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Illicit drug use during pregnancy and its relationship to neonatal outcomes among Hepatitis C positive women in British Columbia Cox, Michelle Byrne


OBJECTIVES: To investigate the relationship between stimulant and/or opiate drug use during pregnancy, and adverse neonatal outcomes in Hepatitis C positive women. METHODS: HCV positive pregnant women in British Columbia who consented to participate in a prospective, cohort study were enrolled in the HCV Vertical Transmission Study. A baseline questionnaire sought information on sociodemographic characteristics, substance use, obstetrical and medical history, and sexual behaviour. Follow-up questionnaires collected details on delivery and neonatal outcomes. The adverse neonatal outcomes of interest, for this analysis, were prematurity, low birth weight, low Apgar score, and admission to a neonatal intensive care unit. Required variables were extracted from the primary study dataset. The secondary analysis included descriptive, univariate, and multivariable statistical techniques to address the above stated objectives. RESULTS: Data from 136 women and their infants were analyzed for this study. Fifty-three (39.0%) of the women gave birth to infants that suffered an adverse neonatal outcome. Approximately half (49.6%) of the cohort used stimulant drugs during their pregnancy, 35.9% used opiates, and 68.4%) smoked cigarettes. Concurrent substance use was very common among these women. Current stimulant use (p<0.01), current opiate use (p<0.001) and current tobacco use (p<0.01) were associated with adverse neonatal outcome. Opiate use during pregnancy remained significant with adverse neonatal outcome after adjusting for stimulant use, tobacco use, age, aboriginal ethnicity, and gravidity. An odds ratio 5.52 (95% Confidence Interval: 1.82, 16.76) was determined through multi-variable analysis. CONCLUSION: Pregnant women living with HCV in British Columbia report high use of stimulants, opiates, and tobacco during their pregnancies. The infants of these women also suffer high incidences of adverse neonatal outcomes. When a wide range of substances, obstetrical risk factors, and lifestyle characteristics were considered, the use of opiates during pregnancy was determined to be the strongest predictor of a poor neonatal outcome. Women who use opiates during their pregnancy are at increased risk of delivering an infant who will experience an adverse neonatal outcome.

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