Cocaine use in pregnancy increased in Northern California since 2011
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The rate of cocaine use during pregnancy increased in a Northern California health system compared with population-level increases in the United States from 2011 to 2019, according to a study in JAMA Network Open.
However, the self-reported rate of prenatal methamphetamine use decreased and the toxicology-confirmed rate remained stable over the study period.
“Cocaine use and methamphetamine use during pregnancy have potential short- and long-term health consequences,” Kelly C. Young-Wolff, PhD, MPH, a licensed clinical psychologist and researcher scientist in the division of research at Kaiser Permanente Northern California in Oakland, California, and colleagues wrote. “Rates of self-reported prenatal stimulant use have increased globally, but epidemiologic studies have not included biochemical verification.”
Young-Wolff and colleagues conducted a cross-sectional analysis of pregnant patients who attended their health system for prenatal care from 2011 to 2019. All patients were screened for cocaine and methamphetamine use by self-report and urine toxicology testing upon presentation for prenatal care.
In total, 326,051 pregnancies were included in analyses. The largest proportion of patients were non-Hispanic white (37.1%) and aged 25 to 34 years (62.8%).
The adjusted prevalence of cocaine use during pregnancy increased from 0.1% (95% CI, 0.07-0.13) to 0.15% (95% CI, 0.12-0.18) from 2011 to 2019, with a relative rate increase of 9% each year (annual RR = 1.09; 95% CI, 1.05-1.12). The annual relative rate increased more for toxicology-confirmed vs. self-reported cocaine use (annual RR = 1.13; 95% CI, 1.09-1.18 vs. annual RR = 1.06; 95% CI, 1.02-1.1).
The adjusted prevalence of methamphetamine use during pregnancy decreased from 0.19% (95% CI, 0.14-0.23) to 0.17% (95% CI, 0.14-0.21) over the study period. This was an annual relative rate of 0.97 (95% CI, 0.95-1). Evaluation of annual relative rates by screening type revealed that toxicology-confirmed use remained stable (annual RR = 0.99; 95% CI, 0.96-1.03) and self-reported use decreased (annual RR = 0.96; 95% CI, 0.93-0.99) from 2011 to 2019.
“Differing trends in prenatal cocaine and methamphetamine use highlight the importance of early screening for different types of prenatal illicit stimulant use, assessment of substance use disorder and linkage to nonpunitive treatment, as needed,” Young-Wolff and colleagues wrote. “Research indicates that stopping stimulant use during pregnancy improves birth outcomes, and continued research is needed to understand factors associated with different types of prenatal stimulant use over time.”