Cocaine is associated with intrauterine fetal death in women with suspected preterm labor

The objectives of this study were to determine the rate of recent cocaine use in a metropolitan population of predominantly Hispanic and African-American women with suspected preterm labor and to evaluate the impact of recent cocaine use on intrapartum complications in this population. Urine toxicology screens were prospectively obtained on 102 women with suspected preterm labor. The urine screen did not influence management decisions. Gestational age at delivery, birthweight, and intrapartum complications were compared using Student's t-test, chi-square analysis, or Fisher's exact test. The rate of positive urine drug screens for cocaine was 12.7%. Women with positive toxicology were older (27.8+/-5.7 versus 22.1+/-4.8 years, p=0.002) and of higher parity (2 [1 to 7] versus 1 [0 to 7], p=0.01). Women with positive toxicology were more likely to be black (92.3%) than Hispanic (7.7% [p=0.0004]). They had more advanced cervical dilation at presentation (3 cm [0 to 6] versus 1 cm [0 to 8], p=0.008), were more likely to be admitted (85% versus 32%, p<0.0001), but less likely to receive tocolysis due to advanced dilation or pregnancy complication (36% versus 79%, p=0.0002). There was no difference in gestational age or birthweight at delivery. There was a significantly higher intrauterine fetal death rate in the cocaine positive group (18.2% versus 0%, p=0.02). These data suggest that recent cocaine use among women with suspected preterm labor is common in only some segments of an urban population and significantly impacts pregnancy outcome.