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Independent risk factors for chronic illicit substance use during pregnancy

Manuel C. Vallejo, MD, DMD, Robert E. Shapiro, MD, Mitchell W. Lippy, BS, Christa L. Lilly, PhD, Leo R. Brancazio, MD


Objective: We aimed to determine the incidence of chronic illicit substance use during pregnancy and to identify associated risk factors.

Design: A 2-year time-matched retrospective maternal quality control database (n = 4,470) analysis of parturients with chronic illicit substance use compared to controls.

Setting: A tertiary academic medical center located in a rural setting.

Results: The rate of chronic illicit substance use was 1.95 percent. Demographic factors associated with chronic illicit substance use in pregnancy-included lower body mass index (BMI; OR: 0.93; 95 percent CI: 0.89-0.96, p < 0.0001), higher gravidity (OR: 1.24; 95 percent CI: 1.13-1.36, p < 0.0001), higher parity (OR: 1.38; 95 percent CI: 1.22-1.57, p < 0.0001), and more live births (OR: 1.30; 95 percent CI: 1.16-1.46, p < 0.0001). A history of smoking (OR: 10.51; 95 percent CI: 5.69-19.42, p < 0.0001), alcohol use (OR: 48.98; 95 percent CI: 17.33-138.40, p < 0.0001), anxiety (OR: 1.88; 95 percent CI: 1.16-3.05, p = 0.01), depression (OR: 2.44; 95 percent CI: 1.55-3.85, p = 0.0001), transfer on admission (OR: 2.12; 95 percent CI: 1.16-3.87, p = 0.01), payor insurance (OR: 2.12, 95 percent CI: 2.10-5.04, p < 0.0001), and Apgar scores < 7 at 1 minute (OR: 0.50; 95 percent CI: 0.25-1.00, p = 0.049) were significant. Multiple variable logistic regression-revealed BMI, smoking, alcohol use, and Apgar score < 7 at 1 minute as significant factors.

Conclusions: Awareness of these factors can assist in identifying and treating parturients with chronic illicit substance use.


pregnancy, maternal outcomes, chronic illicit drug use, risk factors

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