Psychosocial risk factors associated with cocaine use during pregnancy: a case-control study

OBJECTIVE: To investigate whether psychosocial risk factors predict cocaine use during pregnancy. METHODS: We sampled 229 pregnant women from an urban prenatal clinic. Drug use ascertainment was based on self-report and urine toxicology, with 102 subjects classified as drug users and 127 as nonusers. A questionnaire measuring seven psychosocial risk factors was administered. The predictive relation between these characteristics and drug use was ascertained through multivariate analyses, controlling for potential sociodemographic confounders. RESULTS: Six of the seven psychosocial risk factors were significant predictors for this sociodemographic group. Women who used cocaine during pregnancy were more likely to have a family history of alcohol or drug problems, to have been introduced to drugs by a male partner, to be depressed, to have less social support, to have current partners who were substance users, and to have less-stable living situations. Both groups of subjects had high rates of childhood sexual abuse, but this alone was not predictive of drug use. In addition, cigarette smoking was a strong predictor of illicit drug use. CONCLUSION: Identification of multiple psychosocial risk factors has implications for the identification and treatment of substance-using pregnant women. Because cocaine users and nonusers did not differ in gestational age at entry into prenatal care, opportunities exist for intervention during pregnancy. Based on the study findings, evaluation of the following aspects of a patient's lifestyle can aid in the detection of cocaine use during pregnancy: smoking status, family history of alcohol or drug problems, and current drug use by a male partner.