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Mortality within the first 2 years in infants exposed to cocaine, opiate, or cannabinoid during gestation
E M Ostrea1, A R Ostrea, P M Simpson
1Department of Pediatrics, Hutzel Hospital, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan 48201, USA.
Insights
Prenatal drug exposure in infants did not increase overall mortality or sudden infant death syndrome (SIDS) risk in the first two years. However, low birth weight infants exposed to both cocaine and opiates showed higher mortality.
Area of Science:
- Perinatal health
- Neonatal toxicology
- Pediatric mortality studies
Background:
- Prenatal exposure to substances like cocaine, opiates, and cannabinoids is a significant concern.
- Understanding the long-term impact on infant survival is crucial for public health.
- Previous studies have shown associations between prenatal drug exposure and adverse birth outcomes.
Purpose of the Study:
- To investigate the mortality rate in infants exposed to cocaine, opiates, or cannabinoids during gestation.
- To assess the incidence of sudden infant death syndrome (SIDS) in relation to prenatal drug exposure.
- To identify specific risk factors for mortality among exposed infants.
Main Methods:
- A cohort of 2964 infants was screened at birth for gestational drug exposure using meconium analysis.
- Infant mortality data within the first two years of life were collected via the Michigan Department of Public Health death registry.
- Statistical analyses compared mortality rates between drug-exposed and non-exposed infants, including subgroup analyses for birth weight and specific drug combinations.
Main Results:
- 44% of infants tested positive for gestational drug exposure (cocaine, opiates, cannabinoids).
- Drug-exposed infants exhibited lower birth weight, smaller head circumference, and shorter length compared to drug-negative infants.
- Overall mortality rates at two years did not differ significantly between drug-exposed (13.7/1000) and drug-negative (15.7/1000) infants.
- However, low birth weight infants (<=2500g) positive for both cocaine and opiates had a significantly higher mortality risk (OR=5.9).
- Sudden Infant Death Syndrome (SIDS) occurred in 11 infants, with 58% testing positive for drugs, predominantly cocaine (OR=1.9 for cocaine-positive infants).
Conclusions:
- Prenatal exposure to cocaine, opiates, or cannabinoids is not associated with an increased overall mortality rate or SIDS incidence in the first two years of life.
- A significantly higher mortality rate was observed in low birth weight infants exposed to both cocaine and opiates.
- While overall mortality risk may not be elevated, specific subgroups of exposed infants, particularly those with low birth weight and poly-drug exposure, face increased risks.
Objective:
To determine the mortality rate, during the first 2 years of life, in infants who were exposed to cocaine, opiate, or cannabinoid during gestation.
Methods:
For a period of 11 months, a large group of infants were enrolled and screened at birth for exposure to cocaine, opiate, or cannabinoid by meconium analysis. Death outcome, within the first 2 years after birth, was determined in this group of infants using the death registry of the Michigan Department of Public Health.
Results:
A total of 2964 infants was studied. At birth, 44% of the infants tested positive for drugs: 30. 5% positive for cocaine, 20.2% for opiate, and 11.4% for cannabinoids. Compared to the drug negative group, a significantly higher percentage (P < .05) of the drug positive infants had lower weight and smaller head circumference and length at birth and a higher percent of their mothers were single, multigravid, multiparous, and had little to no prenatal care. Within the first 2 years of life, 44 infants died: 26 were drug negative (15.7 deaths per 1000 live births) and 18 were drug positive (13.7 deaths per 1000 live births). The mortality rate among cocaine, opiate, or cannabinoid positive infants were 17.7, 18.4, and 8.9 per 1000 live births, respectively. Among infants with birth weight
Conclusion:
We conclude that prenatal drug exposure in infants, although associated with a high perinatal morbidity, is not associated with an overall increase in their mortality rate or incidence of SIDS during the first 2 years of life. However, a significantly higher mortality rate was observed among low birth weight infants (