Maternal welfare, morbidity and mortality 6-15 years after a pregnancy complicated by alcohol and substance abuse: a register-based case-control follow-up study of 524 women.
BACKGROUND
A register-based retrospective case-control study to investigate the long-term morbidity, mortality, and welfare among women with alcohol and/or substance misuse identified during pregnancy.


METHODS
Cohort of 524 women followed-up ante- and perinatally 1992-2001 at special out-patient clinics of maternity hospitals in the capital area of Finland. The control group of 1792 women with no evidence of alcohol or substance misuse was matched for maternal age, parity, date of birth and hospital of index delivery. Both groups were followed-up until end of 2007.


RESULTS
7.9% (42/524) of the cases and 0.2% (4/1792) of the controls had died by the end of the median follow-up of 9 years (OR 38, 95% CI 14-108). The cases displayed significant morbidity requiring in-patient care in the areas of mental disorders (AOR 8.8, 95% CI 6.5-11.9), viral (AOR 23.5, 95% CI 8.8-62.7) and bacterial (AOR 6.1, 95% CI 3.5-10.4) infections, skin diseases (AOR 3.9, 95% CI 2.0-7.8) and injury and poisoning (AOR 4.2, 95% CI 3.1-5.6). The cases displayed more out-patient visits (OR 2.7, 95% CI 2.7-2.8). Their mean length of hospital stay was longer compared to controls (10.3 vs. 4.4 days, p<0.001). The risk of pension granted due to a disorder, disease or disability (OR 8.8, 95% CI 6.0-13.0) and the risk for minimum unemployment benefit were higher compared to controls (OR 2.1, 95% CI 1.8-2.5).


CONCLUSIONS
These women display significant long-term morbidity, mortality and loss of productivity after delivery. The results emphasize the importance of adequate postnatal follow-up and treatment for misuse.
Kahila
Hanna
H
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140, FIN-00029 HUCH, Helsinki, Finland. hanna.kahila@hus.fi
Gissler
Mika
M
Sarkola
Taisto
T
Autti-Rämö
Ilona
I
Halmesmäki
Erja
E
D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000401:mortality*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008429:Maternal Welfare / Q000639:trends; D009017:Morbidity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D012042:Registries; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications / Q000401:mortality*; D055815:Young Adult