Smoking and illicit drug use during pregnancy - Impact on neonatal outcome

OBJECTIVE: To examine the effects of maternal substance use on neonatal outcomes in 212 pregnant cocaine/opiate dependent women who delivered while in active drug treatment. STUDY DESIGN: Using urine toxicology data at delivery, subjects were classified drug positive (+TOX) (n = 53) or negative (-TOX) (n = 159). RESULTS: Toxicology status was not associated with maternal or neonatal demographic or drug use variables. +TOX patients were enrolled in the treatment program for a shorter period of time than -TOX (68.3 vs. 91.3 days, p = 0.005). Infant birth weight ratio (IBR) was lower in +TOX women (0.84 vs. 0.90, p = 0.003). +TOX women were twice as likely to have small-for-gestational-age (IBR < 0.85) neonates than were -TOX. Length of stay (LOS) in the neonatal intensive care unit (NICU) was not associated with maternal toxicology but was associated with quantity of tobacco per day (p = 0.0001). NICU neonates with heavily smoking mothers (11 + cigarettes/day) averaged LOS = 9.5 days as compared to light (1-10 cigarettes per day) smokers (LOS = 7.9 days) and nonsmokers (LOS = 5.5 days). CONCLUSION. Maternal drug abstinence is associated with higher IBR. Maternal smoking is related to NICU LOS, even among polydrugdependent women. These data are clinically an economically important and support the need for smoking cessation interventions in high-risk populations, such as drug-dependent pregnant women.