Substance abuse doubles the risk of cardiovascular diseases in pregnant women, a new report shows.
The report says illicit substance abuse in pregnancy is associated with high risk of cardiovascular events and maternal mortality.
Pregnant women with a history of substance abuse face an increased risk of death from heart attack and stroke during childbirth compared to those without history of substance abuse, the Smidt Heart Institute study shows.
The study was published in the Journal of the American College of Cardiology: Advances.
Martha Gulati, a senior and corresponding author of the study noted that substance use during pregnancy doubled cardiovascular events and maternal mortality during delivery.
“Substance abuse also doubled the risk of acute heart failure,” she said.
Gulati is the associate director of the Barbra Streisand Women’s Heart Centre in the Department of Cardiology in the Smidt Heart Institute.
She is also the director of Preventive Cardiology in the Smidt Heart Institute and the Anita Dann Friedman Endowed Chair in Women’s Cardiovascular Medicine and Research.
The substances studied in the research included cocaine, opioids, alcohol, amphetamine/methamphetamine and cannabis.
“Each substance carried a different amount of risk on expectant mothers,” the study shows.
"Amphetamine/methamphetamine had the greatest association with the development of acute heart failure, at nine times greater risk, acute heart attack has 7 1/2 times greater risk, cardiac arrest at seven times greater risk and maternal mortality at three times greater risk."
These substances are known to increase heart rate and blood pressure and cause structural and electrical changes of the heart.
Cocaine had the strongest association with stroke and was also found to be associated with arrhythmias, which are abnormal heart rhythms.
Opioid use had the strongest association with infection of the heart valves, a disease known as endocarditis. These drugs are often injected into the bloodstream.
The study associated alcohol use with the greatest risk for arrhythmias. Cannabis, which is the most commonly used substance according to the study, was not associated with maternal mortality but a higher risk of heart attack.
“Despite the widespread legalisation of cannabis, many people are unfamiliar with the risks it can pose during pregnancy. Cannabis causes heart cell death and can also lead to severe cardiovascular events,” Gulati said.
The National Authority for the Campaign against Alcohol and Drug Abuse (Nacada) 2021 survey report indicates that the most commonly abused drugs and substances in Kenya are alcohol, tobacco, cannabis (bhang), glue, miraa (khat) and psychotropic substances.
The Rapid Situation Assessment of Drug and Substance Abuse in Kenya (Nacada, 2017) indicates that 12.2 per cent of persons aged between 15 and 65 are active users of alcohol, with 10.4 per cent of them suffering from alcohol use disorders.
The survey also indicates that other substances of abuse included tobacco (8.3 per cent), miraa at four per cent and cannabis at one per cent.
In addition, findings of a National Survey on the Status of Drugs and Substance Abuse among Primary School Pupils in Kenya (Nacada, 2019) showed the average age of onset of at least one drug or substance abuse was 11 years and lowest age of onset of at least one drug of abuse was four years.
Further, a National Survey on Alcohol and Drug Abuse among Secondary School Students in Kenya (Nacada, 2016) showed that learning institutions are not drug free environments.
Among this age group, alcohol had the highest prevalence at 3.8 per cent, prescription drugs recording 3.6 per cent, miraa at 2.6 per cent, tobacco at 2.5 per cent, cannabis at 1.8 per cent and heroin and cocaine having the lowest prevalence at 0.2 per cent.
The researchers said the findings underscore an important public health issue.
“This study highlights the need for additional medical care for pregnant women with substance use,” Christine Albert, chairperson of the Department of Cardiology in the Smidt Heart Institute, said.
Albert recommended that prenatal care for women with a history of substance use should include a multidisciplinary cardio-obstetrics approach with high-risk pregnancy specialists and cardiologists to help identify and minimise adverse outcomes.
“For the wellbeing of pregnant women and their children, substance abuse needs to be considered an independent risk factor for cardiovascular events in pregnancy,” Albert said.
