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Alcohol Treatment Research: Pregnant substance users can deliver healthy babies with early treatment

Pregnant women who receive treatment for substance abuse early in their pregnancy can achieve the same health outcomes as pregnant women with no substance abuse, according to a study published online in the Journal of Perinatology.

The study, which is the largest to date, examined 49,985 women in Kaiser Permanente's prenatal care programme and found that integrating substance abuse screening and treatment into routine prenatal care helped pregnant women achieve similar health outcomes as women who were not using cigarettes, alcohol or other drugs. This is also the largest study to examine multiple substances: cigarettes, alcohol, marijuana, methamphetamines, cocaine and heroin.

"This programme can happen everywhere and should become the gold standard for women who are pregnant and using cigarettes, alcohol or other drugs," said study lead author Nancy C. Goler, MD, an OB/GYN and Kaiser Permanente regional medical director of the Early Start Programme for the organisation's Northern California operations. "The study's big finding was that study participants treated in the Early Start programme had outcomes similar to our control group, women who had no evidence of substance abuse."

The study compared 2,073 pregnant women who were screened, assessed and received ongoing intervention during pregnancy through the Early Start programme at 21 Kaiser Permanente Northern California outpatient obstetric clinics from 1999 to 2003 to women in three other groups: 156 women who were screened but did not accept assessment or treatment; 1,203 women were screened, assessed and received brief intervention only; and a control group of 46,553 women who showed no evidence of substance abuse.

The study found the risk of stillborn, placental abruption (when the placental lining separates from the mother's uterus), pre-term delivery, low birth weight and neonatal ventilation were dramatically higher for the 156 untreated substance abusers than the 2,073 women in the Early Start programme.

The women who went through the Early Start programme had the same statistical risks of stillborn, preterm delivery, placental abruption as the control group of women who did not use any cigarettes, alcohol or drugs during their pregnancy.

"The key message here to women who are currently smoking, drinking or using other drugs, or who recently tried to stop, is that it is not too late to seek help when you find out you are pregnant," said Dr. Goler. "The sooner women ask for help, the better the health outcomes will be for themselves, and their babies. My message to all pregnant women, as well as women who are trying to conceive, is to stop all alcohol, cigarette and drug use."

N C Goler, M A Armstrong, C J Taillac and V M Osejo Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard', Journal of Perinatology, advance online publication 26 June 2008; doi: 10.1038/jp.2008.70

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