Original Article
Journal of Perinatology (2005) 25, 368–374. doi:10.1038/sj.jp.7211266 Published online 10 February 2005
The 4P's Plus© Screen for Substance Use in Pregnancy: Clinical Application and Outcomes
Supported in part by grants to: Children's Research Triangle from Maternal Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services Number 1H51MC00013; San Luis Obispo County Public Health Department, Family Health Services Division from First 5 San Luis Obispo, San Luis Obispo, CA, USA; and Southern Illinois Healthcare Foundation Healthy Start from Maternal Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services Numbers 5H49MC00049-03 and 5H75MC00010-030
Ira J Chasnoff MD1, Richard F McGourty PhD1, Gregory W Bailey PhD1, Ellen Hutchins ScD2, Saundra O Lightfoot MPH3, Leslie Lynn Pawson MD4, Cynthia Fahey RN, PHN5, Barbara May RN, MPH6, Paula Brodie MSHPE7, Larry McCulley MS7 and Jan Campbell RN, PHN8
- 1Children's Research Triangle (I.J.C., R.F.McG., G.W.B.) Chicago, IL, USA
- 2Maternal Child Health Bureau (E.H.), Health Resources and Services Administration, US Department of Health and Human Services, Washington, DC, USA
- 3University of Chicago Comer Children's Hospital (S.O.L.), Chicago, IL, USA
- 4Ventura County Medical Center (L.L.P.), Ventura, CA, USA
- 5Ventura County Public Health (C.F.), Ventura, CA, USA
- 6Southern New Jersey Perinatal Coalition (B.M.), Camden, NJ, USA
- 7Southern Illinois Healthcare Foundation (P.B., L.McC.), East St. Louis, IL, USA
- 8San Luis Obispo County Public Health Department (J.C.), Family Health Services Division, San Luis Obispo, CA, USA
Correspondence: Ira J. Ira J. Chasnoff, MD, Children's Research Triangle, 180 North Michigan Avenue, Suite 700, Chicago, IL 60601, USA
Abstract
OBJECTIVE:
Determine the prevalence of substance use among pregnant women in five diverse communities utilizing the 4P's Plus© screen for alcohol, tobacco, and other drug use.
STUDY DESIGN:
Pregnant women enrolled in prenatal care clinics in five communities were screened for substance use with the 4P's Plus©. Those women with a positive screen underwent an assessment for substance use through a follow-up structured clinical interview conducted at the same prenatal visit.
RESULTS:
Among 7818 women in five communities, 2555 (32.7%) had a positive screen for substance use in pregnancy. Four of the communities conducted a follow-up assessment on all women with a positive screen (n=1548). Among these women, 717 (15% of the total population) had continued use after learning of the pregnancy. Overall, 21% of the pregnant women used alcohol prior to recognition of the pregnancy, and 11% continued use after knowledge of the pregnancy. Among the 512 women who continued to use alcohol, 2% were drinking daily, 7% were drinking 3 to 6 days per week, 27% were drinking 1 to 2 days per week, and 63% were drinking less than 1 day per week. The rates of marijuana use and other illicit drug use among the women were 7 and 2%, respectively, prior to knowledge of pregnancy and dropped to 3 and 1% after learning of the pregnancy.
CONCLUSION:
The 4P's Plus© identifies not only those pregnant women whose drinking or drug use is at a high enough level to impair daily functioning, but provides an opportunity for early intervention for the much larger group of women whose pregnancies are at risk from relatively small amounts of substance use.
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