title: Development of a substance abuse program for opioid-dependent nonurban pregnant women improves outcome.
abstract: BACKGROUND
  The goal of this study was to determine whether improved access to medication assisted therapy in the general population, with improved coordination of ancillary services for pregnant women, improved perinatal outcomes in a nonurban area.
  
  
  METHODS
  The cohort of women treated for opioid dependence during pregnancy with medication-assisted therapy and delivered at a single institution between 2000 and 2006 were retrospectively identified (n = 149 women; n = 151 neonates). Access to opioid agonist therapy for the general population was determined as the combined number of available treatment positions for medication-assisted therapy. Treatment during pregnancy (interim substitution therapy vs opioid treatment program) and pregnancy outcomes were noted from chart review. The primary outcome of trend of prenatal care indices and newborn birth weight over time was determined by Kendall's tau.
  
  
  RESULTS
  As access to treatment in the general population expanded from 2000 to 2006, the number of women receiving treatment increased, the proportion of women receiving interim substitution therapy decreased (P < 0.001), gestational age at the initiation of treatment decreased (P < 0.001), and the proportion of women receiving treatment before pregnancy increased (P < 0.001). Infants delivered to mothers in a treatment program had improved birth weight z score compared with those receiving interim substitution therapy (P = 0.007). The proportion of infants discharged to the care of the mother and remaining in maternal care at 1 year improved both over time (P = 0.03; P = 0.004) and with treatment within a treatment program (P < 0.001; P = 0.004).
  
  
  CONCLUSIONS
  Improved access to opioid agonist treatment programs for the general population in nonurban areas improves perinatal outcome and retention of maternal guardianship.
authors.affiliation: Department of Obstetrics and Gynecology, University of Vermont, Burlington, USA. marjorie.meyer@uvm.edu
authors.forename: Marjorie
authors.initials: M
authors.lastname: Meyer
authors.forename: Anna
authors.initials: A
authors.lastname: Benvenuto
authors.forename: Diantha
authors.initials: D
authors.lastname: Howard
authors.forename: Anne
authors.initials: A
authors.lastname: Johnston
authors.forename: Dawn
authors.initials: D
authors.lastname: Plante
authors.forename: Jerilyn
authors.initials: J
authors.lastname: Metayer
authors.forename: Todd
authors.initials: T
authors.lastname: Mandell
mesh_terms: D002047:Buprenorphine / Q000009:adverse effects* / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000534:rehabilitation*; D011446:Prospective Studies; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D016896:Treatment Outcome; D014707:Vermont
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone