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

Abstract

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.

Psychiatric Disorders and Treatment in Low-Income Pregnant Women

“…However, the 7.7% prevalence estimate in this study is similar to the 8.1% reported by Ayers and Pickering for pregnant Caucasian women. 51 The 12-month prevalence of drug abuse=dependence (3.5%) is also similar to rates reported in earlier studies, 52,53 although it is higher than the 1.6% reported for pregnant or postpartum women by Vasga-Lopez and colleagues 21 in their general population sample. The rate of alcohol abuse=dependence (1.1%) was similar to other studies of young low-income nonpregnant women.…”

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

“…Of the women identified on the clinical assessment as using alcohol or illicit drugs during pregnancy, 45% were using less than 1 day per week, a level of use that would not have been elicited through other forms of screening, including urine toxicologies. 20 This is the first published validity study of the 4P's Plus. Although the sample size is relatively small, the use of a population from an urban clinic helps make the findings generalizable to other urban settings.…”

“…9,20 The instrument contains five questions that were chosen from factors identified in the previous research 9 to be most closely correlated with substance use in pregnancy. The last two questions, which had the greatest positive predictive validity, are based on alcohol or tobacco use in the month prior to pregnancy, similar to a study by Hutchins and DiPietro 21 that documented the strong relationship between maternal smoking and illicit drug use by the pregnant woman.…”

Discrete opioid gene expression impairment in the human fetal brain associated with maternal marijuana use

“…According to a recent study carried out in the US, 7% of the participating women used marijuana, and even after awareness of pregnancy, 3% continued taking the drug. 2 The major psychoactive component in cannabis, delta9-tetrahydrocannabinol (THC), can readily pass the placenta and affect the fetus. Delta9-tetrahydrocannabino exerts its function through the type one cannabinoid receptor (CB 1 ) in the brain.…”