Perinatal Substance Use: A Prospective Evaluation of Abstinence and Relapse

Forray A, Merry B, Lin H, Ruger JP, and Yonkers KA. “Perinatal Substance Use: A Prospective Evaluation of Abstinence and Relapse,” Drug and Alcohol Dependence, 2015; 150: 147-55.

9 Pages Posted: 8 May 2015  

Ariadna Forray

Yale University - Department of Psychiatry

Brian Merry

Yale University - Department of Psychiatry

Haiqun Lin

Yale School of Public Health

Jennifer Prah Ruger

University of Pennsylvania

Kimberly A. Yonkers

Yale University - Department of Psychiatry

Date Written: May 1, 2015

Abstract

Background Substance use decreases in pregnancy but little prospective data are available on the rates of abstinence and relapse for specific substances. This study compared rates of abstinence in pregnancy and relapse postpartum for nicotine cigarettes, alcohol, marijuana, and cocaine.

Methods Data from 152 women drawn from a randomized controlled trial comparing psychological treatments for substance use in pregnancy were analyzed. Self-reports of substance use and urine for toxicology testing throughout pregnancy and 3-months, 12-months and 24-months post-delivery were collected. Multivariate Cox models were used to compare rates of abstinence and relapse across substances.

Results In pregnancy, 83% of all women achieved abstinence to at least one substance. The mean (SE) days to abstinence was 145.81 (9.17), 132.01 (6.17), 151.52 (6.24), and 148.91 (7.68) for cigarettes, alcohol, marijuana and cocaine, respectively. Participants were more likely to achieve abstinence from alcohol (HR 7.24; 95% CI 4.47-11.72), marijuana (HR 4.06; 95% CI 1.87-6.22), and cocaine (HR 3.41; 95% CI 2.53-6.51), than cigarettes. Postpartum, 80% of women abstinent in the last month of pregnancy relapsed to at least one substance. The mean days to relapse was 109.67 (26.34), 127.73 (21.29), 138.35 (25.46), and 287.55 (95.85) for cigarettes, alcohol, marijuana and cocaine, respectively. Relapse to cocaine was only 34% (HR 0.34; 95% CI 0.15-0.77) that of cigarettes.

Conclusions Pregnancy-related abstinence rates were high for all substances except cigarettes. Postpartum relapse was common, with cocaine using women being less likely to relapse after attaining abstinence compared to women using cigarettes, alcohol or marijuana.

Keywords: Pregnancy; Postpartum; Drug use; Smoking; Relapse; Abstinence

Suggested Citation

Forray, Ariadna and Merry, Brian and Lin, Haiqun and Prah Ruger, Jennifer and Yonkers, Kimberly A., Perinatal Substance Use: A Prospective Evaluation of Abstinence and Relapse (May 1, 2015). Forray A, Merry B, Lin H, Ruger JP, and Yonkers KA. “Perinatal Substance Use: A Prospective Evaluation of Abstinence and Relapse,” Drug and Alcohol Dependence, 2015; 150: 147-55.. Available at SSRN: https://ssrn.com/abstract=2602500

Ariadna Forray

Yale University - Department of Psychiatry ( email )

New Haven, CT 06520
United States

Brian Merry

Yale University - Department of Psychiatry ( email )

New Haven, CT 06520
United States

Haiqun Lin

Yale School of Public Health ( email )

Jennifer Prah Ruger (Contact Author)

University of Pennsylvania ( email )

Philadelphia, PA 19104
United States

Kimberly A. Yonkers

Yale University - Department of Psychiatry ( email )

New Haven, CT 06520
United States

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