Cocaine and Tobacco Use and the Risk of Spontaneous Abortion
Roberta B. Ness, M.D., M.P.H., Jeane Ann Grisso, M.D., Nancy Hirschinger, M.A., Nina Markovic, Ph.D., Leslie M. Shaw, Ph.D., Nancy L. Day, Ph.D., and Jennie Kline, Ph.D.
Background Cigarette smoking and cocaine use may be risk factorsfor spontaneous abortion, but data supporting such a link arelimited.
Methods We studied the associations between cocaine and tobaccouse and spontaneous abortion among pregnant adolescents andwomen (age range, 14 to 40 years) who sought care at an inner-cityemergency department. A total of 400 adolescents and women hadspontaneous abortions either at study entry or during follow-up(which lasted until 22 weeks' gestation), and 570 adolescentsand women remained pregnant past 22 weeks' gestation. Cocaineuse was measured at base line by self-reports and analysis ofurine and hair samples. Cigarette smoking was measured by self-reportsand urine analysis.
Results The adolescents and women in both groups were predominantlyblack and of lower socioeconomic status. Among those who hadspontaneous abortions, 28.9 percent used cocaine on the basisof hair analysis and 34.6 percent smoked on the basis of a urinecotinine assay, as compared with 20.5 percent and 21.8 percent,respectively, of the adolescents and women who did not havespontaneous abortions. The presence of cocaine in hair sampleswas independently associated with an increase in the occurrenceof spontaneous abortion (odds ratio, 1.4; 95 percent confidenceinterval, 1.0 to 2.1) after adjustment for demographic and drug-usevariables. However, the use of cocaine as measured by self-reportsand by urine analysis was not. The presence of cotinine in urinewas also independently associated with an increased risk ofspontaneous abortion (odds ratio, 1.8; 95 percent confidenceinterval, 1.3 to 2.6). Twenty-four percent of the risk of spontaneousabortion could be related to cocaine or tobacco use.
Conclusions Cocaine use and tobacco use were common in our studypopulation and were associated with a significant risk of spontaneousabortion.
Source Information
From the Graduate School of Public Health, University of Pittsburgh, Pittsburgh (R.B.N., N.M.); the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.A.G., N.H.); the Department of Pathology and Laboratory Medicine, University of Pennsylvania Health System, Philadelphia (L.M.S.); the Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (N.L.D.); and the New York State Psychiatric Institute and G.H. Sergievsky Center and School of Public Health, New York (J.K.).
Address reprint requests to Dr. Ness at the University of Pittsburgh, Graduate School of Public Health, 130 DeSoto St., 517 Parran Hall, Pittsburgh, PA 15261.
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