Sprauve M E, Lindsay M K, Herbert S, Graves W
Department of Gynecology and Obstetrics, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA.
Obstet Gynecol. 1997 May;89(5 Pt 1):674-8. doi: 10.1016/s0029-7844(97)00078-1.
To determine the risk of adverse pregnancy outcome among crack cocaine users in a large homogeneous prenatal population with objective documentation of drug use.
A retrospective cohort study was performed on a population of inner-city women who were offered routine voluntary urine drug screening and who delivered between January and December 1992 at a large county hospital. The study population consisted of 483 users (positive drug screens) and 3158 non-users (negative drug screens). Univariate analysis and multiple logistic regression were used to identify the relation between crack cocaine use and adverse perinatal outcome.
Users were significantly more likely than nonusers to deliver low birth weight (LBW) infants (31.3% versus 14.9%; crude odds ratio [OR] 2.6; 95% confidence interval [CI] 2.1, 3.2), growth-restricted infants (29.0% versus 13.0%; crude OR 2.7; 95% CI 2.2, 3.4), and preterm infants (28.2% versus 17.1%; crude OR 1.9; 95% CI 1.5, 2.4). In addition, users were more likely to have abruptions (3.3% versus 1.1%; crude OR 3.0; 95% CI 1.6, 5.6) and infants with low 5-minute Apgar scores (7.9% versus 4.5%; crude OR 1.8; 95% CI 1.2, 2.7). After adjusting for confounders (including alcohol use and smoking), only the risks of LBW and fetal growth restriction (FGR) remained significant, with adjusted OR 1.6 (95% CI 1.03, 2.4) and adjusted OR 1.7 (95% CI 1.2, 2.3), respectively. Although there was no significant difference in the rate of low 5-minute Apgar scores between users and non-users after controlling for confounders, users with a positive urine drug screen within 1 week of delivery were significantly more likely than non-users to deliver infants with low 5-minute Apgar scores: crude OR 2.4; adjusted OR 2.0 (95% CI 1.1, 3.7).
In this inner-city population, crack cocaine use is associated with adverse pregnancy outcomes, as noted by increased risks of LBW and FGR.
在有药物使用客观记录的大量同质性产前人群中，确定使用快克可卡因的孕妇出现不良妊娠结局的风险。
对市中心区的女性人群进行了一项回顾性队列研究，这些女性接受了常规自愿尿液药物筛查，并于1992年1月至12月在一家大型县医院分娩。研究人群包括483名使用者（药物筛查阳性）和3158名非使用者（药物筛查阴性）。采用单因素分析和多因素logistic回归来确定使用快克可卡因与围产期不良结局之间的关系。
与非使用者相比，使用者分娩低出生体重（LBW）婴儿的可能性显著更高（31.3%对14.9%；粗比值比[OR]2.6；95%置信区间[CI]2.1，3.2）、分娩生长受限婴儿的可能性显著更高（29.0%对13.0%；粗OR 2.7；95%CI 2.2，3.4）以及分娩早产婴儿的可能性显著更高（28.2%对17.1%；粗OR 1.9；95%CI 1.5，2.4）。此外，使用者发生胎盘早剥的可能性更高（3.3%对1.1%；粗OR 3.0；95%CI 1.6，5.6），且分娩5分钟阿氏评分低的婴儿的可能性更高（7.9%对4.5%；粗OR 1.8；95%CI 1.2，2.7）。在对混杂因素（包括酒精使用和吸烟）进行调整后，仅LBW和胎儿生长受限（FGR）的风险仍然显著，调整后的OR分别为1.6（95%CI 1.03，2.4）和1.7（95%CI 1.2，2.3）。尽管在控制混杂因素后，使用者和非使用者之间5分钟阿氏评分低的发生率没有显著差异，但在分娩前1周内尿液药物筛查呈阳性的使用者比非使用者分娩5分钟阿氏评分低的婴儿的可能性显著更高：粗OR 2.4；调整后的OR 2.0（95%CI 1.1，3.7）。
在这个市中心区人群中，使用快克可卡因与不良妊娠结局相关，如LBW和FGR风险增加所示。
