Maternal and Neonatal Effects of Substance Abuse during Pregnancy: Our Ten-year Experience

PURPOSE: The aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country. MATERIALS AND METHODS: Data on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997-2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group. RESULTS: During the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score < or = 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers. CONCLUSION: Addiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

Gender differences in in-hospital mortality and mechanisms of death after the first acute myocardial infarction

There are conflicting data about gender differences in short-term mortality after acute myocardial infarction [AMI] after adjusting for age and other prognostic factors. Therefore, we investigated the risk profile, clinical presentation, in-hospital mortality and mechanisms of death in women and men after the first AMI. The data were obtained from a chart review of 3382 consecutive patients, 1184 [35%] women [69.7 +/- 10.9 years] and 2198 [65%] men [63.5 +/- 11.8 years] with a first AMI. The effect of gender and its interaction with age, risk factors and thrombolytic therapy on overall mortality and mechanisms of death were examined using logistic regression. Unadjusted in-hospital mortality was higher in women [OR 1.77, 95% Cl 1.47-2.15]. Adjustment that included both age only and age and other base-line differences [hypertension, diabetes mellitus, hypercholesterolemia, smoking, AMI type, AMI site, mean peak CK value, thrombolytic therapy] decreased the magnitude of the relative risk of women to men but did not eliminate it [OR 1.26, 95% Cl 1.03-1.54 and OR 1.31 95% Cl 1.03-1.66, respectively]. Multivariate analysis revealed that female gender was an independent predictor of in-hospital mortality after the first AMI. Women were dying more often because of mechanical complications-refractory pulmonary edema and cardiogenic shock [P=0.02] or electromechanical dissociation [P=0.03], and men were dying mostly by arrhythmic death, primary ventricular tachycardia/fibrillation [P=0.002]. Female gender was independently associated with mechanical death [OR 1.56, 95% Cl 1.35-2.58; P=0.01] and anterior AMI was independently associated with arrhythmic death [OR 0.54,95% Cl 0.34-0.86; P=0.01]. Our results demonstrate significant differences in mechanisms of in-hospital death after the first AMI in women and men, suggesting the possibility that higher in-hospital mortality in women exists primarily because of the postponing AMI death due to the gender-re-lated differences in susceptibility to cardiac arrhythmias following acute coronary events