RESUMO
There is an increased prevalence of maternal substance abuse during pregnancy in younger women in all socioeconomic classes and races. Our aim was to determine the prevalence and correlates of self-reported substance abuse among pregnant women and obstetric complications or neonatal outcomes in Iran. This retrospective cohort study is covering a five year period on medical records of pregnant women attending the maternity unit of four major hospitals [Mahdieh, Taleghani, Imam Hossein and Akbarabadi Hospitals]. Women who reported using opium, heroin, crack, cannabis or methamphetamine were compared with women with no reported history of drug abuse for obstetric complications and prenatal morbidity and neonatal mortality. From 100,620 deliveries substance abuse was recorded for 519 women giving a prevalence of 0.5%. Opium was the most prevalent substance abused followed by crack [a mix of heroin and amphetamines]. The exposed group had significantly more obstetric complications including preterm low birth weight and postpartum hemorrhage than the non-exposed group. The exposed group had significantly worse prenatal outcomes including more admissions to intensive care unit and higher infant mortality than the non-exposed group. None of the women in the exposed group was on methadone treatment at time of delivery. Risks of maternal and neonatal complications were increased in substance using pregnant women, especially preterm birth and low birth weight. We recommend a multidisciplinary team to provide methadone maintenance therapy for substance using pregnant women and urinary screen of all pregnant women presenting to hospital
RESUMO
Substance abuse is a major public health issue in all over the world. The types and ingredients of drugs used in our country are different from other countries. The study was conducted to determine relationship between substance abuse during pregnancy, and perinatal complications in Iran. A retrospective cohort study was carried out over a 6 years period on all the substance user pregnant women [519 cases] and 519 non users attending 4 major educational university hospitals labor ward. All the substance user pregnant mothers abusing heroin, opium, crack, cannabis, crystal, methadone, and polydrug were included and compared to non-exposed ones. Our study demonstrated a 0.5% prevalence of substance abuse in pregnant women. Opium [62.6%] was the most prevalent substance followed by crack [20.3%]. Pre-term birth was higher in all substance user groups, the most in crack group [45.8%] with relative risk of 2.55. Neonatal abstinence syndrome developed in 38.7% of infants born of addicted mothers [40.4% crack, 38.6% opiates, 35.3% crystal and 45.5% poly drug use]. Neonatal birth weight of infants of mothers using crack, opium and polydrug were significantly lower to non users [P<0.05]. Neonatal Intensive Care Unit [NICU] admission in substance using mothers was significantly higher than non-users [P < 0.001]. Neonatal death was 10.1% in crack group [RR=3.48] and 5.8% in opium user group [RR=2.79] with significant difference with non-users [P<0.05]. The frequent types of substances used during pregnancy in our country are different from others [opium was the most prevalent substance]. Subsequently the frequencies of the complications during pregnancy are different. Substance abuse during pregnancy has increased risk of pre-term birth, Small for Gestational Age, NICU admission and neonatal death