[Retrospective analysis of neonatal data in a monocentric cohort of 170 newborns of polydrug-using mothers, Île-de-France, 1999-2008]. / Analyse rétrospective des données de 170 nouveau-nés de mères consommatrices de substances psychoactives.

OBJECTIVES: To analyze neonatal morbidity in a single-center retrospective cohort (1999-2008) according to the mothers' polydrug use and to the social and demographic context. MATERIAL AND METHODS: One hundred and seventy newborns were identified whose mothers used two or more substances (such as heroin, cocaine, opioid maintenance treatment, tobacco, alcohol, hashish, amphetamines, benzodiazepines, or other psychotropics) at the beginning of their pregnancies. The database included 168 sociodemographic variables describing mothers' living conditions and their drug-abuse characteristics; perinatal variables such as gestational age, weight, neonatal abstinence syndrome, and modalities of discharge; and correlations with the main neonatal morbidities. RESULTS: The mothers' mean age at delivery was 31.6yrs. It was the first pregnancy for 35.2% of the mothers but the mean number of previous abortions was 1.14 and 16.3% already had previous children in foster care. At delivery only 8.2% used only one product, 52.9% 2 or 3 products, and 37.6% four or more substances. All sociodemographic variables, the deprivation score, the number of previous abortions and miscarriages, and poor prenatal monitoring were significantly different for the mothers using four products or more. The uses changed along the years of study: fewer mothers used heroin but more used hashish, combined with other substances. The medical care also changed: greater participation on the part of mothers in neonatal care, more frequent breastfeeding, less medication for neonatal abstinence syndrome with the same severity score: i.e., 45.5% of infants with a Lipsitz score between 8 and 12 received a morphine treatment in 1999-2000 versus only 5.5% in 2005-2006 and none in 2007-2008. The mean gestational age was 38.1weeks. Preterm births (22.2%) and intrauterine growth restriction (18% with birth weight <10th percentile) were mainly correlated with the number of substances at delivery (17.3% preterm if three substances or less and 31.3% if four substances or more; p<0.001), social deprivation, poor prenatal care, and mothers having gained less than 5kg in weight during pregnancy (57.1% of intrauterine growth restriction versus 14.5%). Birth weight, height, and head circumference were significantly different for mothers having drunken alcohol. Among the newborns, seven showed complete fetal alcohol syndrome. The neonatal abstinence syndrome severity (23% with a Lipsitz score>9, one-quarter of whom were medicated with morphine) was correlated with an in-utero exposure to opiates, mainly in combination with benzodiazepines, and with the use of four or more substances. The mean age of infants at discharge was 18.1days (SD 3.39): 21.1% stayed 30 days or more in the hospital, mainly because of prematurity or intrauterine growth restriction, a high neonatal abstinence syndrome score, maternal polydrug use, psychosocial deprivation, or foster care placement decisions. Decisions for foster care placement (15%) applied to polydrug users, with social deprivation, undermonitored pregnancies, or bonding difficulties. CONCLUSION: The main factors correlated with poor neonatal results were polydrug use, maternal psychiatric pathologies, and social deprivation. Overall, prenatal and postnatal care such as rooming-in improved the results.

[Consequences for the newborn of alcohol consumption during pregnancy]. / Conséquences, pour l'enfant à naître, du maintien de la consommation d'alcool pendant la grossesse.

BACKGROUND: This paper aims at showing the immediate and long-term consequences affecting newborns whose mothers did not reduce or stop their consumption of alcohol when they were pregnant; these women were chosen among women who also used psychoactive substances. METHODS: A retrospective cohort was constituted of babies who were found to have been exposed in utero to one or more legal or illegal psychoactive substance(s) and who were born or hospitalized between 1999 and 2008 in a hospital near Paris. Among the cohort of 170 babies, 56 had mothers who had not modified their alcohol consumption when they were pregnant, 30 had mothers who had reduced their alcohol consumption, and 84 had mothers who declared having been abstinent. RESULTS: The babies born to mothers who did not modify their alcohol consumption when pregnant were more likely to be premature (30%) and hospitalized in the neonatology hospital unit (60.7%). They needed specific care for durations significantly longer than the babies exposed in utero to other psychoactive substances (P<0.005). They were more often diagnosed with fetal alcohol spectrum disorders (18%) and placed in a foster family (18%). CONCLUSION: Given the negative consequences on the babies born to mothers who do not modify their alcohol consumption when pregnant, these mothers should be identified and provided with better care. The successful strategies for early therapeutic interventions used in other countries should be studied as examples. This would make it possible to reduce the enormous financial, material and human costs that are a direct consequence of alcohol consumption during pregnancy.

[Maternal and obstetrical data in a retrospective cohort of 170 newborns from polydrug using mothers, in the Paris area, 1999-2008]. / Analyse des données maternelles et obstétricales dans une cohorte rétrospective de 170 nouveau-nés de mères polyconsommatrices, Île-de-France, 1999-2008.

OBJECTIVES: Polydrug use in pregnancy is harmful. This survey aimed to explore the issue of the associations of substances during pregnancy and to determine the consumer profiles. PATIENTS AND METHODS: One hundred and seventy newborns whose mothers were psychoactive substances users were identified over the period 1999 to 2008. The data relating to maternal consumption, their reproductive history, and their living environment were collated. RESULTS: At the end of their pregnancy, the mothers reported using on average 3.14 substances. Three profiles were determined: 65 women were heroin users or had consumed it in their lifetime and were currently on substitution treatment, and had a very unfavourable social living environment; 30 women were mainly consumers of alcohol, with or without benzodiazepines or other psychotropic drugs, and had a history of abortions; 75 women were mainly tobacco and cannabis smokers, with or without substitution treatment, had good social living conditions and had wanted the pregnancy. CONCLUSION: Polydrug use increases the risk for the women to avoid prenatal care and is often linked with a history of abortions.