Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard.
OBJECTIVE
To evaluate the impact of Early Start, an obstetric clinic-based prenatal substance abuse treatment program, on perinatal outcomes.


METHODS
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.


RESULTS
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).


CONCLUSIONS
Substance abuse treatment integrated with prenatal visits was associated with a positive effect on maternal and newborn health.
Goler
N C
NC
Department of Obstetrics and Gynecology, The Permanente Medical Group, Northern California Region, Vallejo, CA 94590-2406, USA. nancy.goler@kp.org
Armstrong
M A
MA
Taillac
C J
CJ
Osejo
V M
VM
D000037:Abruptio Placentae / Q000453:epidemiology; D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012189:Retrospective Studies; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000628:therapy*; D055815:Young Adult