Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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

An Erratum to this article was published on 28 January 2009

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.

Your institute does not have access to this article

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Bauer CR . Perinatal effects of prenatal drug exposure. Neonatal aspects. Clin Perinatol 1999; 26 (1): 87–106.

    CAS  Article  Google Scholar 

  2. Dattel BJ, Kandall SR . Substance abuse in pregnancy. Semin Perinatol 1990; 14 (2): 179–187.

    CAS  PubMed  Google Scholar 

  3. Finnegan LP . Maternal and neonatal effects of alcohol and drugs. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG (eds). Substance Abuse: a Comprehensive Textbook. Williams and Wilkins: Baltimore, MD, 1997, pp 513–532.

    Google Scholar 

  4. Johnson K, Greenough A, Gerada C . Maternal drug use and length of neonatal unit stay. Addiction 2003; 98 (6): 785–789.

    CAS  Article  Google Scholar 

  5. Paine LL, Garceau LM . Health behaviors during pregnancy: risks and interventions. In: McCormick MC, Siegel JE (eds). Prenatal Care. Effectiveness and Implementation. Cambridge University Press: New York, NY, 1999, pp 33–62.

    Chapter  Google Scholar 

  6. Shiono PH . Prevalence of drug-exposed infants. Future Child 1996; 6 (2): 159–163.

    CAS  Article  Google Scholar 

  7. Smeriglio VL, Wilcox HC . Prenatal drug exposure and child outcome. Past, present, future. Clin Perinatol 1999; 26 (1): 1–16.

    CAS  Article  Google Scholar 

  8. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. The National Survey on Drug Use and Health Report. Substance Use During Pregnancy: 2002 and 2003 Update 2005; Office of Applied Studies: Rockville, MD, 1–3.

  9. Office of Disease Prevention and Health Promotion. Healthy People 2010: Vol. II. Objectives for Improving Health (Part B). Department of Health and Human Services, Rockville, MD, 2001.

  10. American College of Obstetricians and Gynecologists Committee on Ethics. At-Risk Drinking and Illicit Drug Use: Ethical Issues in Obstetric and Gynecological Practice. Committee Opinion no. 294. ACOG: Washington DC, 2004 pp 1–11.

  11. American Psychiatric Association 2000. (DSM-IV-TR) Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision American Psychiatric Press Inc: Washington, DC, 2000.

  12. Armstrong MA, Lieberman L, Carpenter DM, Gonzales VM, Usatin MS, Newman L et al. Early Start: an obstetric clinic-based, perinatal substance abuse intervention program. Qual Manag Health Care Winter 2001; 9 (2): 6–15.

    CAS  Article  Google Scholar 

  13. Armstrong MA, Gonzales Osejo V, Lieberman L, Carpenter DM, Pantoja PM, Escobar GJ . Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes. J Perinatol 2003; 23 (1): 3–9.

    Article  Google Scholar 

  14. Escobar GJ, Li DK, Armstrong MA, Gardner MN, Folck BF, Verdi JE et al. Neonatal sepsis workups in infants 2000 grams at birth: a population-based study. Pediatrics 2000; 106 (2 Part 1): 256–263.

    CAS  Article  Google Scholar 

  15. Selby JV . Linking automated databases for research in managed care settings. Ann Int Med 1997; 127 (8 part 2): 719–724.

    CAS  Article  Google Scholar 

  16. Escobar GJ, Fischer A, Kremers R, Usatin MS, Macedo AM, Gardner MN . Rapid retrieval of neonatal outcomes data: the Kaiser Permanente Neonatal Minimum Data Set. Qual Manag Health Care Summer 1997; 5 (4): 19–33.

    CAS  Article  Google Scholar 

  17. Escobar GJ . The neonatal ‘sepsis work-up’: personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization. Pediatrics 1999; 103 (1 Supplement E): 360–373.

    CAS  PubMed  Google Scholar 

  18. Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM . Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynecol 2005; 192 (1): 191–198.

    Article  Google Scholar 

  19. MacDorman MF, Hoyert DL, Martin JA, Munson ML, Hamilton BE . Fetal and perinatal mortality, United States, 2003. Hyattsville MD. National Vital Statistics Reports. National Center for Health Statistics 2007; 55 (6): 1–18.

    Google Scholar 

Download references

Acknowledgements

This project was supported by a grant from the Direct Community Benefit Investment Fund of the Kaiser Foundation Research Institute, Oakland, CA.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N C Goler.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Goler, N., Armstrong, M., Taillac, C. et al. Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard. J Perinatol 28, 597–603 (2008). https://doi.org/10.1038/jp.2008.70

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2008.70

Keywords

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

Further reading

Search

Quick links