřad vlády České republiky, 2011.

26. Murin, S., Rafii, R., Bilello, K. Smoking and smoking cessation in pregnancy. Clin Chest Med, 2011, 32 (1), p. 75–91.

27. O’Brien, PL. Ego-dystonic pregnancy and prenatal consumption of alcohol among first-time mothers. Matern Child Health J, 2011, 2 [Epub ahead of print].

28. Ortega-García, JA., Gutierrez-Churango, JE., Sánchez-Sauco, MF., et al. [Epub ahead of print] Head circumference at birth and exposure to tobacco, alcohol and illegal drugs during early pregnancy. Childs Nerv Syst, 2011, 15.

29. Patra, J., Bakker, R., Irving, H., et al. Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA) – a systematic review and meta-analyses. BJOG, 2011, 118, p. 1411–1421.

30. Pei, J., Job, J., Kully-Martens, K., Rasmussen, C. Executive function and memory in children with Fetal Alcohol Spectrum Disorder. Child Neuropsychol, 2011, 17 (3), p. 290–309.

31. Ripabelli, G., Cimmino, L., Grasso, GM. Alcohol consumption, pregnancy and fetal alcohol syndrome: implications in public health and preventive strategies. Ann Ig, 2006, 18 (5), p. 391–406.

32. de Sanctis, L., Memo, L., Pichini, S., et al. Fetal alcohol syndrome: new perspectives for an ancient and underestimated problem. J Matern Fetal Neonatal Med, 2011, 24, Suppl. 1, p. 34–37.

33. Shah, PS., Balkhair, T., Ohlsson, A., et al. Intention to become pregnant and low birth weight and preterm birth: a systematic review. Matern Child Health J, 2011, 15 (2), p. 205–216.

34. Thäle, V., Schlitt, A. Effects of alcohol and smoking in pregnancy. Internist (Berl), 2011, 52 (10), p. 1185–1190.

35. Vavřinová, B., Binder, T. Návykové látky v těhotenství. Zaostřeno na drogy 2007, 5 (4), p. 1–12.

36. Vert, P., Hamon, I., Hubert, C., et al. Infants of drug-addicted mothers: pitfalls of replacement therapy. Bull Acad Natl Med, 2008, 192 (5), p. 961–969; discussion p. 969.

37. Wyper, KR., Rasmussen, CR. Language impairments in children with fetal alcohol spectrum disorders. J Popul Ther Clin Pharmacol, 2011, 18 (2), e364–376. Epub 2011 Jun 15.

38. Ye, X., Skjaerven, R., Basso, O., et al. In utero exposure to tobacco smoke and subsequent reduced fertility in females. Hum Reprod, 2010, 25 (11), p. 2901–2906.

39. Zuckerman, B., Frank, DA., Hingson, R., et al. Effects of maternal marijuana and cocaine use on fetal growth. N Engl J Med, 1989, 320(12) p. 762–768.