Crystal abuse even during pregnancy

Methamphetamine (MA), also known as crystal meth, is the world's most widely-used illegal drug amongst amphetamine-type stimulants. In 2015, a total of 132 tonnes were seized worldwide.  Europe’s illegal production is concentrated in the Czech Republic and the Baltic States. Due to the Free State of Saxony’s proximity to the Czech Republic, bordering regions have simplified access to MA. Doctors and researchers have been observing a growing rate of methamphetamine consumption here for years. However, studies on the risks of MA consumption for pregnancy and childbirth have not yet been carried out in German-speaking countries.

Scientists from TU Dresden's Institute of Forensic Medicine at the Carl Gustav Carus Faculty of Medicine as well as at the Clinic and Outpatient Clinic for Gynaecology and Obstetrics at the University Hospital Dresden have therefore examined the treatment files of all pregnancies and births with documented MA consumption between 2010 and 2015. It was possible to evaluate the records of 115 female MA users, who had a total of 119 pregnancies with 113 births. In health exams, 88 women admitted to using MA, 28 women denied it, and in three cases there was no information on file. In 113 cases, an immunochemical drug test for MA was performed with the patient’s consent. The test was positive in 93 cases. The data from the annual quality assurance report on obstetrics in 2015 served as the control group.

"The data showed that methamphetamine users were significantly younger when they became pregnant, that they often lived without a steady partner, that they rarely had a job and that they usually had few occupational qualifications," summarises Dr. Uwe Schmidt, lead author of the study. "The initial confirmation of pregnancy occurs later, the number of screenings including ultrasounds is lower compared to the reference group," emphasises Dr. Katharina Nitzsche, the co-author of the study. "Seven women did not take part in any health screenings at all."

Premature contractions, a weakness of the cervix with the risk of premature dilation as well as gestational diabetes were much more frequent. During pregnancy, MA users were significantly more likely to experience premature onset of labour. At 3.5%, the mortality rate of unborn infants was far above that of the reference group (0.35%).

The State Criminal Police Office of Saxony also reported a sharp increase in the percentage of MA-associated crime in drug-related crime from 18.3% in 2005 to over 37% in 2016. For more than ten years, there has been a continuous increase in the number of in-patient treatments in Saxony as a result of stimulant abuse (F15 diagnosis according to ICD-10). In 2015, 1693 patients were treated and over 90% were MA-dependent. For the first time, a decrease to 1173 patients could be observed in 2016, but the proportion of MA-associated in-patient treatments (individual diagnosis of illegal drug abuse) was still over 90%. Approximately one third of these patients were female and predominantly of childbearing age. In Saxon addiction counselling centres, the proportion of clients receiving crystal meth-related counselling is nearly 24%, well above the national average of 6.9%.

Female MA users are also more sexually active. This increases the risk of unwanted pregnancy and of contracting a sexually transmitted disease. Despite pregnancy, MA is often still consumed, subjecting the embryo or foetus to prenatal methamphetamine exposure (PME). Exact data on MA consumption during pregnancy is not available for Germany. However, analysis of data from the central registry of treated newborns provides an estimate. In Saxony, the number of treated infants with neonatal withdrawal syndrome remained relatively stable until 2012, at 2 to 3 cases per 1000 newborns. This figure is consistent with the German average. In recent years, however, there has been a significant increase in neonatal withdrawal syndrome due to PME, rising to more than 5 cases per 1000 newborns in Saxony. The true number is likely to be even higher.

It is not possible to attribute the complications observed in the mother and child solely to MA use because other addictive substances are frequently consumed concurrently. Nevertheless, the results of the present study are in line with the scientific literature and represent an important supplement to the available data. Early intervention by integrating pregnant women into multi-professional support systems such as the Dresden Crystal Path for better health screenings provides an opportunity for pregnant women and mothers to access addiction counselling and therapy and to ensure the wellbeing of the child by fostering maternal expertise.

Publication details:
Schmidt, Uwe; Capek, Claudia; Birdir, Cahit; Erfurt, Christine; Nitzsche, Katharina: „Crystal“ und Schwangerschaft – erste Ergebnisse einer retrospektiven Studie zum Schwangerschafts- und Geburtsverlauf Methamphetamin-konsumierender Frauen in Sachsen; in: Zeitschrift für Geburtshilfe und Neonatologie; DOI 10.1055/a-0831-3642
https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-0831-3642

Media enquiries:
Dr. med. Uwe Schmidt
Director of the department of forensic medicine
Carl Gustav Carus Faculty of Medicine
Institute of Forensic Medicine
Tel.: 0351 458-2782

Internet: https://tu-dresden.de/med/mf/rem

Dr. med. Katharina Nitzsche
Obstetrics, prenatal diagnostics, foetal therapy and surgery
Clinic and Outpatient Clinic for Gynaecology and Obstetrics
Carl Gustav Carus University Hospital Dresden
Tel.: 0351 458-3420

Internet: https://www.uniklinikum-dresden.de/gyn