Methamphetamine Use in Pregnancy: What Happens to Baby?

Problem Statement  Methamphetamine (meth) is the leading illicit drug of abuse in the United States.  Although some studies have suggested poor outcomes in both newborns and new mother behavior, the impact of meth use by pregnant women on neonatal outcomes is not widely understood. 
 
Objective The purpose of this study was to report neonatal outcomes of meth-exposed pregnancies compared to controls in a tertiary care medical center located in the center of the meth epidemic, Phoenix, Arizona.
 
Methodology  A retrospective review of medical of records between 2000 and 2006, that were identified by ICD-9 coding for subtance abuse and pregnancy was performed.  Records documenting either positive meth screen or history of use during pregnancy were analyzed for birth events, which resulted in a cohort of neotatal subjects.  These neonatal charts were then evaluated for the following outcome measures:  gestational age, APGAR, site and mode of delivery, disposition of infant and neonatal mortality. 
 
Results  The table below illustrates statistically significant differences between meth patients and a non-meth exposed control population.  Additionally, the following outcomes were also noted:  15/273 (6%) unattended delivery (car, toilet, home, ambulance), 87/215 (40%) mother/infant seperation (adoption, CPS/foster care, POA other than mother) which included 23/215 (11%) planned adoption.  Also noteworthy was that many women abused multiple substances, thus complicating neotatal withdrawal. The record review also revealed increased demands on nursing staff (neonatal abstinence protocols, collection of specimens for drugs of abuse, management of withdrawal symptoms, lack of parental involvement in care, psychosocial and mental health concerns).
 

Table of Neonatal Outcomes
	Meth (%) n=273	Controls (%) n=34055	p Value
Preterm Birth	139 (52)	5627 (17)	<0.0001
1" APGAR	16 (6)	665 (2)	<0.0001
5" APGAR	16 (6)	328 (1)	<0.0001
C-Section	79 (29)	7730 (23)	<0.02
Neonatal Mortality	11 (4)	325 (1)	<0.001

 

Interpretation  Pregnancies complicated by maternal meth use were associated with a marked and significant increase in neonatal morbidity and mortality.  Perinatal complications were not solely limited to medical outcomes but also involved a dramatic breakdown of expected mother-infant bonding as demonstrated by the high foster care and adoption rate.  Meth-exposed neonates tax the hospital staff and burden the state foster care system. The significance of the meth epidemic in pregnancy is poorly understood and further study is indicated; however, these data begin to describe the magnitude of this public health crisis and emphasizes the increased demands and challenges for the maternal/neonatal nursing staff.