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 Kaiser Permanente 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 program 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 program 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, M.D., an OB/GYN and Kaiser Permanente regional medical director of the Early Start Program for the organization's Northern California operations. "The study's big finding was that study participants treated in the Early Start program 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 program 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 program:
- Risk of stillbirth was 16.2 times higher for women who were screened but did not accept assessment or treatment than those who received Early Start treatment
- Risk of placental abruption was 6.8 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
- Risk of pre-term delivery was 2.1 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
- Risk of low birth weight (under 5.5 pounds) was 1.8 times higher for women who were screened but did not accept assessment or treatment than those who received treatment
- Risk of neonatal ventilation was 2.2 times higher for women who were screened but did not accept assessment or treatment than those who received treatment.
The women who went through the Early Start program 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.