Substance Use
Polysubstance use during pregnancy and preterm birth Xiaozhong Wen* Xiaozhong Wen Aye Moe Hanchen Jiang Porsche Lee
Objective: We aimed to 1) examine the distributions of polysubstance use during pregnancy and 2) investigate the associations between polysubstance use during pregnancy and the risk of preterm birth.
Methods: We used data from 237,288 mothers enrolled in the U.S. Pregnancy Risk Assessment Monitoring System from 2016-2021. Postpartum mothers reported the status of their use of combustible cigarettes, electronic cigarettes (e-cigarettes), marijuana, alcohol, and drugs in the last 3 months of pregnancy. Our primary outcome was preterm birth, defined as birth before the 37 weeks of pregnancy. We created a correlation matrix to explore the patterns of polysubstance use. We used multivariable logistic regression models to estimate the associations between the different polysubstance use groups during pregnancy with preterm birth, adjusting for socio-demographic and pregnancy-related confounders.
Results: The three most prevalent substances used during pregnancy were alcohol (9.35%), cigarettes (7.11%), and marijuana (4.84%). The highly correlated substance combinations were cigarettes and e-cigarettes (r=0.600), cigarettes and marijuana (r=0.553), cigarettes and amphetamines (r=0.595), cigarettes and methadone (r=0.620), e-cigarettes and methadone (r=.518), marijuana and amphetamines (r=0.635), Adderall and amphetamines (r=.636), and amphetamines and methadone (r=.689). The use of cigarettes and marijuana (confounder-adjusted odds ratio or aOR=1.59 [95% confidence intervention or CI, 1.29-1.95]; p-value <0.001) as well as the use of cigarettes and amphetamines (aOR=1.71 [95% CI, 1.18-2.48]; p-value=0.005) was associated with increased odds of preterm birth compared to non-users. Furthermore, the use of all three cigarettes, marijuana, and amphetamines was also significantly linked to preterm birth (aOR=1.73 [95% CI, 1.06-2.84]; p-value=0.029).
Conclusion: Co-use of cigarettes/marijuana and cigarettes/amphetamines is associated with preterm birth.