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PEDIATRICS Vol. 114 No. 2 August 2004, pp. e226-e234

ELECTRONIC ARTICLE

Association Between Patterns of Maternal Substance Use and Infant Birth Weight, Length, and Head Circumference

Seetha Shankaran, MD^*, Abhik Das, PhD^,**, Charles R. Bauer, MD^,**, Henrietta S. Bada, MD^||,**, Barry Lester, PhD^¶,**, Linda L. Wright, MD^#,** and Vincent Smeriglio, PhD^*,**

^* Wayne State University, Detroit, Michigan
Research Triangle Institute, Chapel Hill, North Carolina
University of Miami, Miami, Florida
^|| University of Tennessee at Memphis, Memphis, Tennessee
^¶ Women and Infants Hospital, Providence, Rhode Island
^# National Institutes of Child Health and Human Development, Bethesda, Maryland
^** National Institute on Drug Abuse, Bethesda, Maryland

Objective. To determine the effects of patterns of drug use during term pregnancy on infant growth parameters at birth.

Methods. Histories of cocaine, opiate, alcohol, tobacco, and marijuana use during the 3-month period before pregnancy and the 3 trimesters of pregnancy were recorded at the infants’ 1-month visit. Patterns of use were categorized as consistently high, moderate, or low/none or increasing/decreasing, and effects on growth parameters were analyzed in multivariate linear regression analyses, with adjustment for clinical site, maternal age, prepregnancy weight, multidrug use, and socioeconomic status.

Results. A total of 241 cocaine-exposed women and 410 non–cocaine-exposed women participated in the study. In the cocaine-exposed group, 75% used alcohol, 90% used tobacco, and 53% used marijuana; in the non–cocaine-exposed group, 57% used alcohol, 34% used tobacco, and 19% used marijuana. Birth weight, birth length, and head circumference were significantly greater among infants born to women who used no drugs, compared with women with any cocaine, opiate, alcohol, tobacco, or marijuana use, and were greater among infants born to cocaine nonusers, compared with cocaine users. With adjustment for confounders, birth weight was significantly affected by cocaine (deficit of 250 g with consistently low pattern) and tobacco (deficits of 232 g with consistently high pattern, 173 g with consistently moderate pattern, 153 g with decreasing pattern, and 103 g with consistently low pattern). Head size was affected by cocaine (deficit of 0.98 cm with consistently moderate pattern) and tobacco (deficits of 0.72 cm with consistently high pattern and 0.89 cm with consistently moderate pattern). Birth length was affected by tobacco use only (deficits of 0.82 cm with consistently high pattern and 0.98 cm with decreasing use).

Conclusion. Patterns of tobacco use during pregnancy affect birth weight, length, and head circumference, whereas cocaine affects birth weight and head size, when adjustments are made for confounders, including multidrug use.

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Key Words: prenatal • cocaine • alcohol • tobacco • marijuana • infant birth weight • length • head circumference

Abbreviations: MISU, Maternal Inventory of Substance Use

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Received for publication Feb 18, 2004; Accepted Mar 4, 2004.

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