Maternal and fetal complications associated with stimulant abuse during pregnancy are substantial and reported to be similar for cocaine and amphetamines. Researchers from the Centers for Disease Control and Prevention queried the Healthcare Cost and Utilization Project National Inpatient Sample to determine trends in cocaine and amphetamine-related hospitalizations, and complications during these hospitalizations, among pregnant women between 1998 and 2004. During the study period,

• The annual cocaine-related hospitalization rate decreased from 0.74 per 100 deliveries to 0.41, while the amphetamine-related rate increased from 0.11 to 0.22.
• 82% of the amphetamine-related hospitalizations were in Western states.
• The proportion of women younger than 24 years was higher in the amphetamine group than in the cocaine group.
• Amphetamine-related hospitalizations were more common than cocaine-related hospitalizations among rural hospitals.
• Psychiatric disorders, poor fetal growth, and premature delivery were more common in the cocaine group compared with the amphetamine group; while cardiovascular disorders, hypertension complicating pregnancy, and placenta previa were more common in the amphetamine group.
• No significant differences between cocaine and amphetamine groups were detected for anemia, genitourinary infections, hepatitis, seizure disorder, injury, placental abruption, or premature labor.
• Psychiatric disorders, anemia, genitourinary tract infections, hepatitis, epilepsy, cardiovascular disorders, injury, hypertension complicating pregnancy, premature rupture of membranes, placenta previa, placental abruption, infection of amniotic cavity, intrauterine death, and poor fetal growth were all more common among the amphetamine group compared with the non-substance abuse group. 

Comments by Tommie Ann Bower, MA
This study carefully teases out the impact of amphetamine versus cocaine use in pregnant women and highlights the urgent need to improve prenatal screening and intervention. Over the years, sound bites about an epidemic have all but stopped. The authors rightly conclude that "clinicians who serve reproductive-age women have an ethical obligation to provide complete and comprehensive medical care . . . universal screening, brief interventions, and referral." An "epidemic" of one infant lost to the consequences of cocaine and amphetamine use is one too many for clinicians not to broach the subjects of treatment and prenatal care.