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Women's Health

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Pregnant women are as likely to deny tobacco use as they are to deny illegal drug use

Use of tobacco, alcohol, and illegal drugs during pregnancy has the potential to harm unborn children and greatly increase medical expenses for the children. For example, the costs associated with caring for neonatal problems resulting from smoking are estimated to be between $1.4 and $2 billion a year, and neonatal care costs for cocaine-positive infants are 10-fold higher than for infants who are free of cocaine at birth.

Before public education campaigns broadcast the harm of smoking during pregnancy, women generally admitted cigarette use to researchers if they were smokers. Now pregnant women appear to be just as likely to under-report cigarette use as they are to under-report use of marijuana or cocaine, according to a study that was supported in part by the Agency for Healthcare Research and Quality (HS08358).

Nina Markovic, Ph.D., of the University of Pittsburgh, and her colleagues compared self-reported use of tobacco, marijuana, and cocaine by 789 predominantly inner-city, pregnant women with urine tests for these substances (and hair analysis for cocaine). Overall, one-fourth of the women reported current cigarette smoking, about 10 percent reported smoking marijuana during the past month, and 3.4 percent reported recent cocaine use. However, urinalysis indicated that 27 percent of women were exposed to tobacco, 23 percent were exposed to marijuana, and 8 percent were exposed to cocaine. Hair analysis—which is a better indicator of past cocaine use—indicated that 24 percent of the women had been exposed to cocaine.

Among those reporting only past use of tobacco, marijuana, and cocaine, 25 percent, 24 percent, and 23 percent, respectively, had positive results of urinary assays. Among those reporting current use, 77 percent, 87 percent, and 76 percent had positive findings; among women reporting no history of use, 6 percent, 6 percent, and 4 percent of results were positive. Women were more likely to underreport current than past use of these substances.

For more information, see "Substance use measures among women in early pregnancy," by Dr. Markovic, Roberta B. Ness, M.D., M.P.H., Denise Cefilli, and others, in the September 2000 American Journal of Obstetrics & Gynecology 183, pp. 627-632.

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