Maternal Periconceptional Illicit Drug Use and the Risk of Congenital Malformations

van Gelder, Marleen M. H. J.a,b; Reefhuis, Jennitaa; Caton, Alissa R.c; Werler, Martha M.d; Druschel, Charlotte M.c; Roeleveld, Nelb; the National Birth Defects Prevention Study

doi: 10.1097/EDE.0b013e31818e5930
Early Development: Original Article

Background: In 2004, the Survey on Drug Use and Health showed that 5% of American women reported use of an illicit drug during pregnancy. The results of studies determining the association between periconceptional illicit drug use and birth defects have been inconsistent.

Methods: We analyzed data from the National Birth Defects Prevention Study, a case-control study of major birth defects, and assessed all birth defects categories in which there were at least 250 interviewed case mothers. We included 10,241 infants with major congenital malformations (case infants) and 4,967 infants without major congenital malformations (control infants) born between 1997 and 2003 for whom there was a completed maternal interview with detailed information on prenatal illicit drug use and potential confounders. We used multivariable logistic regression to estimate the associations between cannabis, cocaine, and stimulant use in the month before pregnancy or during the first trimester (periconceptional period) and the occurrence of selected birth defects.

Results: In the periconceptional period, 5% of the 15,208 mothers reported any use of illicit drugs. We did not find associations between illicit drug use and most of the 20 eligible categories of congenital malformations. Periconceptional cannabis use seemed to be associated with an increased risk of anencephaly (adjusted odds ratio = 1.7; 95% confidence interval = 0.9–3.4), whereas cocaine use in the periconceptional period was associated with the risk of cleft palate (2.5; 1.1–5.4).

Conclusions: There were very few suggestions of positive associations between periconceptional illicit drug use and the 20 birth defects categories.

From the aNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; bDepartment of Epidemiology, Biostatistics, and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; cCongenital Malformations Registry, Center for Environmental Health, New York State Department of Health, Troy, NY; dSlone Epidemiology Center at Boston University, Boston, MA.

Submitted 12 October 2007; accepted 22 April 2008; posted 2 December 2008.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Correspondence: Jennita Reefhuis, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Mail-Stop E-86, 1600 Clifton Road, Atlanta, GA 30333. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.