Perinatal Substance Abuse Intervention in Obstetric Clinics Decreases Adverse Neonatal Outcomes

Armstrong, Mary Anne; Osejo, Veronica Gonzales; Lieberman, Leslie; Carpenter, Daniel; Pantoja, Philip; Escobar, Gabriel J.

doi:10.1038/sj.jp.7210847

Cited by 85 publications

(55 citation statements)

References 33 publications

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“…12 Initial research on Early Start demonstrated that pregnant women who were screened positive, assessed and treated for substance abuse problems by Early Start had neonatal outcome rates for assisted ventilation, preterm delivery and low birth weight similar to control women, and significantly lower than substance abusers who were screened positive only or screened positive and assessed but not treated. 13 The purpose of this study, which looked over a longer time period and at maternal outcomes not included in the original study, was to provide a more comprehensive evaluation of Early Start on maternal and neonatal outcomes to support this becoming the standard of care for all prenatal clinics and establish the program as a gold standard for replication.…”

Section: Introductionmentioning

confidence: 99%

Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

et al. 2008

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Objective: To evaluate the impact of Early Start, an obstetric clinic-based prenatal substance abuse treatment program, on perinatal outcomes. Result: 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) ¼ 2.1, 1.3 to 3.2), placental abruption (OR ¼ 6.8, 3.0 to 15.5) and IUFD (OR ¼ 16.2, 6.0 to 43.8).Conclusion: Substance abuse treatment integrated with prenatal visits was associated with a positive effect on maternal and newborn health.

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Section: Introductionmentioning

confidence: 99%

Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

et al. 2008

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“…25 A study of 6774 pregnant women receiving prenatal care through Kaiser Permanente Managed Care Plan demonstrated that pregnant women, who screened positive for alcohol and other drug use and received even a single brief intervention had a reduced rate of low birth weight infants, preterm infants and infants who required ventilation. 26 Identification of the lighter drinker takes on added importance in that research into the effects of alcohol as a teratogen have revealed that even low doses of alcohol may have serious long-term consequences for children. 18,27 Over the last few years, physicians' attitudes toward intervening in their patients' drug and alcohol problems have become more positive, 28 and the American College of Obstetricians and Gynecologists recently stated that obstetricians are ethically obligated to address substance use as a part of routine prenatal care with all patients.…”

Section: Discussionmentioning

confidence: 99%

Validation of the 4P's Plus© screen for substance use in pregnancy validation of the 4P's Plus

et al. 2007

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Objective: The purpose of this study is to validate the 4P's Plus screen for substance use in pregnancy.Study Design: A total of 228 pregnant women enrolled in prenatal care underwent screening with the 4P's Plus and received a follow-up clinical assessment for substance use. Statistical analyses regarding reliability, sensitivity, specificity, and positive and negative predictive validity of the 4Ps Plus were conducted.Result: The overall reliability for the five-item measure was 0.62. Seventy-four (32.5%) of the women had a positive screen. Sensitivity and specificity were very good, at 87 and 76%, respectively. Positive predictive validity was low (36%), but negative predictive validity was quite high (97%). Of the 31 women who had a positive clinical assessment, 45% were using less than 1 day per week. Conclusion:The 4P's Plus reliably and effectively screens pregnant women for risk of substance use, including those women typically missed by other perinatal screening methodologies.

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“…27 In addition, a recent study at Kaiser Permanente Medical Care Program documented the cost savings accrued when pregnant substance using women are identified early in pregnancy and provided substance abuse interventions. 3 A highly sensitive screening instrument addresses the need to identify all women at risk. It identifies not only those pregnant women who are drinking heavily or whose drug use is at a high enough level to impair daily functioning, but also identifies those women whose pregnancies are at risk from tobacco use as well as relatively small amounts of alcohol, marijuana or other drugs.…”

Section: Significancementioning

confidence: 99%

“…A number of studies have found poor pregnancy and neonatal outcomes among women who used alcohol or illegal drugs during pregnancy, [1][2][3][4] and the long-term impact of prenatal alcohol or illicit drug exposure on the development and behavior of the exposed child [5][6][7][8] is now being documented. However, despite the concern over the consequences of prenatal exposure to alcohol and other drugs, substance use by the pregnant woman remains a frequently missed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

et al. 2005

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Determine the prevalence of substance use among pregnant women in five diverse communities utilizing the 4P's Plus r screen for alcohol, tobacco, and other drug use. STUDY DESIGN:Pregnant women enrolled in prenatal care clinics in five communities were screened for substance use with the 4P's Plus r . Those women with a positive screen underwent an assessment for substance use through a follow-up structured clinical interview conducted at the same prenatal visit. RESULTS:Among 7818 women in five communities, 2555 (32.7%) had a positive screen for substance use in pregnancy. Four of the communities conducted a follow-up assessment on all women with a positive screen (n ¼ 1548). Among these women, 717 (15% of the total population) had continued use after learning of the pregnancy. Overall, 21% of the pregnant women used alcohol prior to recognition of the pregnancy, and 11% continued use after knowledge of the pregnancy. Among the 512 women who continued to use alcohol, 2% were drinking daily, 7% were drinking 3 to 6 days per week, 27% were drinking 1 to 2 days per week, and 63% were drinking less than 1 day per week. The rates of marijuana use and other illicit drug use among the women were 7 and 2%, respectively, prior to knowledge of pregnancy and dropped to 3 and 1% after learning of the pregnancy. CONCLUSION:The 4P's Plus r identifies not only those pregnant women whose drinking or drug use is at a high enough level to impair daily functioning, but provides an opportunity for early intervention for the much larger group of women whose pregnancies are at risk from relatively small amounts of substance use.

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Perinatal Substance Abuse Intervention in Obstetric Clinics Decreases Adverse Neonatal Outcomes

Cited by 85 publications

References 33 publications

Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

Validation of the 4P's Plus© screen for substance use in pregnancy validation of the 4P's Plus

The 4P's Plus© Screen for Substance Use in Pregnancy: Clinical Application and Outcomes

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