Mortality risk associated with perinatal drug and alcohol use in California

OBJECTIVE: To analyze the relationship between perinatal drug/alcohol use and maternal, fetal, neonatal, and postneonatal mortality. STUDY DESIGN: Linked California discharge, birth and death certificate data from 1991-1998 were used to identify drug/alcohol-diagnosed births. Mortality relative risk (RR) ratios were calculated and logistic models were generated for mortality outcomes. RESULTS: Among 4,536,701 birth records, 1.20% contained drug/alcohol discharge diagnostic codes (n = 54,290). The unadjusted RRs for maternal (RR = 2.7), fetal (RR = 1.3), neonatal (RR = 2.4), and postneonatal (RR = 4.3) mortality were increased for drug/alcohol-diagnosed births. After controlling for potential confounding, the odds of material death for cocaine use (OR = 2.15) remained significant as did amphetamine (OR = 1.77), cocaine (OR = 1.43), polydrug (OR = 2.01) and other drug/alcohol use (OR = 1.79) for postneonatal mortality. CONCLUSIONS: The association of cocaine use with maternal mortality and any drug/ alcohol use with postneonatal mortality supports screening and identifying women using illicit drugs and alcohol during pregnancy. increased collaboration with drug treatment programs and closer follow-up for drug-using women and their children may improve mortality outcomes.