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Observational Study
. 2025 Apr 16;25(1):456.
doi: 10.1186/s12884-024-07062-1.

Risk of adverse obstetrical and neonatal outcomes in women consuming recreational drugs during pregnancy

Sreemanjari Kandhasamy  1   2 , Karine Lepigeon  3 , Stéphanie Baggio  1   4 , Roulet Céline  3 , Michael Ceulemans  5   6   7 , Ursula Winterfeld  8 , Stephen P Jenkinson  1   9 , Katyuska Francini  3 , Emeline Maisonneuve #  1   2   3 , Alice Panchaud #  10   11
Affiliations
Observational Study

Risk of adverse obstetrical and neonatal outcomes in women consuming recreational drugs during pregnancy

Sreemanjari Kandhasamy et al. BMC Pregnancy Childbirth. .

Abstract

Background: Previously conducted studies have observed an increased risk of adverse maternal and neonatal outcomes with prenatal exposure to cocaine and opioids. However, these studies used drug-free reference groups which did not efficiently control for confounders associated with polysubstance use in pregnancy. Thus, we conducted an observational study to compare the risk of adverse obstetrical and neonatal outcomes in women who consumed cocaine and/or opioids during pregnancy to women who consumed only cannabis in pregnancy.

Methods: This observational study was conducted with data collected from pregnant women followed for addiction from the beginning of their pregnancy until childbirth at the perinatal consultation center Addi-Vie at CHUV Lausanne, Switzerland. Women who reported consuming cocaine, opioids, or both along with or without cannabis were included in the exposed group, while women who reported use of only cannabis during pregnancy were included in the reference group. We assessed for two adverse composite outcomes namely: adverse obstetrical composite outcome (4 outcomes) and adverse neonatal composite outcome (7 outcomes). Weighted logistic regression with weights obtained through inverse probability treatment weighting was conducted. For this analysis, we reported a conditional odds ratio (ORconditional) and 95% confidence interval (CI).

Results: We included 177 pregnant women in this study, with 80 included in the exposed group and 97 included in the reference group. In the exposed group, 81.2% of women reported the use of opioids, and 39.9% of women reported the use of cocaine during pregnancy. In this study, prenatal cocaine and/or opioid exposure was associated with reduced odds of adverse obstetrical composite outcomes (ORconditional: 0.39, 95% CI: 0.17-0.88) compared to prenatal cannabis use. We also observed that the pregnant women exposed to cocaine and/or opioids during pregnancy were at 3.88 (ORconditional: 3.88, 95% CI: 1.23-12.23) times higher odds of experiencing the adverse neonatal composite outcome compared to our reference group.

Conclusion: Prenatal use of cocaine and/or opioids during pregnancy is observed to increase the odds of adverse neonatal composite outcomes. Encouraging substance users to seek antenatal care in earlier stages of pregnancy and targeted treatment approaches through interprofessional collaboration could prevent such adverse outcomes in pregnancy.

Keywords: Adverse outcomes; Cocaine; Opioids; Pregnancy; Substance use.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The ethical approval for this study was provided by the Ethics committee of Canton de Vaud (Protocol number: 76/15). The Ethics committee of Canton de Vaud (Commission cantonale d'éthique de la recherche sur l'être humain) waived the need for informed consent for this study as per Art.34 HRA for further use of data in the absence of informed consent. The study was performed in accordance with the relevant guidelines and regulations of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of Study groups
Fig. 2
Fig. 2
The Venn diagram describes the drug use in the exposure group: cocaine(39.9%), cannabis(38.8%), and opioids (81.2%)
Fig. 3
Fig. 3
Covariate balance plot for IPTW: overall balance of covariates improved but variables depicting “psychological conditions or psychoactive conditions and support from family/friend” were not completely balanced (not within the threshold of 0.1- 0.25)
See this image and copyright information in PMC

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