COCAINE AND CIGARETTES - A COMPARISON OF RISKS

In order to provide additional data and perspective to current clinica l, policy, and legal debates surrounding the prenatal use of cocaine i n the USA, a retrospective cohort study was conducted to examine effec ts of cocaine on selected perinatal outcomes, and to compare the relat ive risks of adverse perinatal outcomes among users of cocaine and use rs of cigarettes. Using data from a large urban perinatal registry, re lative risks of selected perinatal outcomes were determined for matern al cocaine users who were non-smokers of cigarettes, and used no marij uana, heroin, amphetamines, or alcohol (n = 64), and for cigarette smo kers who do not use illicit drugs or alcohol during pregnancy (n = 320 9). When compared with women with no recorded prenatal exposure to dru gs or cigarettes (n = 13 043), cocaine users had higher risks than smo kers for the following adverse outcomes: low birthweight [Relative Ris k (RR) 5.3, 95% Confidence Interval (CI) 3.0-9.3], small-for-gestation al age (SGA) [RR 4.2, 95% CI 2.4-7.3], prematurity [RR 4.0, 95% CI 2.3 -7.0], abruptio placentae [RR = 10.0, 95% CI 3.5-29.0], placenta praev ia [RR = 2.4, 95% CI 0.3-17.8] and perinatal death [RR = 5.3, 95% CI 1 .9-15.2]. Smokers who did not use any drugs experienced most of the sa me adverse perinatal outcomes as cocaine users, but the magnitude of r isk was greater in cocaine users than in smokers for all outcomes. How ever, given the greater numbers of cigarette smokers than cocaine user s in the population the numbers of infants in the population suffering these adverse outcomes is likely to be greater among offspring of cig arette smokers.:The data support current concern about the risk of coc aine, and current efforts to provide treatment to pregnant cocaine use rs. The data also underline the continued substantial risks of cigaret te smoking to large numbers of pregnant women.