The Impact of Self-Reported Alcohol, Tobacco, and Recreational Drug Use during Pregnancy on Adverse Pregnancy Outcomes in First-Time Mothers.

Daggy JK, Silver RM, Guise D, Haas DM. The Impact of Self-Reported Alcohol, Tobacco, and Recreational Drug Use during Pregnancy on Adverse Pregnancy Outcomes in First-Time Mothers. American journal of perinatology. 2022 Sep 12.

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Abstract:

OBJECTIVE: The objective of this study was to derive profiles of alcohol, tobacco, and recreational drug use during pregnancy for first-time mothers with latent class growth analysis (LCGA) and determine the association of these classes with the risk of adverse pregnancy outcomes (APO). STUDY DESIGN: A secondary analysis of a prospective cohort of Nulliparous Outcomes in Pregnancy: Monitoring Mothers-to-Be was conducted in eight medical centers across the United States from September 30, 2010, to September 23, 2013. Self-reported use of any alcohol, tobacco, or recreational drugs in the 1 month prior to the visit was assessed at up to four visits throughout pregnancy, and APOs included a composite of preterm birth, hypertensive disorder of pregnancy (HDP), small for gestational age (SGA) infant, or stillbirth, and each adverse outcome separately. RESULTS: Four latent classes were identified from the LCGA for 10,031 nulliparous pregnant women that were on average 26.9 years old (standard deviation [SD]? = 5.7) and mostly non-Hispanic White (59.7%). Classes included consistent tobacco users (? = 517, 5.2%), nonusers (? = 8,945, 89.2%), alcohol users (? = 500, 5.0%), and a combination of alcohol/tobacco/drug users (? = 69, 0.7%). Logistic regression demonstrated that the class of tobacco users was more likely to have an APO (odds ratio [OR]? = 1.48, 95% confidence interval [CI]? = 1.22-1.81), preterm birth (OR? = 1.53, 95% CI? = 1.15-2.02), and SGA (OR? = 1.79, 95% CI? = 1.36-2.35) relative to the class of nonusers. The class of alcohol users was more likely to have HDP (OR? = 1.37, 95% CI? = 1.11-1.70) and less likely to have preterm birth (OR? = 0.59, 95% CI? = 0.38-0.90) and SGA (OR? = 0.61, 95% CI? = 0.40-0.93) compared to nonusers. CONCLUSION: Trajectories of substance use are associated with APOs; thus, interventions to mitigate the use when encountered early in pregnancy are warranted. KEY POINTS: · Four classes of substance use were identified.. · Tobacco users were at a higher risk of APO and alcohol users were at higher risk of HDP.. · Mitigation strategies are warranted to reduce APO..