Cocaine and tobacco use and the risk of spontaneous abortion

N Engl J Med. 1999 Feb 4;340(5):333-9. doi: 10.1056/NEJM199902043400501.


Background: Cigarette smoking and cocaine use may be risk factors for spontaneous abortion, but data supporting such a link are limited.

Methods: We studied the associations between cocaine and tobacco use and spontaneous abortion among pregnant adolescents and women (age range, 14 to 40 years) who sought care at an inner-city emergency department. A total of 400 adolescents and women had spontaneous abortions either at study entry or during follow-up (which lasted until 22 weeks' gestation), and 570 adolescents and women remained pregnant past 22 weeks' gestation. Cocaine use was measured at base line by self-reports and analysis of urine and hair samples. Cigarette smoking was measured by self-reports and urine analysis.

Results: The adolescents and women in both groups were predominantly black and of lower socioeconomic status. Among those who had spontaneous abortions, 28.9 percent used cocaine on the basis of hair analysis and 34.6 percent smoked on the basis of a urine cotinine assay, as compared with 20.5 percent and 21.8 percent, respectively, of the adolescents and women who did not have spontaneous abortions. The presence of cocaine in hair samples was independently associated with an increase in the occurrence of spontaneous abortion (odds ratio, 1.4; 95 percent confidence interval, 1.0 to 2.1) after adjustment for demographic and drug-use variables. However, the use of cocaine as measured by self-reports and by urine analysis was not. The presence of cotinine in urine was also independently associated with an increased risk of spontaneous abortion (odds ratio, 1.8; 95 percent confidence interval, 1.3 to 2.6). Twenty-four percent of the risk of spontaneous abortion could be related to cocaine or tobacco use.

Conclusions: Cocaine and tobacco use were common in our study population and were associated with a significant risk of spontaneous abortion.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Abortion, Spontaneous / chemically induced*
  • Abortion, Spontaneous / epidemiology
  • Adolescent
  • Adult
  • Case-Control Studies
  • Cocaine / adverse effects*
  • Cocaine / analysis
  • Cocaine / urine
  • Confounding Factors, Epidemiologic
  • Cotinine / urine
  • Female
  • Hair / chemistry
  • Humans
  • Multivariate Analysis
  • Pregnancy
  • Risk Factors
  • Smoking / adverse effects*
  • Substance Abuse Detection


  • Cocaine
  • Cotinine