Health-care utilization among mothers and infants following cocaine exposure

Objective: To examine utilization of health-care resources among mothers and infants following cocaine use during pregnancy. Design: Prospective observational study. Setting: Four clinical sites. Patients/Methods: Medical and social resource use was examined among 8514 mother-infants dyads, 1072 of whom used cocaine and 7442 who did not. Use was stratified by < 1500 g and > 1500g birth-weight strata to differentiate the low birth weight the larger weight group adjusting for site,infant gender, and maternal race and education. Outcome Measures: Resource use evaluated among mothers included prenatal care, hospitalizations, medications and mode of delivery. Resource use for infants included therapies, procedures and length of stay. Results: Fewer cocaine-exposed women, compared to those in the nonexposed group, had prenatal care or used medications during pregnancy in both < 1500 g category 0.10 (0.01 to 0.22) (OR (99% CI) and 0.26 (0.10 to 0.65), respectively, and in the > 1500 g category 0.14 (0.11 to 0.19) and 0.61 (0.49to 0.74), respectively. Length of hospital stay for social reasons and referrals to child protective services were increased in cocaine-exposed infants in both < 1500 g category 66.8 (4.38 to 999.9) and 77.4 (17.64 to 289.13), respectively and in the > 1500 g category 70.74 (41.73 to 119.94) and 125.88 (81.78 to 193.77), respectively. In addition, among > 1500 g cocaine-exposed infants, length of stay in neonatal intensive care unit was increased 1.53 (1.16 to 2.02) as was therapies 1.76 (1.45 to 2.13), procedure 1.50 (1.23 to 1.83), need for formula feeds 5.45 (2.28 to 13.02) and intravenous fluids 1.50 (1.19 to 1.87). Conclusion: Cocaine exposure has no deleterious or protective effects on medical resource needs of <1500 g infants or their mothers. Resource needs reflect those of morbidity of being born premature. The increase in health-care resources for >1500 g cocaine-exposed infants for surveillance and monitoring in the absence of an increase in congenital anomalies should be discouraged.