beth bailey, phd; judy mccook, phd, rn; alexis hodge, bsn; andrea clements, phd; lana mcgrady, ms
DESCRIPTION
Beth Bailey, PhD; Judy McCook, PhD, RN; Alexis Hodge, BSN; Andrea Clements, PhD; Lana McGrady, MS. Infant birth outcomes among substance using women: why quitting smoking is just as important as quitting harder drugs. - PowerPoint PPT PresentationTRANSCRIPT
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INFANT BIRTH OUTCOMES INFANT BIRTH OUTCOMES AMONG SUBSTANCE USING AMONG SUBSTANCE USING
WOMEN: WOMEN: WHY QUITTING SMOKING IS WHY QUITTING SMOKING IS
JUST AS IMPORTANT AS JUST AS IMPORTANT AS QUITTING HARDER DRUGSQUITTING HARDER DRUGSBeth Bailey, PhD; Judy McCook, PhD, RN;
Alexis Hodge, BSN; Andrea Clements, PhD; Lana McGrady, MS
Departments of Family Medicine and Psychology, and the College of
Nursing, East Tennessee State University
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BACKGROUBACKGROUNDND Significant intervention resources have necessarily
and successfully been devoted to helping substance using pregnant women become drug free
Unfortunately, the vast majority of pregnant women who successfully quit using illicit drugs continue to smoke
Health professionals often prioritize cessation of illicit drug use over the elimination of smoking during pregnancy
Reasons cited include the belief that illicit drug use is more harmful to the fetus than smoke exposure and the need to save limited time available to focus on that drug use and other negative health behaviors
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A substantial body of research has examined the link between pregnancy substance use and birth outcomes
Evidence supports an association between pregnancy alcohol use and preterm and low birth weight delivery
Evidence is mixed for the link between pregnancy opiate use, benzodiazepine use, and birth outcomes; effects often minimal when control for confounding factors
Evidence is also mixed for the link between stimulant use (i.e. methamphetamine) and birth outcomes
No significant evidence for link between marijuana use and birth outcomes
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BACKGROUBACKGROUNDND
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Link between pregnancy smoking and birth outcomes has also been well studied
At this point evidence is unequivocal – strong support for a causal association between exposure and poor birth outcomes
Babies born to smokers are up to 300 gm lighter and half an inch shorter
Preterm delivery has also been noted in some studies, but significant evidence that size effects are due primarily to intrauterine growth restriction rather than preterm delivery
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BACKGROUBACKGROUNDND
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Due to the magnitude of effects of prenatal cigarette exposure and the relative prevalence, a recent population-based study found that the elimination of smoking would have a much greater impact on decreasing poor birth outcomes than elimination of any other substance
However, few studies have quantified the relative impact on birth outcomes of different prenatal exposures
Such knowledge is important in order to prioritize limited pregnancy intervention resources5
BACKGROUBACKGROUNDND
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STUDY STUDY OBJECTIVEOBJECTIVE
The goal of the current study was to examine the impact of pregnancy tobacco use, relative to the use of
illicit drugs, on birth outcomes.
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METHODSMETHODS
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Women were recruited at entry to prenatal care at multiple medical practices in NE TN
Background and substance use information was collected via interviews, medical chart review, and UDS during pregnancy
Final sample was restricted to infants who had biological testing for substances at delivery (i.e. meconium), which oversampled substance users
Final sample contained 265 infants: No cigarette/no drug use (n=46) Cigarette use only (n=75) Illicit drug use only (n=21) Cigarette & illicit drug use
(n=123)
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Birth Weight (gm)
Gestational Age (wk)
No Cig/No Drug 3232 38.9Cigarette Only 3068 38.7Illicit Drug Only 3054 38.1Cig AND Drug 2954 38.5F, p 3.70, p=.012 .89, p=.447
Substance Use Group Differences on Primary Birth Outcomes
RESULTSRESULTS
Effect for birth weight remained significant after control for significant confounders (education, preeclampsia, race): F=4.55, p=.004
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RESULTSRESULTS
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Adjusted Birth Weights for the 198 Smokers: Smoked Only (n=75)
3065 gm Smoked AND Used Marijuana (n=39)
3068 gm Smokes AND Hard Illicit Drug Use (n=84)
2902 gm Test for group difference: F=3.39,
p=.036 Adjusted Birth Weight Difference = 163
gm Interpretation: Compared with those who
both smoked and used hard illicit drugs, those who smoked but DID NOT USE HARD ILLICIT DRUGS had a 163gm gain in adjusted birth weight – a 5.6% improvement.
Effect of Illicit Drug Use on Birth Weight
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RESULTSRESULTS
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Adjusted Birth Weights for the 105 Hard Illicit Drug Users: Hard Drug Use Only (n=21)
3207 gm Hard Drug Use AND Smoked (n=84)
2890 gm Test for group difference: F=6.28,
p=.014 Adjusted Birth Weight Difference =
317gm Interpretation: Compared with those who
both smoked and used hard illicit drugs, those who used hard illicit drugs BUT DID NOT SMOKE had a 317 gm gain in adjusted birth weight – an 11.0% improvement.
Effect of Smoking on Birth Weight
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RESULTSRESULTS
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Adjusted Birth Weights: No smoking/No Drug Use (n=46)
3248 gm Smoked AND Hard Drug Use (n=84)
2896 gm Test for group difference: F=17.42,
p<.001 Adjusted Birth Weight Difference =
352gm Interpretation: Compared with those who
both smoked and used hard illicit drugs, those who USED NEITHER SUBSTANCE had a 352 gm gain in adjusted birth weight – a 12.2% improvement.
Effect of BOTH Smoking AND Hard lllicit Drug Use on Birth Weight
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CONCLUSIONSCONCLUSIONS
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Pregnancy substance use was NOT associated with early delivery in the current sample
This finding is consistent with many previous studies
This suggests that links found between pregnancy substance use and birth weight are a result of the effects of substances on prenatal growth, rather than a result of shortened gestation
Substance Use and Gestational Age
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CONCLUSIONSCONCLUSIONS
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Pregnancy marijuana use did not adversely impact birth weight BEYOND the effects of cigarette smoking
Could not tell from current study the impact of marijuana use on birth weight in the absence of cigarette use
This finding is consistent with many previous studies
This finding suggests that for pregnant women who both smoke and use marijuana, quitting marijuana use while continuing to smoke will not lead to improved birth outcomes
Pregnancy Marijuana Use
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CONCLUSIONSCONCLUSIONS
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The current study demonstrated that pregnancy smoking had twice the impact on birth weight as illicit drug use
Findings support the assertions of those who have suggested that pregnancy smoking may be even more detrimental to the developing fetus than the use of any illicit drugs
Findings also support the need to direct more attention toward increasing pregnancy smoking cessation efforts
Pregnant women should be strongly advised of the risks of continued smoking, and should be assisted in their efforts to eliminate the use of ALL substances, including tobacco
Hard Illicit Drug Use Vs. Smoking in Pregnancy
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CONCLUSIONSCONCLUSIONS
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Possible misclassification of substance use
With the exception of marijuana, unable to separately examine the impact of different illicit substances on birth outcomes, or the impact of alcohol use
Representativeness of current sample
Did not look at longer term impact of exposures – on child health or development; testing of the current sample at 15 months of age is underway – have seen health and developmental effects related to smoking specifically
Study Limitations
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INFANT BIRTH OUTCOMES INFANT BIRTH OUTCOMES AMONG SUBSTANCE USING AMONG SUBSTANCE USING
WOMEN: WOMEN: WHY QUITTING SMOKING IS WHY QUITTING SMOKING IS
JUST AS IMPORTANT AS JUST AS IMPORTANT AS QUITTING HARDER DRUGSQUITTING HARDER DRUGSBeth Bailey, PhD; Judy McCook, PhD, RN;
Alexis Hodge, BSN; Andrea Clements, PhD; Lana McGrady, MS
Accepted for Publication (2/2011):
Maternal and Child Health Journal