Drug use by women of child-bearing age has become a topic of growing concern for health policymakers and health service providers during the 1980s [1]. Among the many reasons for this is that new drug use occurs at a rate for females that is twice that of males [2]. In addition to the behavioral health implications of drug abuse by a woman who is a prospective mother, the teratological effects of some psychoactive substances, particularly alcohol [3-5], crack cocaine [6-8], PCP [9, 10], and opiates [11, 12], are known to contribute to both morphological and behavioral complications in infants born to drug-abusing women.

An Office of Substance Abuse Prevention (OSAP) demonstration project, the Pregnant Adolescent Substance Abuse Project (PASAP), was initiated in early 1988 for the purpose of identifying, educating, and referring for counseling or treatment all pregnant maternal health clinic attendees under 21 years determined to be occasional or current users of psychoactive substances. The subject pool was drawn from among the majority of the 16 Maternal Health Clinics in Prince George’s County, Maryland.

Prince George’s County, Maryland, forms the eastern border of Washington, D.C., and contains elements of urban, suburban, and rural life. In the County there has been a growing proportion of infants identified as “at risk” due to maternal drug abuse. In 1986, 16% of all high risk newborn infants were so designated because of maternal drug abuse. By 1989 that figure had risen steadily to 46% (annualized N = 522 of 1,142). This represents a threefold increase in drug-related infant outcome problems identified in just 4 years. The PASAP research demonstration project was initiated to specifically reduce the number of pregnant adolescents using drugs, and in so doing decrease the number of drug-compromised infants. (*)

While the PASAP has had among its objectives a county-wide risk-reduction/prevention program and the education of area health care providers about drug use during pregnancy, the following results focus on a description of the maternal health sample characteristics.

METHODS

The PASAP progrma sampled new walk-in patients at 11 Prince George’s County Maternal Health Clinics. Young women under age 21 and pregnant were asked to participate in a confidential interview. There were four different interviewers.

The interview process proceeded to establish initial rapport through an informal discussion that addressed pregnancy, childbirth planning, and immediate needs of the young woman. The discussion was derivative of a standard intake questionnaire that the interviewee had completed. Personal and demographic information preceded questions concerning the use of legal substances (tobacco and alcohol) in the home and social support environment. These questions preceded more specific probing about the personal use of drugs, drug accessibility, and drug interest.

From the interview and the questionnaire responses, a profile of risk was determined based on the considerations noted below.

Risk Assessments

The assignment to a risk category was not strictly operational, but among the determining factors were the drug use that may have been occurring in the immediate environment of the pregnant adolescent, such as by friends and family, the stability of her circumstances, support structures, her past experience with drugs, her inclination toward further use, etc. In general, the following definitions apply.

Not at risk assumes an avowed disinterest in drug use of any kind including tobacco and having no close friends or members of the family involved in substance use.

At some risk assumes either soem noncontinuing past personal use of substances or use by a friend or family member.

At high risk is designated for those who smoke cigarettes and/or report only infrequent use of other psychoactive substances, those who stopped using upon learning they were pregnant, or who may be living with or be friends with a known drug abuser having a significant emotional connection to the patient.

Abuser is one who continues to report at least occasional use of illicit substances during her pregnancy. This low use criterion for “abuser” is regarded as appropriate for a pregnant woman. This is justified both on the basis of infant risk and historical underreporting about drug use.

On the basis of the risk assignment at the time of the interview, the young woman was referred to one of four optional interventions described below.

A retrospective reexamination of the factors correlated with risk group assignment was done at the completion of the data collection phase to categorically identify criteria associated with the composite interviewer judgment of risk.

Interventions

All pregnant patients interviewed by PASAP received education concerning the effects of alcohol, drugs, and cigarettes upon the unborn child and upon their own ability to function as a parent. Those judged to be at risk were offered counseling and/or encouraged to attend peer group sessions that explored issues of pregnancy, health, and substance use. Identified substance abusers were referred to various remediation services operating under the Prince George’s (PG) County Health Department, Directorate of Addictions.