ILLICIT DRUG USE AND BIRTH OUTCOMES: A CONTEXTUAL EXAMINATION IN BALTIMORE, MARYLAND
Schempf, Ashley H.
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Background: Despite prevalent perceptions of devastating consequences, the neonatal impact of illicit drug use is less established than for tobacco or alcohol. The objectives of this study were to evaluate the effect of drug use on birth outcomes independent of surrounding contextual factors and to determine the role of the neighborhood environment on birth outcomes. Methods: Data are from a clinic-based study of low-income women who delivered infants at Johns Hopkins Hospital in 1995 and 1996 (n=808). Use of marijuana, cocaine, and opiates was determined by the medical record, urine toxicology screens at delivery, and self-report. A postpartum interview gathered detailed information on various sociodemographic, psychosocial, and behavioral factors. The independent effect of drug use on birth weight and low birth weight (LBW, <2,500 grams) was determined in multiple regression models. Multilevel analyses were performed to evaluate the impact of neighborhood context on birth weight. Results: In unadjusted results, cocaine and opiate use were related to mean birth weight (-329 and -239 grams, p<0.01) and LBW (ORs: 1.93 and 2.06, p<0.05). After adjusting for all associated factors, only the effect of cocaine on mean birth weight remained significant (-143 grams, p<0.05); no drug was significantly related to LBW. Most of the unadjusted effects of drug use were explained by stress, smoking, and lack of early prenatal care. The effect of moderate to severe stress was particularly large (-244 grams, OR LBW: 2.2, p<0.01). In multilevel models, a birth weight difference of nearly 300 grams separated the best and worst neighborhoods (p=0.01) independent of sociodemographic characteristics. The neighborhood effect was no longer significant after adjusting for smoking, drug use, and prenatal care utilization, suggesting that neighborhoods may influence birth outcomes by shaping behavioral risks. Conclusions: Given that associated psychosocial and behavioral factors explained most of the effect of illicit drugs on birth outcomes, prevention efforts that aim to improve newborn health in treatment programs and more generally must address surrounding factors in addition to drug use. Interventions targeting the neighborhoods in which women live should be considered as a population-based strategy to address multiple maternal and infant health risks.