Substance abuse care in pregnancy helps mom, baby

Infants born to women with substance abuse problems will fare better if their mothers undergo treatment for these problems early in pregnancy, according to the largest study to date to investigate this issue.

In fact, they did just as well as babies born to mothers who didn't have issues with drug or alcohol use on nearly all of the measures the researchers looked at, Dr. Nancy C. Goler of The Permanente Medical Group in Vallejo, California, and her colleagues found.

"It is time for our nation to look at the issue of substance abuse in pregnancy with a non-judgmental, coordinated, effective intervention that all pregnant women can easily access," they write in the Journal of Perinatology. Such treatment should become the "national standard," Goler and her team urge.

Kaiser Permanente Northern California (KPNC) screens pregnant members for substance abuse with questionnaires and urine tests and offers "state of the art" treatment through its Early Start program, the researchers explain in their report. Women identified as having problems receive care from a specialist in both prenatal care and substance abuse treatment who is based at her local Woman's Health Clinic.

To evaluate the program's effectiveness, the researchers looked at outcomes for 49,985 women who underwent screening at KPNC clinics from January 1, 1999 to June 1, 2003. They compared four groups: the 46,553 women who screened negative for substance abuse problems (control group); 2,073 who screened positive and underwent treatment; 1,203 with substance abuse problems who were assessed as part of the Early Start program but weren't treated; and 156 who tested positive for substance abuse but weren't assessed or treated.

Most women in each of the four groups received the same amount of prenatal care, but the control and treatment groups were more likely to begin prenatal care before 13 weeks of pregnancy than women in the other two groups.

The rates of 8 of the 10 maternal or fetal complications the researchers evaluated were similar for the control group and the group of women who received treatment. However, infants born to treated women were slightly more likely to be low birth weight or to require admission to the newborn intensive care unit.

Infants born to women treated for substance abuse were less likely to require assistance in breathing shortly after birth than babies born to women with substance abuse issues who weren't assessed or treated, Goler and her colleagues found. And fewer of these infants were preterm or low birth weight.

Rates of these and other complications for babies born to mothers who were assessed but not treated for substance abuse were generally between those of the treated women and those who weren't assessed or treated.

Substance-abusing women who weren't assessed or treated were significantly more likely than any other women in the study to develop a serious pregnancy complication called placental abruption. Their risk was nearly seven times as great as that for women in the control group. The fetuses of these women also were 16 times more likely to die in utero compared to the control group, while rates of fetal death for women who were assessed or assessed and treated weren't significantly different from the control group.