Vice Director Kunming Prevention and Control Center of Taipei City Hospital, Taipei
Background & Introduction: Central nervous system stimulants, including methamphetamines and cocaine, are well established risk factors for intracranial hemorrhage (ICH) in adults. Emerging evidence suggests that prenatal cocaine exposure may increase cerebrovascular risks in children; however, the effects of prenatal methamphetamine exposure on ICH in neonates and infants remain poorly understood. This knowledge gap is notable given the increasing global prevalence of methamphetamine use among women of reproductive age. We aimed to investigate the association between prenatal exposure to methamphetamines, 3,4-methylenedioxymethamphetamine (MDMA), or illicit opioids and the risk of intracranial hemorrhage in neonates, infants, and mothers using nationwide population-based data from Taiwan.
Methods: We conducted a nationwide, population-based cohort study using linked administrative data from Taiwan’s National Health Insurance Research Database, Birth Notification System, Maternal and Child Health Database, and Integrated Illegal Drug Database. The cohort included 53,455 women with singleton pregnancies between 2004 and 2017, comprising 10,691 women with documented illicit drug exposure during pregnancy and 42,764 matched non-exposed controls. Exposure groups included methamphetamines, MDMA, and illicit opioids, alone or in combination. Offspring and mothers were followed for 2 to 15 years. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), adjusting for maternal age, obstetric and medical comorbidities, and socioeconomic status.
Results: Children prenatally exposed to methamphetamines had a significantly higher risk of intracranial hemorrhage compared with unexposed children (0.5% vs. 0.2%; HR = 1.68, 95% CI 1.08–2.63). This association remained significant among pregnancies with exclusive methamphetamine exposure (aHR = 1.75, 95% CI 1.01–3.04). No significant increase in pediatric ICH risk was observed with prenatal exposure to MDMA or illicit opioids alone. Stratified analyses demonstrated that the increased risk associated with methamphetamine exposure was confined to full-term infants, with no significant association observed among preterm infants. Maternal outcomes mirrored these findings: methamphetamine use during pregnancy, alone or in combination with other substances, was associated with an increased risk of maternal ICH, whereas MDMA showed no association and illicit opioids increased risk only when combined with methamphetamine exposure.
Conclusion & Discussion: This nationwide cohort study demonstrates a significant association between prenatal methamphetamine exposure and an increased risk of intracranial hemorrhage in both offspring and mothers. The elevated risk was particularly evident among full-term infants, suggesting that methamphetamine-related cerebrovascular vulnerability extends beyond mechanisms related to prematurity alone. Limitations include sample size, lack of data on dose–response relationships and precise timing or persistence of substance use during pregnancy, and inability to stratify intracranial hemorrhage subtypes. Despite these limitations, these findings highlight prenatal methamphetamine exposure as a critical and potentially preventable risk factor and emphasize the need for targeted screening, preventive interventions, and integrated perinatal addiction care.
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Disclosure(s):
Chun Lin, MD: No financial relationships to disclose
Learning Objectives:
Upon completion, participants will be able to describe the association between prenatal methamphetamine exposure and the risk of intracranial hemorrhage (ICH) in neonates, infants, and mothers.
Upon completion, participants will be able to analyze the role of preterm birth, polysubstance use, and other confounding factors in modulating the risk of ICH associated with prenatal methamphetamine exposure.
Upon completion, participants will be able to discuss clinical and public health implications of prenatal methamphetamine exposure, including screening, trauma-informed prenatal care, and access to addiction treatment.
