Substance abuse treatment linked with prenatal visits improves perinatal outcomes: A new standard

Department of Obstetrics and Gynecology, The Permanente Medical Group, Northern California Region, Vallejo, CA 94590-2406, USA.
Journal of perinatology: official journal of the California Perinatal Association (Impact Factor: 2.07). 03/2009; 29(2):181. DOI: 10.1038/jp.2008.142
Source: PubMed


To evaluate the impact of Early Start, an obstetric clinic-based prenatal substance abuse treatment program, on perinatal outcomes.

Study design:
Subjects were 49 985 women who completed Prenatal Substance Abuse Screening Questionnaires at obstetric clinics between 1 January 1999 and 30 June 2003, had urine toxicology screening tests and either live births or intrauterine fetal demises (IUFDs). Four groups were compared: women screened/assessed positive and treated by Early Start ('SAT', n=2073); women screened/assessed positive without treatment ('SA', n=1203); women screened positive only ('S', n=156); controls who screened negative (n=46,553). Ten neonatal and maternal outcomes were studied.

SAT women had either similar or slightly higher rates than the control women on most outcomes but significantly lower rates than S women. SA women generally had intermediate rates to the SAT and S groups. In multivariate analysis, the S group had significantly worse outcomes than the SAT group: preterm delivery (odds ratio (OR)=2.1, 1.3 to 3.2), placental abruption (OR=6.8, 3.0 to 15.5) and IUFD (OR=16.2, 6.0 to 43.8).

Substance abuse treatment integrated with prenatal visits was associated with a positive effect on maternal and newborn health.

Download full-text


Available from: Cosette Taillac, Oct 03, 2015
1 Follower
11 Reads
  • Source
    • "One study found that pregnant women who have high internal loci of control in the prenatal period are more likely to attend childbirth classes and to decrease cigarette, caffeine, and illegal drug use (Goodman et al., 2004; Schempf and Strobino, 2009). Because such factors contribute to the health of the infant, a high locus of internal control in the prenatal period may help to produce a better birth outcome and, therefore, higher birth satisfaction levels (Goler et al., 2008; Schempf and Strobino, 2009). Increased prenatal control in the form of childbirth preparation has also been shown to teach the mother techniques to maintain control in the delivery room and to develop healthy expectations for the birth experience (Goodman et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper explores the relationship between perceptions of prenatal control, expectations for childbirth, and experienced control in labour and birth and how they individually and collectively affect birth satisfaction. A repeated measures exploratory study was conducted with 31 primiparous women between 26 and 40 weeks pregnant. Standardised interviews were conducted prior to birth to assess levels of prenatal control and expectations for control during childbirth. Six weeks after the birth, women were interviewed again to assess experiences of control and birth satisfaction. Prenatal clinic, North Carolina, USA. Results show experienced control to be a significant predictor of birth satisfaction, with high levels of control correlating with high satisfaction levels. However, no correlations were found between the three aspects of control, and both prenatal control and birth expectations were found to have no significant effect on birth satisfaction. Findings also indicate that women cared for by midwives have significantly higher experienced control and birth satisfaction than women whose care was provided by obstetricians, while incidence of caesarean birth did not affect either measure. Experienced control during labour and birth is an important predictor of birth satisfaction. Health care providers should collaborate with the women they care for to use techniques that maximize the experience of control especially during labour and birth.
    Midwifery 03/2011; 28(1):39-44. DOI:10.1016/j.midw.2010.10.013 · 1.57 Impact Factor
  • Source
    • "In general, outcomes improve when pregnant substance abusing women engage in treatment services. Goler, Armstrong, Taillac, and Osejo (2008) report that pregnant drug abusing women in substance abuse treatment integrated with prenatal visits achieve significantly better clinical outcomes (e.g., lower rates of preterm delivery, placental disruption, and intrauterine fetal demise) as compared with similar women not enrolled in treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Substance abusing mothers comprise a significant proportion of caregivers in public child welfare, and achieve low reunification rates. Unfortunately little is known about treatment options intended to facilitate recovery and increase reunification. This study focuses particular attention on the relationship between specific treatment modalities (e.g., residential and outpatient), recovery from substance abuse and family reunification. Analyzing a sample of 160 mothers and their substance exposed infants, the findings clearly identify the benefits of residential treatment in terms of both treatment progress (directly) and family reunification (indirectly), but only when residential services are delivered in combination with transitional services.
    Children and Youth Services Review 02/2011; 33(2):322-329. DOI:10.1016/j.childyouth.2010.09.015 · 1.27 Impact Factor
  • Source
    • "In addition, some have suggested that public providers, who serve a higher proportion of Black women [12], are more likely to screen than private providers [6, 13]. However, while screening practices appear to vary across institutions [10, 14], it is not clear that public providers are more likely than private providers to screen [1, 15, 16]. More research is needed to better understand racial disparities in provider screening practices. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Agencies and organizations promoting universal screening for alcohol and drug use in prenatal care argue that universal screening will reduce White versus Black racial disparities in reporting to Child Protective Services (CPS) at delivery. Yet, no published research has assessed the impact of universal screening on reporting disparities or explored plausible mechanisms. This review defines two potential mechanisms: Equitable Surveillance and Effective Treatment and identifies assumptions underlying each mechanism. It reviews published literature relating to each assumption. Research relating to assumptions underlying each mechanism is primarily inconclusive or contradictory. Thus, available research does not support the claim that universal screening for alcohol and drug use in prenatal care reduces racial disparities in CPS reporting at delivery. Reducing these reporting disparities requires more than universal screening.
    Maternal and Child Health Journal 11/2010; 15(8):1127-34. DOI:10.1007/s10995-010-0720-6 · 2.24 Impact Factor
Show more