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 = 0.0). 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.