Postpartum psychoactive substance abuse after severe maternal morbidity

To evaluate drug use among mothers during the postpartum period after a severe pregnancy-related complication. MethodsA 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 3months. ResultsOf 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. ConclusionDrug 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. Maternal complications and drug use during pregnancy influence drug use behavior after childbirth. Postpartum follow-up requires updated guidance and must go beyond family planning.1473368374CNPQ - Conselho Nacional de Desenvolvimento Científico e Tecnológico471142/2001-

CL measurement curve line technique.

Transvaginal ultrasonography in sagittal section. The endocervical mucosa (arrow) is used as a guide to identify the internal (IO) and external (EO) os. The curve technique is presented (continue line): two lines are drawn respecting the curvature of the endocervical canal.</p

Multiple analysis for cervical length ≤ 25 mm in women with previous pregnancies.

Multiple analysis for cervical length ≤ 25 mm in women with previous pregnancies.</p

Multiple analysis for cervical length ≤ 25 mm.

Multiple analysis for cervical length ≤ 25 mm.</p

Main sociodemographic characteristics of the sample population, mean, median of the ultrasonographic measurements in straight line of the uterine cervix in millimeters and percentage of cervical length ≤ 25 mm.

Main sociodemographic characteristics of the sample population, mean, median of the ultrasonographic measurements in straight line of the uterine cervix in millimeters and percentage of cervical length ≤ 25 mm.</p

Values of percentile 5, 10, 25, 50, 75, 90 e 95 for the cervical length measurement in linear distance between internal and external os and in curve by ultrasonography according to gestational age.

Values of percentile 5, 10, 25, 50, 75, 90 e 95 for the cervical length measurement in linear distance between internal and external os and in curve by ultrasonography according to gestational age.</p

Inclusion and exclusion flowchart.

Eligible pregnant women, excluded and included in the analysis.</p

P5 trial description.

(DOCX)</p

STROBE statement checklist.

(DOCX)</p

CL measurement in straight line technique.

Transvaginal ultrasonography in sagittal section. The endocervical mucosa (arrow) is used as a guide to identify the internal (IO) and external (EO) os. The straight-line technique is presented (dashed line).</p