PREVALENCE AND MAGNITUDE OF PERINATAL SUBSTANCE EXPOSURES IN CALIFORNIA

Background. Perinatal substance exposure has been linked to many neona tal and obstetrical complications. There have been few population-base d epidemiologic studies to identify the prevalence and demographic pro files associated with drugs, alcohol, and smoking during pregnancy. Me thods. We studied a population sample selected according to a multista ge probability sampling design to estimate the prevalence of perinatal substance exposures in California in 1992. Urine samples from 29,494 women presenting for delivery in 202 hospitals were coded and screened for toxins; the results of toxicology screening were later linked by code number to the subjects' demographic variables and their reported use of tobacco and prescribed drugs. Urinary toxicologic tests provide conservative estimates because they can detect only very recent subst ance use. Results. The weighted prevalence for perinatal substance exp osure was 5.16 percent for the use of one or more drugs, 6.72 Percent for alcohol (analyzed independently), and 8.82 percent for self-report ed smoking. The percentage of women testing positive for any drug, inc luding alcohol, was 11.35 percent. Estimates for racial and ethnic gro ups varied widely. Black women had the highest prevalence of total dru g use (14.22 percent), alcohol use (11.58 percent), cocaine use (7.79 percent), and tobacco use (20.12 percent). Most drug exposures occurre d among white non-Hispanic and Hispanic women. White non-Hispanic wome n had the second highest prevalence rate for the use of one or more dr ugs (6.79 percent) and self-reported tobacco use (14.82 percent). Hisp anic women had the second highest prevalence rate for alcohol (6.87 pe rcent). Conclusions. In California in 1992, there were 67,361 estimate d perinatal exposures to one or more drugs, including alcohol, and 52, 346 self-reported exposures to tobacco. These findings have clinical a nd public health implications.