PRENATAL-CARE IN COCAINE-EXPOSED PREGNANCIES

Objective: To examine the effect of prenatal care with and without dru g rehabilitation on perinatal outcome in cocaine-using women. Methods: Cocaine-exposed pregnancies of 905 human immunodeficiency Virus (HIV) -negative women were frequency matched (ratio 6:1) and compared with 1 50 nonusers. Cocaine subgroups consisted of 278 women who received pre natal care and drug rehabilitation (''comprehensive care''), 206 women who received prenatal care only, and 421 who received neither. Matern al and fetal complications, drug screening, and attendance were record ed. Pregnancy rates and HIV seroconversion were determined over the ye ar following delivery. Results: The groups were similar in age, race, education and poverty level. Linear trends of increasing incidence of maternal complications were seen across the four groups. Comparing non users with cocaine users, the odds ratios, with 95% confidence interva ls were: 28.0 (4.2, 103.2) for both anemia and weight under 100 lb; 2. 4 (1.8, 5.0) for urinary tract infections; 15 (4.6, 36.1) for syphilis ; and 11.2 (4.0, 35.8) for other sexually transmitted diseases. Perina tal outcome measures were similar for nonusers and ''comprehensive car e'' groups but significantly worse for the other two groups. Four mate rnal deaths and two myocardial infarctions occurred with no care. Posi tive toxicology at delivery was 1.5 and 4.3 times more likely for the two groups without drug treatment, than for ''comprehensive care.'' Co ngenital anomalies and HIV seroconversion increased in cocaine users. Repeat pregnancy was less likely and more often drug free with ''compr ehensive care.'' Conclusion: ''Comprehensive care'' of the cocaine-usi ng gravida increases the likelihood of carrying to term, having fewer complications, being drug free at delivery, and having fewer exposed r epeat pregnancies. (Obstet Gynecol 1998;92: 193-200. (C) 1998 by The A merican College of Obstetricians and Gynecologists.)