Substance use before or during pregnancy and the risk of child mortality, perinatal morbidities and congenital anomalies

Abstract

Aims We aimed to investigate child mortality, perinatal morbidities and congenital anomalies born by women with substance misuse during or before pregnancy (DP or BP). Methods Taiwan Birth Registration from 2004 to 2014 linking Integrated Illicit Drug Databases used to include substance misuse participates. Children born by mothers convicted of substance misuse DP or BP were the substance-exposed cohort. Two substance-unexposed comparison cohorts were established: one comparison cohort selected newborns from the rest of the population on a ratio of 1:1 and exact matched by the child’s gender, child’s birth year, mother’s birth year and child’s first use of the health insurance card; another comparison cohort matched newborns from exposed and unexposed mothers by their propensity scores calculated from logistic regression. Results The exposure group included 1776 DP, 1776 BP and 3552 unexposed individuals in exact-matched cohorts. A fourfold increased risk of deaths in children born by mothers exposed to substance during pregnancy was found compared to unexposed group (hazard ratio [HR] = 4.54, 95% confidence interval (CI): 2.07–9.97]. Further multivariate Cox regression models with adjustments and propensity matching substantially attenuated HRs on mortality in the substance-exposed cohort (aHR = 1.62, 95% CI: 1.10–2.39). Raised risks of perinatal morbidities and congenital anomalies were also found. Conclusions Increased risks of child mortality, perinatal morbidities or congenital anomalies were found in women with substance use during pregnancy. From estimates before and after adjustments, our results showed that having outpatient visits or medical utilizations during pregnancy were associated with substantially attenuated HRs on mortality in the substance-exposed cohort. Therefore, the excess mortality risk might be partially explained by the lack of relevant antenatal clinical care. Our finding may suggest that the importance of early identification, specific abstinence program and access to appropriate antenatal care might be helpful in reducing newborn mortality. Adequate prevention policies may be formulated.

Neurobehavioral disorders among children born to mothers exposed to illicit substances during pregnancy

“…Most illicit substances would affect embryos through the placenta and may cause obstetric complications, excess mortality, neonatal abstinence syndrome, abnormal physical problems, or neurodevelopment issues (7,8). Prior research and our previous study have shown elevated risks of short-term neonatal outcomes, such as the abstinence syndrome, stillbirths, low birth weight (9), congenital heart defects, small head circumferences, or neural tube defects in children born by mothers exposed to opioid, heroin, or amphetamine during pregnancy (10)(11)(12). Few studies have mentioned the raised long-term risks of prenatal exposures of opioids or heroin on children's intellectual functions or neurobehavioral disorders, such as autistic disorder or attention de cit hyperactivity disorder (ADHD) after birth (13,14).…”

“…Children born to mothers with illicit drug use before or during pregnancy were our study cohort. (9), We established the study cohort by identifying pregnant women being arrested by the police due to illicit substance use from the 'Substance Abuse Control Databases'.…”

“…The propensity scores were calculated by entering all covariates into a logistic regression model to estimate the probability (propensity score) of each individual based on the selected covariates. To further mitigate the impact of confounders and ensure comparability between substance-exposed DP or BP groups and unexposed groups, we further categorized the exposed cohort into substance-exposed during or before pregnancy subgroups, and selected exact-and PS-matched subjects from the unexposed cohort for comparisons in the second stage of matching (detailed ow chart of our matching process is demonstrated in our previous work (9)). To avoid choosing the extreme cases, children who did not use the health insurance in exposed and unexposed cohorts were not included.…”

“…Using the same nationwide, population-based criminal database of illicit substance use as our previous research (9), with linkages to several governmental birth, household registrations, and data on health and medical utilizations in Taiwan, the present study investigates the risks of intellectual disability and relatively rarer neurobehavioral outcomes of autistic disorders and ADHD from birth to age of 13 among cohorts of children born by mothers exposed or unexposed to heroin, amphetamine, ketamine, or other substances.…”

“…The rst stage exact-and propensity-matching by mother's year of birth, child's gender, child's year of birth, and child's rst use of health insurance card (all p > 0.99 after exact matching) of mothers exposed to substances before pregnancy (n = 1776, the 'substance-exposed before pregnancy cohort'), mothers exposed to substances during pregnancy (n = 1776, the 'substance-exposed during pregnancy cohort'), and the comparison cohort ('substance-unexposed mothers', n = 3552). More details may be referred to our previous work(Lee et al, 2023).ADHD: Attention de cit and hyperactivity disorderThe comparison cohort was selected by two-stages of exact-and propensity score (PS) matching. The rst stage exact-and propensity-matching by mother's year of birth, child's gender, child's year of birth, and child's rst use of health insurance card (all p > 0.99 after exact matching) of mothers exposed to substances before pregnancy (n = 1776, the 'substance-exposed before pregnancy cohort'), mothers exposed to substances during pregnancy (n = 1776, the 'substance-exposed during pregnancy cohort'), and the comparison cohort ('substance-unexposed mothers', n = 3552).…”