title: Alcohol and substance abuse identified during pregnancy: maternal morbidity, child morbidity and welfare interventions.
abstract: OBJECTIVE
  To study the relations between postnatal maternal morbidity, child morbidity and welfare interventions in families with prenatal alcohol or substance abuse.
  
  
  METHODS
  A register-based longitudinal retrospective cohort study. The exposed cohort included 638 children born to 524 women followed-up during pregnancy for alcohol or substance abuse 1992-2001. Non-exposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Perinatal and follow-up data of both cohorts were collected from national registers until 2007.
  
  
  RESULTS
  Postnatal maternal abuse-related healthcare utilization and use of medication were associated with child out-of-home care. Significant differences were in particular observed in the categories of maternal mental and behavioural disorders caused by psychoactive substance use as well as injury and poisoning. Maternal inpatient care for mental and behavioural disorders peaked at the time of child out-of-home care. Maternal abuse-related healthcare utilization was associated with early child healthcare utilization and use of medication for mental and behavioural disorders. These associations were largely explained by the association with child out-of-home care.
  
  
  CONCLUSIONS
  Postnatal maternal abuse-related morbidity is associated with significant early child morbidity, use of medication and timing of out-of-home care.
authors.affiliation: Children's Hospital, University of Helsinki, Finland. taisto.sarkola@helsinki.fi
authors.forename: Taisto
authors.initials: T
authors.lastname: Sarkola
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.forename: Hanna
authors.initials: H
authors.lastname: Kahila
authors.forename: Ilona
authors.initials: I
authors.lastname: Autti-Rämö
authors.forename: Erja
authors.initials: E
authors.lastname: Halmesmäki
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D005581:Foster Home Care / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D016015:Logistic Models; D008137:Longitudinal Studies; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000401:mortality