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.

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Available from: Cosette Taillac
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    • "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). "
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    • "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. "
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    • "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. "
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