Articles

Maternal and Neonatal Complications of Substance Abuse in Iranian Pregnant Women

Abstract

There is an increased prevalence of maternal substance abuse during pregnancy in younger women in all socioeconomic classes and races. Our aim was to determine the prevalence and correlates of self-reported substance abuse among pregnant women and obstetric complications or neonatal outcomes in Iran. This retrospective cohort study is covering a five year period on medical records of pregnant women attending the maternity unit of four major hospitals (Mahdieh, Taleghani, Imam Hossein and Akbarabadi Hospitals). Women who reported using opium, heroin, crack, cannabis or methamphetamine were compared with women with no reported history of drug abuse for obstetric complications and prenatal morbidity and neonatal mortality. From 100,620 deliveries substance abuse was recorded for 519 women giving a prevalence of 0.5%. Opium was the most prevalent substance abused followed by crack (a mix of heroin and amphetamines). The exposed group had significantly more obstetric complications including preterm low birth weight and postpartum hemorrhage than the non-exposed group. The exposed group had significantly worse prenatal outcomes including more admissions to intensive care unit and higher infant mortality than the non-exposed group. None of the women in the exposed group was on methadone treatment at time of delivery. Risks of maternal and neonatal complications were increased in substance using pregnant women, especially preterm birth and low birth weight. We recommend a multidisciplinary team to provide methadone maintenance therapy for substance using pregnant women and urinary screen of all pregnant women presenting to hospital.

Amaro H, Fried LE, Cabral H, Zuckerman B. Violence during pregnancy and substance use. Am J Public Health 1990;80(5):575-9.

Hutchins E, DiPietro J. Psychosocial risk factors associated with cocaine use during pregnancy: a casecontrol study. Obstet Gynecol 1997;90(1):142-7.

Ebrahim SH, Gfroerer J. Pregnancy-related substance use in the United States during 1996-1998. Obstet Gynecol 2003;101(2):374-9.

Vega WA, Kolody B, Hwang J, Noble A. Prevalence and magnitude of perinatal substance exposures in California. N Engl J Med 1993;329(12):850-4.

Chasnoff IJ, Landress HJ, Barrett ME. The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. N Engl J Med 1990;322(17):1202-6.

Chasnoff IJ, McGourty RF, Bailey GW, Hutchins E,Lightfoot SO, Pawson LL, Fahey C, May B, Brodie P, McCulley L, Campbell J. The 4P's Plus screen forsubstance use in pregnancy: clinical application andoutcomes. J Perinatol 2005;25(6):368-74.

Kuczkowski KM. Anesthetic implications of drug abuse in pregnancy. J Clin Anesth 2003;15(5):382-94.

U.S. Department of Health and Human Services. 2006 National Survey on Drug Use & Health: Detailed Tables.[Internet] 2008 Jun [cited 2012 May]; Available from:http://www.oas.samhsa.gov/NSDUH/2k6NSDUH/tabs/sect 7peTabs48to93.htm

Sheehan TJ. Stress and low birth weight: a structural modeling approach using real life stressors. Soc Sci Med 1998;47(10):1503-12.

Soepatmi S. Developmental outcomes of children of mothers dependent on heroin or heroin/methadone duringpregnancy. Acta Paediatr Suppl 1994;404:36-9.

van Baar AL, Soepatmi S, Gunning WB, Akkerhuis GW. Development after prenatal exposure to cocaine, heroin and methadone. Acta Paediatr Suppl 1994;404:40-6.

Hulse GK, Milne E, English DR, Holman CD. Assessing the relationship between maternal opiate use and antepartum haemorrhage. Addiction 1998;93(10):1553-8.

Lifschitz MH, Wilson GS, Smith EO, Desmond MM. Factors affecting head growth and intellectual function in children of drug addicts. Pediatrics 1985;75(2):269-74.

Behnke M, Eyler FD. The consequences of prenatal substance use for the developing fetus, newborn, and young child. Int J Addict 1993;28(13):1341-91.

Hobbs JA, Graham NA, Gold MS. Prenatal care shouldinclude drug testing . Pediatrics 2009;123:4.

Mokri A. Brief overview of the status of drug abuse in Iran. Arch Iranian Med 2002;5:184-90.

Kennare R, Heard A, Chan A. Substance use during pregnancy: risk factors and obstetric and perinatal outcomes in South Australia. Aust N Z J Obstet Gynaecol 2005;45(3):220-5.

Crome IB, Kumar MT. Epidemiology of drug and alcoholuse in young women. Semin Fetal Neonatal Med 2007;12(2):98-105.

Australian Institute of Health and Welfare. Statistics on drug use in Australia. Canberra: Australian Institute of= Health and Welfare, 2004.

Vucinovic M, Roje D, Vučnović Z, Capkun V, Bucat M, Banović I. Maternal and neonatal effects of substance abuse during pregnancy: our ten-year experience. Yonsei Med J 2008;49(5):705-13.

Mayet S, Groshkova T, Morgan L, MacCormack T, StrangJ. Drugs, alcohol and pregnant women: changing characteristics of women engaging with a specialist perinatal outreach addictions service. Drug Alcohol Rev2008;27(5):490-6.

Day C, Nassirimanesh B, Shakeshaft A, Dolan K. Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran. Harm Reduct J 2006;3:2.

Fountain J, Howes S, Strang J. Unmet drug and alcohol service needs of homeless people in London: a complex issue. Subst Use Misuse 2003;38(3-6):377-93.

Abdel-Latif ME, Bajuk B, Lui K, Oei J; NSW on ACT Neonatal Intensive Care Units' Study (NICUS) Group. Short-term outcomes of infants of substance-using mothers admitted to neonatal intensive care units in New SouthWales and the Australian Capital Territory. J Paediatr Child Health 2007;43(3):127-33.

Little BB, Snell LM, Klein VR, Gilstrap LC 3rd, Knoll KA, Breckenridge JD. Maternal and fetal effects of heroinaddiction during pregnancy. J Reprod Med 1990;35(2):159-62.

Burns L, Mattick RP, Cooke M. The use of record linkage to examine illicit drug use in pregnancy. Addiction 2006;101(6):873-82.

Connaughton JF, Reeser D, Schut J, Finnegan LP. Perinatal addiction: outcome and management. Am J Obstet Gynecol 1977;129(6):679-86.

Dolan K, Salimi S, Nassirimanesh B, Mohsenifar S, Mokri A. The establishment of a methadone treatment clinic for women in Tehran, Iran. J Public Health Policy 2011;32(2):219-30.

Little M, Shah R, Vermeulen MJ, Gorman A, Dzendoletas D, Ray JG. Adverse perinatal outcomes associated with homelessness and substance use in pregnancy. CMAJ 2005;173(6):615-8.

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IssueVol 50, No 6 (2012) QRcode
SectionArticles
Keywords
Maternal Neonatal Complications Neonatal Complications Substance abuse Pregnancy Methadone

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How to Cite
1.
Saleh Gargari S, Fallahian M, Haghighi L, Hosseinnezhad-Yazdi M, Dashti E, Dolan K. Maternal and Neonatal Complications of Substance Abuse in Iranian Pregnant Women. Acta Med Iran. 1;50(6):411-416.