Maternal Drug Exposure Declining, at Least at One Large Center

Less Cocaine Abuse Noted

By Caroline Helwick

Washington, DC—Maternal substance abuse has decreased over the past decade, in particular cocaine use, at the University of Maryland Medical Center in Baltimore. At 2011 American College of Obstetri cians and Gynecol ogists annual meeting, Mishka Terplan, MD, MPH, de scribed the trends in drug-exposed deliveries at her center for the period 2001-2009. She and her colleagues reviewed ma ternal and newborn administrative data, which included urine toxicology and International Classification of Diseases, Ninth Revision, codes for substance abuse and birth outcomes.

The population included 15,150 women, 10% of whom had drugexposed deliveries. But drug use peaked in 2004 to nearly 12%, and has since declined to approximately 6%, Dr Terplan reported.

For individual drug classes, rates of abuse have varied across the time period, but a trend is evidence for the decline in cocaine abuse:

In 2004, cocaine exposure was 3.25%, which dropped to 0.8% in 2009
Opiate exposure peaked in 2005 to 4.43% and fell to 2.62% in 2009
Marijuana exposure at delivery has ranged from 2.23% to 4.51% in 2001 and fell again to 2.25% in 2009. By total use at the time of delivery:
435 women were exposed to marijuana (69% aged, 20-30 years)
413 exposed to opiates (46% aged 20-30, 42%, >30 years)
141 exposed to cocaine (57% aged >30 years).

Risk Factors for Drug exposure at Delivery
Significant demographic differences were noted among drug-exposed women. Drug exposure was documented for 11% of black women, 13% of white women, and 6% of women of other races. Only 7% of mothers younger than age 20 years were drugexposed compared with 10% of those aged 20 to 30 years and 14% of women aged >30 years.

Drug exposure was more common among:
Women with public, versus private, insurance coverage • Unemployed women
Those living within the city of Baltimore
Smokers.

Drug exposure at the time of delivery was associated with increased length of stay for the baby: 11.2 days versus 7.8 days. All these differences were statistically significant, Dr Terplan noted.