Original Article

Journal of Perinatology (2008) 28, 597–603; doi:10.1038/jp.2008.70; published online 26 June 2008

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

N C Goler1, M A Armstrong2, C J Taillac3 and V M Osejo3

  1. 1Department of Obstetrics and Gynecology, The Permanente Medical Group, Northern California Region, Vallejo, CA, USA
  2. 2Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, USA
  3. 3Kaiser Foundation Health Plan, Patient Care Services, Oakland, CA, USA

Correspondence: Dr NC Goler, Department of Obstetrics and Gynecology, The Permanente Medical Group, 1617 Broadway Street, Vallejo, CA 94590-2406, USA. E-mail: nancy.goler@kp.org

Received 7 December 2007; Revised 7 April 2008; Accepted 13 April 2008; Published online 26 June 2008.

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Abstract

Objective:

 

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.

Result:

 

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).

Conclusion:

 

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

Keywords:

prenatal substance abuse, program evaluation, prenatal care, pregnancy complications, neonatal outcomes, maternal outcomes

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