Association Between Stillbirth and Illicit Drug Use and Smoking During Pregnancy

• Type of Material: Article
• Authors: Michael W. Varner, University of Utah; Robert M. Silver, University of Utah; Carol J Hogue, Emory University; Marian Willinger, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Corette B. Parker, RTI International; Vanessa R. Thorsten, RTI International; Robert L. Goldenberg, Columbia University; George R. Saade, University of Texas Medical Branch Galveston; Donald J. Dudley, University of Texas Health Science Center; Donald Coustan, Brown University; Barbara Stoll, Emory University; Radek Bukowski, University of Texas Medical Branch Galveston; Matthew A. Koch, RTI International; Deborah Conway, University of Texas Health Science Center; Halit Pinar, Brown University; Uma M. Reddy, Eunice Kennedy Shriver National Institute of Child Health and Human Development
• Language: English
• Date: 2014-01-01
• Publisher: Lippincott, Williams & Wilkins: No Hybrid Open Access
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by The American College of Obstetricians and Gynecologists.
• Final Published Version (URL): http://dx.doi.org/10.1097/AOG.0000000000000052
• Title of Journal or Parent Work: Obstetrics and Gynecology
• ISSN: 0029-7844
• Volume: 123
• Issue: 1
• Start Page: 113
• End Page: 125
• Grant/Funding Information: Supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health: U10-HD045953 (Brown University, Rhode Island); U10-HD045925 (Emory University, Georgia); U10-HD045952 (University of Texas Medical Branch at Galveston); U10-HDO45955 (University of Texas Health Sciences Center at San Antonio); U10-HD045944 (University of Utah Health Sciences Center); and U01-HD045954 (RTI International, North Carolina).
• Keywords: RISK-FACTORS; WOMEN; COTININE LEVELS; Science & Technology; PERINATAL OUTCOMES; NICOTINE; ENVIRONMENTAL TOBACCO-SMOKE; UNITED-STATES; MARIJUANA USE; EXPOSURE; Obstetrics & Gynecology; Life Sciences & Biomedicine; EPIDEMIOLOGY
• Research Categories: Health Sciences, Human Development; Health Sciences, Epidemiology; Health Sciences, Obstetrics and Gynecology

Abstract

OBJECTIVE: To compare illicit drug and smoking use in pregnancies with and without stillbirth. METHODS: The Stillbirth Collaborative Research Network conducted a case-control study from March 2006 to September 2008, covering more than 90% of deliveries to residents of five a priori-defined geographically diverse regions. The study attempted to include all stillbirths and representative liveborn controls. Umbilical cord samples from cases and controls were collected and frozen for subsequent batch analysis. Maternal serum was collected at delivery and batch analyzed for cotinine. RESULTS: For 663 stillbirth deliveries, 418 (63%) had cord homogenate and 579 (87%) had maternal cotinine assays performed. For 1,932 live birth deliveries, 1,050 (54%) had cord homogenate toxicology and 1,545 (80%) had maternal cotinine assays performed. A positive cord homogenate test for any illicit drug was associated with stillbirth (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.16-3.27). The most common individual drug was cannabis (OR 2.34 95% CI 1.13-4.81), although the effect was partially confounded by smoking. Both maternal selfreported smoking history and maternal serum cotinine levels were associated in a dose-response relationship with stillbirth. Positive serum cotinine less than 3 ng/mL and no reported history of smoking (proxy for passive smoke exposure) also were associated with stillbirth (OR 2.06, 95% CI 1.24-3.41). CONCLUSION: Cannabis use, smoking, illicit drug use, and apparent exposure to second-hand smoke, separately or in combination, during pregnancy were associated with an increased risk of stillbirth. Because cannabis use may be increasing with increased legalization, the relevance of these findings may increase as well.