Perinatal outcome of illicit substance use in pregnancy—comparative and contemporary socio-clinical profile in the UK
- 776 Downloads
The aim of the study was to determine the contemporary socio-clinical profile and perinatal outcome of illicit substance use in pregnancy in a large UK city and compare with published literature. Cases were identified retrospectively from the ‘cause for concern’ referrals over 5 years (2003–2007). Data was collected on mother–infant pair from medical notes and laboratory records. Chi-square and Mann–Whitney U tests were used where appropriate for statistical analysis. One hundred sixty-eight women were identified as using illicit substance in pregnancy. Smoking (97.4%), unemployment (85.4%) and single status (42.3%) were frequent. Besides controlled use of methadone, heroin, cannabis and benzodiazepines were the most commonly used drugs. Hepatitis C prevalence was high (29.9%) despite low antenatal screening rates (57.7%). Neonatal morbidity was related to prematurity (22.9%), small for dates (28.6%) and neonatal abstinence syndrome (NAS; 58.9%). By day 5 of life, 95.1% of the babies developing NAS and 96.1% of those requiring pharmacological treatment were symptomatic. Of the infants developing NAS, 31.7% required pharmacological treatment. A total of 82.5% babies went home with their mother, and 21.2% were placed on the Child Protection Register. Only 14.3% were breast feeding at discharge. Illicit substance use in pregnancy continues to be associated with significant maternal and neonatal morbidity, and the socio-clinical profile in this decade appears unchanged in the UK. Hepatitis C prevalence is high, and detection should be improved through targeted antenatal screening. Where facility in the community is unavailable, 5 days of hospital stay is sufficient to safely identify babies at risk of developing NAS. Most babies were discharged home with their mother.
KeywordsIllicit substance use Substance misuse Socio-clinical profile Perinatal outcome Neonatal abstinence syndrome
We would like to thank Virginia Hewitt, lead midwife for vulnerable adults and children, for her suggestions in the formative stage of the study and Cerys Nicholls for her help in collecting maternal data. We would like to thank the audit department at Singleton Hospital and Mrs. Lynda Challacombe for their help in obtaining medical notes.
Conflict of interest
The authors declare no conflict of interest.
- 3.Department of Health (2002) Statistics from the regional drug misuse databases for six months ending March 2001 Statistical Bulletin; 2002/07. Department of Health. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4023196.pdf. Accessed 25 Aug 2010
- 4.Department of Health (2007) Drug misuse and dependence: UK guidelines on clinical management. DOH and devolved administrations. http://www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf. Accessed 3 Jun 2010
- 6.European Monitoring Centre for Drugs and Drug Addiction (2009) Drug-related infectious diseases and drug-related deaths. EMCDDA, Luxembourg. http://www.emcdda.europa.eu/attachements.cfm/att_93236_EN_EMCDDA_AR2009_EN.pdf. Accessed 3 Jun 2010
- 8.Hoare J (2009) Drug misuse declared: findings from the 2008/09 British Crime Survey—England and Wales. Home Office Statistical Bulletin, London. http://rds.homeoffice.gov.uk/rds/pdfs09/hosb1209.pdf. Accessed 3 Jun 2010
- 11.National Institute of Drug Abuse (1999) Substance Abuse and Mental Health Services Administration (SAMHSA): National Household Survey on Drug Abuse (NHSDA). http://www.oas.samhsa.gov/NHSDA/99StateTabs/toc.htm. Accessed 3 Jun 2010
- 12.Neonatal drug withdrawal (1998) American Academy of Pediatrics Committee on Drugs. Pediatrics 101:1079–1088Google Scholar
- 13.Northern and Yorkshire Public Health Observatory (2002) Drug misuse in pregnancy in the Northern and Yorkshire Region. Occasional Paper No.6. http://www.dur.ac.uk/ne.pho/view_file.php?c=349. Accessed 3 Jun 2010
- 16.Office for National Statistics (2007) Press release, 24 May 2007, based on 2005 data. http://www.statistics.gov.uk/pdfdir/preterm0507.pdf. Accessed 3 Jun 2010
- 18.Rajagopal R, Mang A, Wisdom S (2008) Substance abuse in pregnancy and maternal & neonatal outcome—5 year study. Abstract of Societies. Scot Med J 53:49Google Scholar
- 22.Welsh Assembly Government (2009) Maternity statistics, Wales: method of delivery, 1998–2008. Welsh Assembly Government, Cardiff, UK. http://wales.gov.uk/docs/statistics/2009/090325sdr422009aen.pdf?lang=en. Accessed 3 Jun 2010
- 23.Welsh Index of Multiple Deprivation (2005) National Assembly of Wales Statistic Directorate. http://wales.gov.uk/cisd/publications/statspubs/wimd2005summaryrevised/en.pdf?cr=5&lang=en. Accessed 3 Jun 2010