Racine A, Joyce T, Anderson R
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
JAMA. 1993 Oct 6;270(13):1581-6.
Although the association between antenatal cocaine use and adverse birth outcomes has been well documented, relatively little is known about interventions that may ameliorate these consequences. We therefore examined the relationship between prenatal care and birth weight among a population of prenatal cocaine users.
Population-based retrospective analysis.
All single-gestation live births to white non-Hispanic, black non-Hispanic, and Hispanic residents of New York City who gave birth between 1988 and 1990 with a positive indication for cocaine recorded on birth certificates (N = 7923).
We contrasted mean birth weight and rates of low birth weight (< 2500 g) among cocaine users with one to three prenatal care visits, four or more visits, and unknown numbers of visits with users who reported no prenatal care. We used ordinary least squares and logistic regression to control for age, parity, smoking, alcohol, other drugs, weight gain, prepregnancy weight, employment, marital status, participation in the Supplemental Food Program for Women, Infants and Children, and method of finance.
Adjusted odds ratios of low birth weight for cocaine users with four prenatal care visits or more as compared with those who had none were 0.51 for blacks (95% confidence interval [CI], 0.44 to 0.59), 0.39 for whites (95% CI, 0.23 to 0.66), and 0.37 for Hispanics (95% CI, 0.28 to 0.48). Adjusted mean birth weight differences between users with four visits or more and those with none were 262 g for blacks (P < .001), 247 g for whites (P < .001), and 317 g for Hispanics (P < .001).
The receipt of prenatal care among cocaine users is associated with significant improvements in birth weight. Enrollment of cocaine users in prenatal care may be an effective start to a more comprehensive approach to this problem.
虽然产前使用可卡因与不良分娩结局之间的关联已有充分记录，但对于可能改善这些后果的干预措施却知之甚少。因此，我们研究了产前可卡因使用者群体中产前护理与出生体重之间的关系。
基于人群的回顾性分析。
1988年至1990年间在纽约市分娩的所有单胎妊娠活产的非西班牙裔白人、非西班牙裔黑人和西班牙裔居民，其出生证明上记录有可卡因使用阳性指征（N = 7923）。
我们对比了进行一至三次产前检查、四次或更多次检查以及检查次数不明的可卡因使用者与未进行产前检查的使用者之间的平均出生体重和低出生体重（<2500 g）发生率。我们使用普通最小二乘法和逻辑回归来控制年龄、产次、吸烟、饮酒、使用其他药物、体重增加、孕前体重、就业状况、婚姻状况、是否参与妇女、婴儿和儿童补充食品计划以及支付方式。
与未进行产前检查的可卡因使用者相比，进行四次或更多次产前检查的黑人可卡因使用者低出生体重的校正比值比为0.51（95%置信区间[CI]，0.44至0.59），白人为0.39（95%CI，0.23至0.66），西班牙裔为0.37（95%CI，0.28至0.48）。进行四次或更多次检查的使用者与未进行检查的使用者之间校正后的平均出生体重差异，黑人是262 g（P <.001），白人为247 g（P <.001），西班牙裔为317 g（P <.001）。
可卡因使用者接受产前护理与出生体重显著改善相关。让可卡因使用者登记接受产前护理可能是更全面解决这一问题的有效开端。
