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

Substance use during pregnancy remains a serious problem. This study 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, placental abruption, and intrauterine fetal demise compared with women treated by Early Start.

Comments by Tom Delaney, MSW, MPA
Substance abuse treatment advocates have long lobbied for screening and treatment of pregnant women for drug and alcohol use. In this study, linking substance abuse treatment with comprehensive prenatal care significantly reduced placental abruption and intrauterine fetal demise. These results should encourage substance abuse counselors and policy advocates to focus on integrating substance abuse treatment with OB/GYN services not only to improve mother and child health but also to reduce the burden of untreated maternal substance abuse on families and communities.

Comments by Peter D. Friedmann, MD, MPH
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.