The perinatal impact of cocaine, amphetamine, and opiate use detected by universal intrapartum screening

Issues in prenatal cocaine use research: Problems in identifying users and choosing an appropriate comparison group

“…As previously noted, the characteristics found more frequently among cocaine users (Frank et al, 1988;Gillogley et al, 1990;Spence et al, 1991) are also common among women of lower socioeconomic status and consequently are characteristic of many nonusers as well. In general these women are more likely to have worrisome obstetrical histories and poorer pregnancy outcomes.…”

“…Although some studies have included only subjects with urine screens positive for cocaine metabolites at delivery (Chouteau, Namerow, & Leppert, 1988;Gillogley, Evans, Hansen, Samuels, & Batra, 1990;Hollinshead et al, 1990;McCalla et al, 1991;Neerhof, MacGregor, Retzky, & Sullivan, 1989;Oro & Dixon, 1987;Spence, Williams, DiGregorio, KirbyMcDonnell, & Polansky, 1991), this selection process excludes admitted users and misclassifies nonadmitting users when these women did not use within a few days prior to delivery. For example, Spence et al (1991) included 18 (5.2%) women, who admitted prenatal cocaine use but had negative urine specimens at delivery, in the "cocaine-negative" group for comparison with urine-positive users.…”

“…Intuitively, it would seem that screening either the mother or her infant would be acceptable. However, there are reports of discordance of positive specimens between a mother and her infant (Gillogley et al, 1990;Osterloh & Lee, 1989). Osterloh and Lee (1989) reported a 14% discordance for cocaine metabolites found in maternal, but not infant urine specimens, and a 2% discordance for cocaine metabolites found in infant, but not maternal urine specimens.…”

“…Suspicion of use usually includes a variety of risk factors, such as poor prenatal care, premature delivery, the presence of sexually transmitted disease(s), and poor neonatal outcome. Although some of these risk factors have been demonstrated to be more frequent among cocaine users than nonusers (Frank et al, 1988;Gillogley et al, 1990;Spence et al, 1991), they are also common among women of low socioeconomic status. Thus screening women on the basis of these factors may result in a bias toward women of low socioeconomic status being included in the study samples.…”

“…The most consistent finding of the effect of prenatal cocaine exposure is poor fetal growth resulting in premature and/or smallfor-gestational-age infants (Bingol et al, 1987;Chasnoff et al, 1989;Gillogley et al, 1990;Handler et al, 1991;MacGregor et al, 1987). Both outcomes are well known to have a negative effect on long-term growth and development.…”