89 - Prenatal Exposure to Illicit Substance/s and the Risk of Severe Intraventricular Hemorrhage in Premature Infants.

Poster Number: 89
Publication Number: 89.341

Background: Maternal substance use disorder (MSUD) during pregnancy has been rising and causing major public health concern. MSUD during pregnancy increases risk of stillbirth, birth defects, low birth weight and premature birth. Per CDC, ~5% of pregnant women use one/more illicit substance/s. Illicit substance/s can easily cross placenta, have neurovascular pharmacodynamic effects and can potentially increase risk of severe intraventricular hemorrhage (IVH). Published reports on infants with gestational age (GA) < 32 weeks or birth weight (BW) < 1500 grams showed incidence of all grades IVH remains at ~25 % and severe-IVH at ~7.7%. However, the incidence of IVH in premature neonates exposed to illicit substance/s is unknown.

Objective: We hypothesized that fetal exposure to illicit substance/s will increase risk of IVH in premature infants.

Design/Methods: This is a prospective cohort study of Cranial Ultrasound (CUS) findings in preterm infants who had in-utero illicit substance/s exposure. Serial CUS are obtained within first 14 days, at 21-30 days-of-life and at corrected-GA of 35 weeks. We included all live birth with GA < 32wk or BW < 1,500g that were born in 2014 - 2020. In-utero illicit drug exposed infants were identified from maternal history, maternal urine toxicology test and confirmed with post-natal umbilical cord tissue toxicology test. We excluded complex congenital and chromosomal anomalies infants.

Results: 1,164 infants (GA < 32wk or BW < 1,500g) were born in our maternity hospital from 2014 - 2020. We considered CUS to be abnormal based on the worst grade identified in the first 30 days-of-life. The incidence of IVH in non-exposed infants was as follows: grade I 19.6%, grade II 7.8%, grade III 2.9% and grade IV 6.3%. We identified 55 infants that were exposed prenatally to illicit substance/s. Of the exposed infants, 58.2% (32/55) had abnormal CUS; compared to non-exposed; the incidence of IVH was as follows: grade I 43.6% [p < 0.01; OR 3.89, 95% CI 2.11-7.17], grade II 9.1% [p=0.09; OR 2.02, 95% CI 0.74-5.52], grade III 1.8% [p=0.46; OR 1.1, 95% CI 0.14-8.44] and no grade IV IVH [p=0.33; OR 0.24, 95% CI 0.01-4.07]. Maternal-Infant characteristics (Table 1).

Conclusion(s): Low grade IVH (grade 1 and 2) was noted in majority of the illicit substance/s-exposed premature infants, and severe IVH (grade 3 and 4) was lower compared to non-exposed infants. We plan to further investigate the severity of IVH and its correlation with the abused drug/s, umbilical cord drug concentrations, maternal lifestyle, and other relevant medical-social issues.