Perinatal substance use: a prospective evaluation of abstinence and relapse

Abstract

Background: Substance use decreases in pregnancy but little prospective data are available on the rates of abstinence and relapse for specific substances. This study compared rates of abstinence in pregnancy and relapse postpartum for nicotine cigarettes, alcohol, marijuana, and cocaine.

Methods: Data from 152 women drawn from a randomized controlled trial comparing psychological treatments for substance use in pregnancy were analyzed. Self-reports of substance use and urine for toxicology testing throughout pregnancy and 3-months, 12-months and 24-months post-delivery were collected. Multivariate Cox models were used to compare rates of abstinence and relapse across substances.

Results: In pregnancy, 83% of all women achieved abstinence to at least one substance. The mean (SE) days to abstinence was 145.81 (9.17), 132.01 (6.17), 151.52 (6.24), and 148.91 (7.68) for cigarettes, alcohol, marijuana and cocaine, respectively. Participants were more likely to achieve abstinence from alcohol (HR 7.24; 95% CI 4.47-11.72), marijuana (HR 4.06; 95% CI 1.87-6.22), and cocaine (HR 3.41; 95% CI 2.53-6.51), than cigarettes. Postpartum, 80% of women abstinent in the last month of pregnancy relapsed to at least one substance. The mean days to relapse was 109.67 (26.34), 127.73 (21.29), 138.35 (25.46), and 287.55 (95.85) for cigarettes, alcohol, marijuana and cocaine, respectively. Relapse to cocaine was only 34% (HR 0.34; 95% CI 0.15-0.77) that of cigarettes.

Conclusions: Pregnancy-related abstinence rates were high for all substances except cigarettes. Postpartum relapse was common, with cocaine using women being less likely to relapse after attaining abstinence compared to women using cigarettes, alcohol or marijuana.

Keywords: Abstinence; Drug use; Postpartum; Pregnancy; Relapse; Smoking.

Figure 1. Flow of Study Participants

Of the 2661 women screened, 289 were eligible, and 91 (32%) declined to participate. Of the 196 women consented, 184 completed enrollment, and 166 had sufficient data collected to determine baseline substance use according to the predefined use levels. From these 166 women, 152 met baseline substance use criteria and were included in the analysis for abstinence (potential abstinence cohort), and 126 of the 152 women achieved abstinence prior to delivery and were included in the postpartum relapse analysis (potential relapse cohort).

Figure 2. Time to Abstinence in Pregnancy by Drug

Kaplan-Meier estimates of the time interval in pregnancy (weeks in pregnancy) to abstinence from cigarettes, alcohol, marijuana or cocaine.

Figure 3. Time to Relapse After Delivery by Drug

Kaplan-Meier estimates of the time from delivery until relapse to cigarettes, alcohol, marijuana or cocaine in the 24 months postpartum.