Prenatal methamphetamine use increases risk of adverse maternal and neonatal outcomes - 11/07/24

Doi : 10.1016/j.ajog.2024.05.033

Sarena Hayer, MD, MA, MSc ^a,^⁎ , Bharti Garg, MBBS, MPH ^a, Jessica Wallace, MD ^c, Kristin C. Prewitt, MD, MPH ^a,^b,^d, Jamie O. Lo, MD, MCR ^a,^b,^e, Aaron B. Caughey, MD, PhD ^a,^b
^a Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
^b Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
^c Department of Family Medicine, University of Colorado, Denver, CO
^d Department of Internal Medicine, Addiction Medicine Section, Oregon Health & Science University, Portland, OR
^e Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR

^∗Corresponding author: Sarena Hayer, MD, MA, MSc.

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Abstract

Background

Although methamphetamine use has been increasing in recent years and occurring within new populations and in broader geographical areas, there is limited research on its use and effect in pregnancy.

Objective

This study aimed to examine the association between prenatal methamphetamine use and maternal and neonatal outcomes in a large, contemporary birth cohort.

Study Design

This was a retrospective cohort study using California-linked vital statistics and hospital discharge data from 2008 to 2019. Methamphetamine use was identified using the International Classification of Disease, Ninth Revision and Tenth Revision, codes. Chi-square tests and multivariable Poisson regression models were used to evaluate the associations between methamphetamine use and maternal and neonatal outcomes.

Results

A total of 4,775,463 pregnancies met the inclusion criteria, of which 18,473 (0.39%) had methamphetamine use. Compared with individuals without methamphetamine use, individuals with methamphetamine use had an increased risk of nonsevere hypertensive disorders (adjusted risk ratio, 1.81; 95% confidence interval, 1.71–1.90), preeclampsia with severe features (adjusted risk ratio, 3.38; 95% confidence interval, 3.14–3.63), placental abruption (adjusted risk ratio, 3.77; 95% confidence interval, 3.51–4.05), cardiovascular morbidity (adjusted risk ratio, 4.30; 95% confidence interval, 3.79-4.88), and severe maternal morbidity (adjusted risk ratio, 3.53; 95% confidence interval, 3.29–3.77). In addition, adverse neonatal outcomes were increased, including preterm birth at <37 weeks of gestation (adjusted risk ratio, 2.85; 95% confidence interval, 2.77–2.94), neonatal intensive care unit admission (adjusted risk ratio, 2.46; 95% confidence interval, 2.39–2.53), and infant death (adjusted risk ratio, 2.73; 95% confidence interval, 2.35–3.16).

Conclusion

Methamphetamine use in pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes that persists after adjustment for confounding variables and sociodemographic factors. Our results can inform prenatal and postpartum care for this high-risk, socioeconomically vulnerable population.

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Key words : maternal drug use, methamphetamine, prenatal exposure, prenatal substance use, stimulants

Plan

Introduction

Materials and methods

Results

Comment

Principal findings

Results in the context of what is known

Clinical implications

Research implications

Strengths and limitations

Conclusions

	J.O.L. and A.B.C. contributed equally to this work.
	The authors report no conflict of interest.
	The findings of this article were presented at the Society for Maternal-Fetal Medicine 2024 Pregnancy Meeting, National Harbor, MD, February 10–14, 2024.
	Cite this article as: Hayer S, Garg B, Wallace J, et al. Prenatal methamphetamine use increases risk of adverse maternal and neonatal outcomes. Am J Obstet Gynecol 2024;XX:x.ex–x.ex.