Cocaine and cigarettes: a comparison of risks

In order to provide additional data and perspective to current clinical, policy, and legal debates surrounding the prenatal use of cocaine in the USA, a retrospective cohort study was conducted to examine effects of cocaine on selected perinatal outcomes, and to compare the relative risks of adverse perinatal outcomes among users of cocaine and users of cigarettes. Using data from a large urban perinatal registry, relative risks of selected perinatal outcomes were determined for maternal cocaine users who were non-smokers of cigarettes, and used no marijuana, heroin, amphetamines, or alcohol (n = 64), and for cigarette smokers who do not use illicit drugs or alcohol during pregnancy (n = 3209). When compared with women with no recorded prenatal exposure to drugs or cigarettes (n = 13,043), cocaine users had higher risks than smokers for the following adverse outcomes: low birthweight [Relative Risk (RR) 5.3, 95% Confidence Interval (CI) 3.0-9.3], small-for-gestational age (SGA) [RR 4.2, 95% CI 2.4-7.3], prematurity [RR 4.0, 95% CI 2.3-7.0], abruptio placentae [RR 10.0, 95% CI 3.5-29.0], placenta praevia [RR = 2.4, 95% CI 0.3-17.8] and perinatal death [RR = 5.3, 95% CI 1.9-15.2]. Smokers who did not use any drugs experienced most of the same adverse perinatal outcomes as cocaine users, but the magnitude of risk was greater in cocaine users than in smokers for all outcomes. However, given the greater numbers of cigarette smokers than cocaine users in the population the numbers of infants in the population suffering these adverse outcomes is likely to be greater among offspring of cigarette smokers. The data support the current concern about the risk of cocaine, and current efforts to provide treatment to pregnant cocaine users. The data also underline the continued substantial risks of cigarette smoking to large numbers of pregnant women.