Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard

Objective: To evaluate the impact of Early Start, an obstetric clinic-based prenatal substance abuse treatment program, on perinatal outcomes. Study Design: Subjects were 49 985 women who completed Prenatal Substance Abuse Screening Questionnaires at obstetric clinics between 1 January 1999 and 30 June 2003, had urine toxicology screening tests and either live births or intrauterine fetal demises (IUFDs). Four groups were compared: women screened/ assessed positive and treated by Early Start ('SAT', n=2073); women screened/ assessed positive without treatment ('SA', n=1203); women screened positive only ('S', n=156); controls who screened negative (n=46 553). Ten neonatal and maternal outcomes were studied. Result: SAT women had either similar or slightly higher rates than the control women on most outcomes but significantly lower rates than S women. SA women generally had intermediate rates to the SAT and S groups. In multivariate analysis, the S group had significantly worse outcomes than the SAT group: preterm delivery (odds ratio (OR) = 2.1, 1.3 to 3.2), placental abruption (OR = 6.8, 3.0 to 15.5) and IUFD (OR = 16.2, 6.0 to 43.8). Conclusion: Substance abuse treatment integrated with prenatal visits was associated with a positive effect on maternal and newborn health.