Nationwide practices for screening and reporting prenatal cocaine abuse: a survey of teaching programs.
Questionnaires surveying policies and opinions about prenatal cocaine abuse were sent to training programs nationwide. Eighty-one pediatric and 81 obstetric programs from 42 states responded. Although respondents favored routinely screening all patients by maternal history (81%) and by urine toxicology (36%), only 64% and 8%, respectively, reported these as established policy. Physicians reporting higher regional prenatal cocaine abuse rates more commonly favored universal perinatal screening (p = .009), but established policies were similar regardless of local prevalence (p = .19). Fifty-two percent of respondents were unaware of their state's requirements for reporting prenatal cocaine abuse. While most physicians favored interventions such as voluntary drug rehabilitation (64%) and family support services (64%), some physicians favored foster care placement for the infants (28%) and involuntary drug rehabilitation (31%). Only 3% felt that criminal prosecution of the mother was appropriate. Policies for managing prenatal cocaine abuse often did not reflect physicians' opinions. A multidisciplinary medical, social, and legal approach is needed to develop effective management policies.
Pelham
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Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
DeJong
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D003042:Cocaine / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008403:Mass Screening / Q000331:legislation & jurisprudence; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control; D037841:Pregnant People; D015813:Substance Abuse Detection / Q000331:legislation & jurisprudence; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
D003042:Cocaine