Relationships of substance abuse to the nutritional status of pregnant African-American Women - Statistical Data Included

Family Economics and Nutrition Review,  Spring, 2001  by Hazel A.B. Hiza,  Allan A. Johnson,  Enid M. Knight,  Claudette S. Welch,  Cecile H. Edwards

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Illicit and nonillicit drug abuse is a major interest of clinicians, public health officials, and social authorities (e.g., child welfare). Moreover, one of the major concerns is drug abuse during the periconceptional period and throughout pregnancy because of its potential adverse effects on the health of the mother, embryo, fetus, and neonate (14,36,37).

Age, race, and socioeconomic status are among the most frequently cited factors associated with low birth weight and preterm delivery. Specifically, being young, being African American, and having a low socioeconomic status are most often associated with adverse pregnancy outcomes (1,11,18,19,32, 39). A higher maternal educational level is associated with better health knowledge and behavior (35).

One to 58 percent of pregnant women use drugs (47). Such wide variations in reported use could be attributed to the voluntary nature and lack of adequate drug-screening techniques, disparate patterns of drug use among different U.S. regions and populations, differences in drug-screening methods, or differences in levels of prenatal care among drag-using populations (27). Lack of agreement exists in the scientific literature regarding the most prevalent illicit drugs used during pregnancy. However, research shows that about 11 percent of pregnant women in the United States use at least one of the following drugs: cocaine, marijuana, heroin, methadone, phencyclidine (PCP), and amphetamines (40). Each year in this country, more than 200,000 infants are exposed in utero to one or more illicit drugs (9,45).

Women who abuse illicit drugs and alcohol during pregnancy are an elusive population. These women often remain unidentified to practitioners and researchers and therefore have not been studied to a great extent (22). Despite the even distribution of illicit substance use across demographic categories, poor women and women of color are far more likely than are other women to be reported to health and child welfare authorities for use of substances during pregnancy, even when their base rates for use of illicit drugs are considered (22).

Little information is available on the nutritional consequences of substance abuse during pregnancy, and the available studies of women who have used nonillicit as well as illicit drugs during pregnancy have provided conflicting results regarding the nutritional effect on users (26,30). Some evidence shows that cocaine acts as an appetite suppressant (52). Another shows increased caloric intake and low levels of plasma zinc among marijuana users (29). Researchers estimate that nearly 50 percent of opiate-dependent women suffered from anemia, heart disease, diabetes, pneumonia, or hepatitis during pregnancy and childbirth (52).

Another study shows that women who consumed alcohol during pregnancy drank more frequently before pregnancy than did women who drank alcohol prenatally but not during pregnancy (33). Jacobson and others (25) also found that many mothers reported higher levels of alcohol consumption before pregnancy than during pregnancy. One plausible interpretation is that the mothers underreported their actual levels of drinking when they were interviewed at prenatal clinics because of the stigma associated with drinking during pregnancy. This may be especially likely when women are interviewed in a prenatal clinic where the health and welfare of the infant is focal. Alternatively, self-reported alcohol consumption by pregnant women may be influenced by their current level of drinking, which is typically higher.

Excessive alcohol consumption impairs the metabolism of most nutrients. Ethanol intake also leads to negative nitrogen balance and an increased protein turnover (8,52). However, evidence concerning the adverse effects of alcohol on specific nutritional indices comes mainly from studies of nonpregnant, hospitalized alcoholics; few data are available on the effect of alcohol on maternal nutrition (52). Information is particularly sparse on the diets of pregnant women of African descent and almost nonexistent for pregnant women who are substance abusers. In one study, maternal and umbilical cord blood zinc levels were lower in pregnant women who consumed alcohol than in those who did not (16). Another study suggested that alcohol may impair placental transport of amino acids (15).

Another behavior--cigarette smoking--may affect maternal nutrition by decreasing the availability of calories and certain nutrients such as vitamin [B.sub.12], amino acids, folate, and zinc (52). Efforts to improve maternal and fetal nutrition during pregnancy have focused on achieving appropriate energy intakes and ensuring that the intake of specific nutrients is adequate to meet maternal and fetal requirements (52).

Despite researchers' efforts in recent years to document the consequence of maternal substance abuse on pregnancy outcomes, information on specific maternal consequences of substance abuse during pregnancy is sparse. Thus this study focused on the relationships of nonillicit (alcohol and tobacco) and illicit (cocaine, marijuana, heroin, PCP, and opiates) substance abuse to the nutritional status of pregnant African-American women residing in an urban environment.