Universal Screening, Assessment, and Treatment of Substance Use at Prenatal Visits Improves Obstetric Outcomes

Substance use during pregnancy remains a serious problem. This naturalistic study from Kaiser Permanente examined whether Early Start, a coordinated program of prenatal substance abuse screening, treatment, and patient/provider education, including a licensed substance-use treatment specialist onsite in the obstetric clinic, improved perinatal outcomes. Investigators compared obstetric outcomes among 2073 women treated by Early Start; 1203 women who screened positive for alcohol or drug use and were assessed by Early Start, but did not receive treatment; 156 women who screened positive but were never assessed or treated; and 46,553 women who screened negative for substance use.

• Adjusting for maternal age, ethnicity, and number of prenatal visits, women who screened positive but were not treated had more preterm deliveries (odds ratio [OR], 2.1), placental abruption (OR, 6.8), and intrauterine fetal demise (OR, 16.2) compared with women
  treated by Early Start.

Comments:

This study suggests that screening and treatment of substance-involved pregnant women during prenatal visits improves obstetric outcomes. The authors correctly note that the study design cannot eliminate the possibility that greater motivation, not the intervention, improved outcomes in the treatment group. That said, this study adds to a growing literature demonstrating that substance-involved patients are more likely to receive needed services in medical settings with routine screening, trained staff, and on-site access to a substance-use treatment specialist.

Peter D. Friedmann, MD, MPH

Reference:

Goler NC, Armstrong MA, Taillac CJ, et al. Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard. J Perinatol. 2008;28(9):597–603.