Background: To evaluate the efficacy of a specific counseling and withdrawal program for drug-abusing pregnant women and its effect on perinatal outcome.
Design and setting: An analysis of 120 pregnancies followed in 111 drug-abusing women giving birth at the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, in 1985-95.
Methods: Personnel responsible for local maternity care in the Helsinki area were trained to identify pregnant drug-abusers and to refer them to our hospital for clinical antenatal care and counseling with psychological and social support. Substance abuse during pregnancy was monitored by self-report and serial urine screenings. Obstetric and perinatal outcome were compared 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-test.
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 reducing drug abuse. Among this group, incidence of preterm birth (4.1%) was smaller (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, the 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 continued drug abuse (65.2% and 47.8%, respectively).
Conclusions: Carefully monitored counseling program for pregnant drug abusers is effective in reducing the amount of drugs used and improves perinatal outcome.