Abstract

Introduction

Substance abuse during pregnancy remains an area that is difficult to study 1. From 1988 to 2004, hospitalization for amphetamine abuse among pregnant women doubled 2. This study aims to analyze whether women with a positive urine drug screen for amphetamine on admission to labor and delivery develop pre-eclampsia at a higher rate than those who test negative. The research study was designed to provide insight into behavioral and social determinant trends within our local community of practice.

METHODS

This study is a retrospective chart review of patients admitted to the labor and delivery service at a community academic hospital. A total of 2,834 patient deliveries from March 3rd, 2018, through April 330th, 2021, were reviewed. Patients met the inclusion criteria if a routine urine drug screen was collected on admission. Patients met exclusion criteria if no urine drug screen was collected. The deliveries were then eligible to be placed into one of the two arms of the study: (1) Patients with a positive urine drug screen for amphetamines, and (2) Patients with a negative urine drug screen for amphetamines. Chi-square, Fisher's exact, and Mann-Whitney U tests were used to analyze the data.

RESULTS

After reviewing the deliveries performed within the timeline, 617 charts were eligible for inclusion, with 490 of these having a negative urine drug screen for amphetamines and 127 having a positive urine drug screen for amphetamines. The primary finding of this study is that amphetamine use during pregnancy is strongly associated with an increased risk of pre-eclampsia. Interestingly, amphetamine users had significant demographic differences from non-users; amphetamine users, on average, were older and had a lower BMI than non-users. Additionally, patients with a positive amphetamine test were also delivered at an earlier gestational age. When comparing patients with a positive urine drug screen for amphetamines to those with a negative urine drug screen, both groups did not show a significant difference in the history of chronic hypertension or previous pre-eclampsia.

CONCLUSION

Our study demonstrates that intrapartum amphetamine use proves to be a significant risk factor for pre-eclampsia in pregnancy. Further research into the pharmacologic actions of amphetamines could provide better insight into the physiologic events that trigger pre-eclampsia. Further investigations could include a closer examination of the effect of other substances on the development of pre-eclampsia.