Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT (LSL, NQ, KAY, AMG); Department of Psychiatry & Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA (SP); Department of Psychiatry, Yale School of Medicine, New Haven, CT (KAY).
J Addict Med. 2018 Jul/Aug;12(4):321-328. doi: 10.1097/ADM.0000000000000409.
Unplanned and poorly timed pregnancies are associated with adverse maternal and neonatal outcomes. Further understanding of preconception substance use with unplanned and poorly timed pregnancy is warranted.
Data were analyzed from a prospective study enrolling women early in pregnancy. Preconception tobacco, alcohol, marijuana, opioid, and cocaine use was ascertained. Participants reported whether their current pregnancy was planned and whether it was a good time to be pregnant. Multivariable logistic regression modeling generated risk estimates for preconception substance use, and pregnancy planning and timing, adjusting for confounders.
Overall, 37.2% reported unplanned pregnancy, 13.0% poorly timed pregnancy, and 39.0% reported either unplanned and/or poorly timed pregnancy. Within 6 months preconception, one-fifth (20.2%) reported nicotine cigarette use. In the month before conception, 71.8% reported alcohol use, 6.5% marijuana, and approximately 1% opioid or cocaine use. Multivariable analysis demonstrated preconception opioid use was associated with increased odds of poorly timed pregnancy (odds ratio [OR] 2.87, 95% confidence interval [CI] 1.03-7.99). Binge drinking the month before conception was associated with increased odds of poorly timed pregnancy and unplanned pregnancy (OR 1.75, 95% CI 1.01-3.05; and OR 1.68, 95% CI 1.01-2.79, respectively). Marijuana use 2 to 3 times in the month preconception was associated with increased risk of unplanned pregnancy, and unplanned and/or poorly timed pregnancy compared with nonuse (OR 1.78, 95% CI 1.03-3.08; and OR 1.79, 95% CI 1.01-3.17, respectively). Preconception tobacco or cocaine use was not associated with unplanned or poorly timed pregnancy following adjustment.
We demonstrate increased odds of unplanned or poorly timed pregnancy among women with preconception binge drinking, marijuana use, and opioid use; however, no association is observed with other substances after multivariable adjustment, including tobacco. Further research to evaluate high-level preconception substance use and substance disorders with pregnancy planning and timing is warranted. Focused efforts optimizing preconception health behaviors and reducing risk of unplanned or poorly timed pregnancy are needed.
无计划和时机不佳的妊娠与不良的母婴结局有关。进一步了解孕前物质使用与无计划和时机不佳的妊娠之间的关系是必要的。
对一项前瞻性研究中早期妊娠的女性进行数据分析。确定孕前烟草、酒精、大麻、阿片类药物和可卡因的使用情况。参与者报告当前妊娠是否计划，以及现在是否是怀孕的好时机。多变量逻辑回归模型生成了孕前物质使用、妊娠计划和时机的风险估计值，并对混杂因素进行了调整。
总体而言，37.2%的人报告妊娠无计划，13.0%的人报告妊娠时机不佳，39.0%的人报告妊娠无计划和/或时机不佳。在受孕前 6 个月内，五分之一（20.2%）报告使用尼古丁香烟。在受孕前一个月，71.8%的人报告饮酒，6.5%的人报告使用大麻，约 1%的人报告使用阿片类药物或可卡因。多变量分析表明，孕前阿片类药物使用与时机不佳的妊娠几率增加有关（比值比[OR]2.87，95%置信区间[CI]1.03-7.99）。受孕前一个月 binge drinking 与时机不佳的妊娠和无计划妊娠几率增加有关（OR 1.75，95% CI 1.01-3.05；OR 1.68，95% CI 1.01-2.79）。受孕前 2-3 次使用大麻与无计划妊娠和无计划及/或时机不佳的妊娠风险增加有关，与不使用者相比（OR 1.78，95% CI 1.03-3.08；OR 1.79，95% CI 1.01-3.17）。调整后，孕前吸烟或可卡因使用与无计划或时机不佳的妊娠无关。
我们发现在有孕前 binge drinking、大麻使用和阿片类药物使用的女性中，无计划或时机不佳的妊娠几率增加；然而，在多变量调整后，与其他物质没有关联，包括烟草。需要进一步研究评估高水平的孕前物质使用和物质障碍与妊娠计划和时机的关系。需要有针对性地努力优化孕前健康行为，降低无计划或时机不佳的妊娠风险。
