Prenatal care and counseling of female drug-abusers: effects on drug abuseand perinatal outcome

Background. To evaluate the efficacy of a specific counseling and withdrawa l program for drug-abusing pregnant women and its effect on perinatal outco me. Design and setting. An analysis of 120 pregnancies-followed in 111 drug-abu sing women giving birth at the Department of Obstetrics and Gynecology, Hel sinki University Central Hospital, in 1985-95. Methods. personnel responsible for local maternity care in the Helsinki are a were trained to identify pregnant drug-abusers and to refer them to our h ospital for clinical antenatal carl and counseling with psychological and s ocial support. Substance abuse during pregnancy was monitored by self-repor t and serial urine screenings. Obstetric and perinatal outcome were compare d between those who succeeded in quitting totally or reducing drug use, and those who continued their drug use throughout pregnancy. The significance of the differences was tested by Student's unpaired t-test and binomial t-t est. Results. Of the women, 62% registered before the 20th week of pregnancy and 32% during the 20th-29th week of pregnancy (mean 18.4+/-6.6 weeks). Twelve women were admitted to an obstetric ward for withdrawal. In 73 of the 120 (61%) pregnancies the woman succeeded either in quitting totally or reducin g drug abuse. Among this group, incidence of preterm birth (4.1%) was small er (p<0.001), and gestational age (39.8+/-2.2 weeks) and birth weight (3393 +/-605 gr) higher (p<0.05) than those (19.6%, 38.3+/-3.4 wk and 3049+/-728 gr, respectively) in the group continuing their drug abuse. Additionally, t he percentage of normal delivery (80.8%) was higher (p<0.05), and incidence of withdrawal symptoms (19.2%), lower (p<0.001) than for those who continu ed drug abuse (65.2% and 47.8%, respectively). Conclusions. Carefully monitored counseling program for pregnant drug abuse rs is effective in reducing the amount of drugs used and improves perinatal outcome.