Postpartum psychoactive substance abuse after severe maternal morbidity

Abstract

Objective: To evaluate drug use among mothers during the postpartum period after a severe pregnancy-related complication.

Methods: A retrospective cohort study of maternal morbidity including maternal near-miss and control groups conducted in a tertiary hospital in Campinas, Brazil, between July 2008 and June 2012. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess drug use during lifetime, pregnancy, and in the previous 3 months.

Results: Of 638 women evaluated, drug use was reported by 165 (25.8%). Alcohol was the most common substance used (n=133, 20.6%), followed by tobacco (n=85, 13.2%), and cocaine (n=15, 2.3%). The highest risk for postpartum drug use was among those using drugs during pregnancy. There were no differences between the morbidity and control groups, but there was a significant difference in the need for intervention to reduce alcohol consumption in the severe maternal morbidity group. Risk for substance abuse intervention increased three-fold in women with PTSD criteria, and all aspects of quality of life were worse among drug users.

Conclusion: Drug use during pregnancy and maternal complications are linked to postpartum drug abuse. These women should be managed during pregnancy; postpartum follow-up requires updated guidance and must go beyond family planning.

Keywords: Drug use; Maternal near miss; Postpartum period; Psychoactive substances; Puerperium; Severe maternal morbidity; Substance use.