Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women

Smid, Marcela C.; Metz, Torri D.; Gordon, Adam J.

doi:10.1097/grf.0000000000000418

Cited by 83 publications

(44 citation statements)

References 152 publications

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“…Similarly, antenatal alcohol users had 2 -fold higher likelihood of preterm baby than those who abstained from drinking (95% CI: AOR = 1.93; 0.52, 3.33), and it was in line with results from USA [ 13 ], Japan [ 16 ], Jordan [ 14 ] and Turkey [ 12 ]. Besides, our study showed significant effect of alcohol use on birth defect where drinkers were 2 times (95%CI: AOR = 2.16; 1.16, 3.17) more likely to possess congenitally defected neonates, and it was congruent with other settings [ 14 , 56 , 57 , 58 , 59 , 60 ]. These adverse effects of alcohol use during pregnancy may be due to the fact that alcohol can disturb fetal development, especially affecting the fetal central nervous system with potentially severe lifelong consequences [ 5 , 6 ].…”

Section: Discussionsupporting

confidence: 78%

The effect of substance use during pregnancy on neonatal outcomes in Ethiopia: A systematic review and meta-analysis

Bayih

Belay

Ayalew

et al. 2021

Heliyon

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Background Substance use during pregnancy mainly khat chewing (20%) and alcohol drinking (18.1%) are commonly practiced in Ethiopia. However, the effect of using these substances has not been studied nationally yet. Thus, this study was aimed to examine national evidence about the effect of substance use during pregnancy on birth outcome in the country, 2020. Methods Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size and reported effect of antenatal substance use on birth outcome on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the fixed-effects model due to homogenous primary studies (I 2 = 0.0%). Presence of publication bias was detected from asymmetry of funnel plot and statistically significant Egger's test (p = 0.000). Results In this systematic review and meta-analysis, a total of 5,343 mother-neonate pairs were included from 15 studies. Alcohol, khat, cigarette and narghile were used during pregnancy, and significant adverse birth outcomes attributable to these substances were reported. From the pooled effect of alcohol use, drinking mothers were twice (95%CI: AOR = 2.16; 1.16, 3.17) likely to have newborns with birth defect; 9 times (95% CI: AOR = 9.39; 2.84, 15.94) more prone to own low birth weight neonates; and 1.9 times more prone to deliver preterm neonates (95% CI: AOR = 1.93; 0.52, 3.33) than the nondrinkers. Khat users were 2.4 times (95%CI: AOR = 2.4; 1.11, 5.19) more likely to have congenitally defected neonates; and 3.1 times (95%CI: AOR = 3.19; 1.01, 5.37) more risked to possess low birth weight neonates. Furthermore, antenatal cigarette smokers (95% CI: AOR = 4.36 (1.75, 6.98)) and narghile users (95% CI: AOR = 20.1; 3.94, 103) were at 4 and 20 times more likelihood of having low birth weight neonates as compared to their counterparts. Conclusion Prematurity, low birth weight and congenital malformation were the investigated adverse effects of antenatal substance use in Ethiopia. Therefore, the existing public health efforts should be encouraged to help women stop using these substances completely before pregnancy. Moreover, increasing public awareness about the potential negative impacts of substance use during pregnancy on birth outcome would be of greatest importance for comprehensive prevention of the problem.

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Section: Discussionsupporting

confidence: 78%

The effect of substance use during pregnancy on neonatal outcomes in Ethiopia: A systematic review and meta-analysis

Bayih

Belay

Ayalew

et al. 2021

Heliyon

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“…The prevalence of congenital anomaly among alcohol users during pregnancy was 37.10% (95% CI: 29.77%-44.43%). This finding was in accordance with other settings, 8 , 35 - 39 which may be due to the fact that alcohol can disturb fetal development especially affecting the fetal central nervous system, with potentially severe lifelong consequences. 45 , 46 The teratogenic effects of alcohol on the developing embryo have been explained to result from different mechanisms including (1) Increased oxidative stress; (2) Disturbed glucose, protein, lipid, and DNA metabolism; (3) Impaired neurogenesis and increased cellular apoptosis, especially of neural crest cells; (4) Endocrine effects; and (5) Effects on gene expression.…”

Section: Discussionsupporting

confidence: 92%

The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis

Bayih

Ayalew

Tadege

et al. 2021

Global Pediatric Health

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Background. Substances mainly khat, alcohol and cigarette are used during pregnancy in Ethiopia. However, to this date, there is no pooled evidence about the burden of adverse neonatal outcomes among the substance users during pregnancy in the country. Methods. Eligible primary studies were accessed from 4 international data bases (Google Scholar, Science Direct, Scopus, and PubMed). The required data were extracted from these studies and then exported to stata version 14 for analysis. Subgroup analyses were conducted for evidence of heterogeneity. Results. A total of 2298 neonates were included from 7 studies. Among these neonates, 530(23.06%) were those whose mothers used substance during pregnancy (exposed group) whereas 1768 neonates were those whose mothers didn’t use substance during pregnancy (controls group). The pooled prevalence of adverse neonatal outcome among the exposed mothers was 38.32% (95% CI: 29.48%, 47.16%; I2 = 76.3%) whereas it was 16.29% (95% CI: 9.45%, 23.13%) among the controls. Adverse neonatal outcome was most burdensome among cigarette smokers 45.20% (95% CI: 37.68%, 52.73%; I2 = .00%) when compared with khat chewers 34.00% (95% CI: 20.87%, 47.13%) and alcohol drinkers 38.47% (95% CI: 17.96%, 58.98%). Low birth weight 42.00% (95% CI: 18.01%, 65.99%; I2 = 91.8%) was the most common adverse birth outcome. Conclusion. It was found that adverse neonatal outcomes were much more burdensome among antenatal substance users than the controls. Therefore, mothers should be enabled to quit using substance before pregnancy. Besides, strict comprehensive screening of every pregnant mother should be made at antenatal care clinics for early identification and management of antenatal substance use.

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“…Stimulant substance use disorder can also affect maternal pregnancy outcomes. These drugs increase the activity of the central nervous system, resulting in euphoric effects 118 . Crack cocaine has been associated with an increased preeclampsia rate, placental abruption, and preterm labor 119 .…”

Section: Overview Of Treatment Plans For Maternal Adverse Eventsmentioning

confidence: 99%

“…Crack cocaine has been associated with an increased preeclampsia rate, placental abruption, and preterm labor 119 . Cocaine toxicity is also associated with severe hypertension, 118,120 for which case hydralazine should be used to lower blood pressure 118,121 . A study showed that although pregnant women using methamphetamine do not experience hypertension, 118 they face other similar adverse perinatal outcomes, including an increased preterm delivery rate, cesarean delivery, and intensive care unit admission.…”

Section: Overview Of Treatment Plans For Maternal Adverse Eventsmentioning

confidence: 99%

“…Cocaine toxicity is also associated with severe hypertension, 118,120 for which case hydralazine should be used to lower blood pressure 118,121 . A study showed that although pregnant women using methamphetamine do not experience hypertension, 118 they face other similar adverse perinatal outcomes, including an increased preterm delivery rate, cesarean delivery, and intensive care unit admission. However, some potential confounding demographic and socioeconomic factors were not accounted for in the study 122 .…”

Section: Overview Of Treatment Plans For Maternal Adverse Eventsmentioning

confidence: 99%

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Maternal Exposure and Neonatal Effects of Drugs of Abuse

Barry

Jasin

Sherwin

2021

The Journal of Clinical Pharma

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The public health crisis of pregnant women being exposed to drugs of abuse and of its impact on their unborn children continues to grow at an alarming rate globally. The state of pregnancy is unique, with physiological changes that can lead to changes in the way drugs are handled by the body in both pharmacokinetics and response. These changes place the pregnant woman, fetus, and newborn infant at risk, as many of these drugs can cross the placenta and into breast milk. The substances most commonly linked to harmful effects include alcohol, tobacco, cannabis, stimulants, and opioids. The pharmacological and toxicological changes caused by in utero exposure or breastfeeding exposure are difficult to study, and the full extent of the mechanisms involved are not fully understood. However, these changes can significantly affect the risks of substance abuse and influence optimal treatment of pregnant women with a substance use disorder. In addition, newborns who were exposed to drugs of abuse in utero can experience withdrawal syndromes. Pharmacological management in infants is used to guide and treat withdrawal symptoms, with the goal being to improve the infant's sleep, eating, and comfort. Several barriers may prevent pregnant women from seeking help for substance use, including stigma and interactions with the legal system. Understanding changes in pharmacology, including pharmacokinetic changes that happen during pregnancy, is essential for anticipating the extent of maternal exposure and neonatal adverse effects.

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Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women

Cited by 83 publications

References 152 publications

The effect of substance use during pregnancy on neonatal outcomes in Ethiopia: A systematic review and meta-analysis

The effect of substance use during pregnancy on neonatal outcomes in Ethiopia: A systematic review and meta-analysis

The Burden of Adverse Neonatal Outcome among Antenatal Substance Users in Ethiopia: A Systematic Review and Meta-Analysis

Maternal Exposure and Neonatal Effects of Drugs of Abuse

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