SOCIAL, ETHICAL AND PRACTICAL ASPECTS OF PERINATAL SUBSTANCE USE

Substance use in pregnancy has garnered increasing attention over the last decade as a particularly concerning facet of the larger national drug problem. This concern stems from the unique circumstance presente d by pregnancy, in which the fetus may suffer harm as a result of mate rnal behavior Furthermore, organizing a response to this problem is co mplicated by the ethically and legally challenging nature of the mater nal-fetal relationship. The medical implications of perinatal substanc e use are profound. A discussion of these associated medical and obste trical complications lies outside the focus of this paper and the read er is referred to other reviews (Andres & Jones, 1994; Robins & Mills, 1993). This article is intended to assist obstetricians and others in their approach to the substance using pregnant patient. We first revi ew the scope of this problem in social and financial terms and then re view the important ethical and legal issues involved in current policy making. Lastly, we suggest a clinical intervention focusing on educati on and improvement in identification and management of this subset of patients. (C) 1997 Elsevier Science Inc.