title: Mortality risk associated with perinatal drug and alcohol use in California.
abstract: OBJECTIVE
  To analyze the relationship between perinatal drug/alcohol use and maternal, fetal, neonatal, and postneonatal mortality.
  
  
  METHODS
  Linked California discharge, birth and death certificate data from 1991-1998 were used to identify drug/alcohol-diagnosed births. Mortality relative risk (RR) ratios were calculated and logistic models were generated for mortality outcomes.
  
  
  RESULTS
  Among 4,536,701 birth records, 1.20% contained drug/alcohol discharge diagnostic codes (n=54,290). The unadjusted RRs for maternal (RR=2.7), fetal (RR=1.3), neonatal (RR=2.4), and postneonatal (RR=4.3) mortality were increased for drug/alcohol-diagnosed births. After controlling for potential confounding, the odds of maternal death for cocaine use (OR=2.15) remained significant as did amphetamine (OR=1.77), cocaine (OR=1.43), polydrug (OR=2.01) and other drug/alcohol use (OR=1.79) for postneonatal mortality.
  
  
  CONCLUSIONS
  The association of cocaine use with maternal mortality and any drug/alcohol use with postneonatal mortality supports screening and identifying women using illicit drugs and alcohol during pregnancy. Increased collaboration with drug treatment programs and closer follow-up for drug-using women and their children may improve mortality outcomes.
authors.affiliation: Family Health Care Nursing (E.L.W.), University of California, San Francisco, San Francisco General Hospital, San Francisco, CA 94110, USA. ewolfe@sfghpeds.ucsf.edu
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Wolfe
authors.forename: Thomas
authors.initials: T
authors.lastname: Davis
authors.forename: Joseph
authors.initials: J
authors.lastname: Guydish
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Delucchi
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008423:Maternal Age; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology / Q000401:mortality*; D011295:Prenatal Care; D018570:Risk Assessment; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000208:ethnology / Q000401:mortality*