Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study

Abstract

Background: There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy. Objectives: To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP). Method: A cohort study using nationwide registries in Czechia (2000–2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (n = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (n = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (n = 1,511,310) with no substance use disorder diagnosis (GP). The neonatal outcomes studied were growth parameters, gestational age, preterm birth, and Apgar score. To explore the associations between MA exposure and neonatal outcomes, regression coefficients (b) and odds ratios from multivariable linear and binary logistic regression were estimated. Results: MA-exposed women had similar socio-economic characteristics to opioid-exposed, both of which were worse than in the GP. After adjustment, MA exposure was associated with a more favourable birthweight when compared to the opioid-exposed (adjusted mean differences [aMD] b = 122.3 g, 95% CI: 26.0–218.5) and length (aMD b = 0.6 cm, 0.0–1.1). Unadjusted results from the comparison with the GP showed that the MA group had poorer neonatal outcomes, especially in the growth parameters. Adjustment for background characteristics had a profound effect on the comparison with the GP. After adjustment, MA exposure was associated only with a slightly reduced birthweight (aMD b = −63.0 g, −123.0 to −3.1) and birth length (aMD b = −0.3 cm, −0.6 to 0.0). Conclusions: Although the observed negative outcomes were large in the MA-exposed newborns, the adjustment had a profound effect on the comparison with the GP, indicating the large influence of lifestyle and socio-economic factors in these high-risk pregnancies. MA-exposed newborns had better neonatal outcomes compared to opioids-exposed.

Effects of Prenatal Methamphetamine Exposure on Birth Outcomes, Brain Structure, and Neurodevelopmental Outcomes

“…And previous studies showed that prenatal MA exposure can also affect postnatal development of newborns [8][9][10]. The delayed development, structural brain changes, impaired neurodevelopment, and other defects were found both in clinical studies [8][9][10][11][12] and animal models [13,14].…”

Prenatal methamphetamine—impact on the mother and child—a review

“…Another review of amphetamine exposure showed increased risk of preterm birth <37 weeks gestation (OR = 4.11; 95% CI = 3.05, 5.550), small for gestational age (5.79; 95% CI = 1.39, 24.06) and low birth weight (OR = 3.29; 95% CI = 1.97, 5.47) but did not provide a sub-analysis specific to MA use [58]. Comparisons of outcomes between drug-using and drug-free women with comparable social vulnerabilities, such as poverty and homelessness, suggest that MA was associated with worse newborn parameters, even after adjustment for confounders [60,61].…”

The tragedy of smoking, alcohol, and multiple substance use during pregnancy

“…The MetDrink group, being the exception, had the lowest mean birthweight and also the lowest mean GA at delivery (<37 weeks), with 45.5% of infants being preterm. Many researchers have found that methamphetamine was associated with lower birthweight, [10,45,53,54] and Black et al [55] found antenatal drug use to increase the risk of LBW infants above that related to cigarette smoking. Odendaal et al [56] and Jackson et al [57] reported that the combined use of cigarettes and alcohol during pregnancy had a synergistic effect for LBW and GR, which also concurs with our findings.…”

“…[8] Methamphetamine use in pregnancy is associated with poorer neonatal outcomes, especially decreased birthweight, head circumference and body length. [9,10] The effects of marijuana use during pregnancy are less clear, with reports ranging from no adverse effect with regard to the likelihood of prematurity or low birthweight (LBW) [11][12][13] to a reduction in birthweight, length and head circumference [3] and an increase in preterm births and growth restriction (GR). [14,15] The association of marijuana use with poor perinatal outcome seems to be attributable to concomitant use of tobacco and other confounding factors.…”