Improving pregnancy outcomes among high-risk mothers who abuse alcohol and drugs: Factors associated with subsequent exposed births

Maternal substance abuse during pregnancy is a serious problem that incurs risk for mother and child. One consequence is disrupted parenting and child foster care placement. Women with addiction disorders have typically experienced social injustices that increase risk for disrupted parenting, including childhood physical/sexual abuse, adult violence, poverty, unstable housing, and lack of social support. The intergenerational cycle of familial dysfunction and loss is characterized by a refrain commonly heard: “I'm going to keep having babies until they let me keep one.” We present data from the Parent-Child Assistance Program (PCAP), a 3-year intervention for high-risk mothers who abused alcohol and/or drugs during an index pregnancy. PCAP aims to improve future pregnancy outcomes by helping mothers prevent subsequent exposed births (SEB), either by becoming clean and sober and staying in recovery, or by using effective family planning. PCAP, operating at multiple U.S. sites, is based on relational theory and harm reduction; case managers guide and support participants in resolving complex problems associated with substance abuse. Among 458 PCAP participants, 14% had a SEB during the intervention. We used logistic regression (backward elimination, based upon likelihood ratio tests) to examine candidate predictors for having a SEB. Significant risk factors included mother losing custody of (“not keeping”) index child (OR= 2.28, CI = 1.31-3.98); and cocaine use during index pregnancy (OR = 1.84; CI=1.002-3.388). Protective factors were older age (OR= .92, CI= .87-.97); and being separated, divorced, widowed (OR= .28, CI=.09-.82). We discuss implications for maternal child welfare policies and practices.