Methamphetamine use during pregnancy tied to maternal and neonatal complications: Study
The use of amphetamine-type stimulants (ATSs) has been increasing among women worldwide. Cases of pregnant mothers with ATS and maternal/fetal complications are also on the rise. The risk for preterm birth, low birth weight, and small stature of gestational-age infants increases in pregnant women who consume methamphetamine.
ATS is a family of potent central nervous system stimulants composed of amphetamine sulfate and methamphetamine. Methamphetamine (MA) is an amphetamine derivative, composed of a mixture of levo and dextro enantiomers in different proportions.
Premchit et al carried out a study with an aim to determine obstetric and neonatal outcomes among methamphetamine-abusing parturient who currently used MA.
This historical cohort study was conducted at Bhumibol Adulyadej Hospital (BAH), Bangkok, Thailand, between January 2017 and December 2019. The total number of women was 206 who were equally divided into a study and control group. Pregnant women who tested positive for methamphetamine in urine tests during the intrapartum period were compared to the control group with no history of drug abuse.
The outcomes of pregnancy such as preterm birth, birth weight, Apgar score, and intrapartum complications were recorded.
The study group had a lower average number of antenatal care (ANC) visits than the control group with a statistical difference. Half of the study group (48/103) had never undergone any ANC visit. All study groups abused MA via the oral route. The study group had significantly more parity, smoking, alcohol drinking, and sexually transmitted diseases than the control group.
Preterm birth rate of the study group was significantly higher than in the control group (33.3% and 11.7%, respectively). Among complications for pregnancy-induced hypertension, only gestational hypertension was found to be significantly increased in the study group compared to the control group at 14.6 vs. 1.0%, respectively (p value < 0.05 with odds ratio 17.4). Preeclampsia with and without severe features were comparable in both the study and the control group. There were no eclampsia cases in this study.
The average birth weight in the study and the control group was 2779.1 ± 486.7 and 3049.5 ± 510 gm, respectively (p value < 0.001). Low-APGAR-score cases in both groups showed no significant difference.
Exposure to ATS during pregnancy was reported to cause both obstetric and neonatal complications. The current study revealed smoking and alcohol consumption in pregnant women with MA at 38.8 and 12.6 percent compared to one and zero percent in the control group, respectively.
Preterm delivery had multifactorial causes either from maternal or fetal underlying conditions. Vasoconstrictive property of MA during intrautero exposure caused increased risk of preterm birth, low birth weight, and small stature of a gestational-age infant. From the present study, it can be seen that MA-addicted pregnant women had a significantly higher preterm birth rate than the control group, at 33.3 vs. 11.7%, respectively, at p < 0.001. MA pregnant women showed a 3.7-fold increased preterm rate compared to the study group.
Preterm labor could be prevented by cessation of MA and other addictive-substance usage. MA addicted pregnant women should be informed about the complications from MA consumption during the ANC visit and encouraged to stop using it with help from experienced healthcare providers.
MA is one of the sympathomimetic amines. It is not categorized as a major teratogen. MA consumption increases dopamine release and decreases dopamine reuptake. Heart rate and blood pressure increase as a consequence of sympathomimetic effects of MA. MA could traverse the placental barrier and reach the fetus in utero.
Hypertensive disorder during pregnancy (PIH) is a catastrophic event in modern obstetrics. MA enhanced PIH incidence. The current study showed that MA-addicted pregnant women had higher prevalence of gestational hypertension than the control group (14.6 vs. 1%, p ≤ 0.001). However, rates of preeclampsia with or without severe features among both groups were comparable.
MA can be collected in the urine in case of repeat usage. The ability to detect MA in urine depended on many factors such as the amount of substance and time of last consumption.
The authors concluded, "The present retrospective cohort study confirmed that the use of MA during pregnancy significantly increased both maternal and fetal complication, namely, preterm birth delivery and gestational hypertension. The knowledge can be used to help healthcare staff create a plan for MA parturient in anticipation of a high-risk delivery and postdelivery maternal-fetal treatment. Moreover, the results from this study can be used to inform pregnant women during antenatal care to promote substance-free pregnancy."
Source: Premchit et al, Hindawi Obstetrics and Gynecology International;