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APHA Scientific Session and Event Listing

MaryAnne Armstrong, MA¹, Nancy Goler, MD², Cosette Taillac, LCSW³, and Veronica Osejo, BS³. (1) Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612-2304, 510-891-3501, maryanne.armstrong@kp.org, (2) Obstetrics and Gynecology, Kaiser Permanente, 39400 Paseo Padre Parkway, Fremont, CA 94538, (3) Patient Care Services, Kaiser Permanente, 1800 Harrison Street, Oakland, CA 94612

Substance abuse during pregnancy is a significant problem in the United States, with adverse maternal, fetal, and neonatal effects. We evaluated the impact of an obstetric clinic-based perinatal substance abuse treatment program (Early Start) in a MCO on neonatal and maternal outcomes. Study subjects were 57,010 female Kaiser Permanente members who completed Early Start Prenatal Substance Abuse Screening Questionnaires between 01/01/99 and 06/30/03, had urine toxicology screening tests, and had either a live birth or an intra-uterine fetal demise. Four groups were compared on neonatal and maternal outcomes: (1) substance abusers screened, assessed, and treated by Early Start (“SAT”, n=2277); (2) substance abusers screened and assessed by Early Start who had no follow-up treatment (“SA”, n=1307); (3) substance abusers who were only screened (“S”, n=173); and (4) controls who screened negative (n=53,253). Neonatal outcomes studied included assisted ventilation, low birthweight (<2500gm), preterm delivery (<37wks), intensive care nursery admission, and rehospitalization within 2 weeks of discharge. Maternal outcomes studied included intrauterine fetal demise, placental abruption, pre-term labor, and stillbirth. SAT women had statistically significantly lower rates than S women on all of the above outcomes. For example, SAT pre-term delivery rate was 8.3% vs S rate of 16.8% (p=0.0002); SAT placental abruption rate = 1.0% vs S rate of 6.0% (p=0.0001). This pattern persisted in multivariate analyses controlled for maternal age, ethnicity, and amount of prenatal care. We conclude that substance abuse treatment for pregnant women which is integrated with prenatal care has a beneficial effect on newborns and their mothers.

Learning Objectives:

• At the conclusion of this presentation, the participant will have learned about the effect of an innovative perinatal substance abuse treatment program on neonatal and maternal outcomes and will be able to assess the applicability of this treatment model to their patient population.

Keywords: Substance Abuse Treatment, Pregnancy Outcomes

Presenting author's disclosure statement:

Not Answered