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Substance use
A retrospective analysis of changing outcomes for pregnant substance users with the establishment of specialist antenatal services
  1. K. Bristow1,
  2. F. Ibrahim2,
  3. E. Gilvarry3,
  4. E. Kaner1,
  5. P. Moran4,
  6. J. Rankin1
  1. 1
    Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  2. 2
    North Shields Community Mental Health Team, Northumberland, Tyne and Wear NHS Trust, Tyne and Wear, UK
  3. 3
    Alcohol & Drug Service, Plummer Court, Northumberland, Tyne and Wear NHS Trust, Newcastle upon Tyne, UK
  4. 4
    Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

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    Objective

    The misuse of substances (alcohol and illicit drugs) during pregnancy is increasingly common in the UK and is associated with poor maternal and foetal outcomes. Current estimates are that 2–3% of children have a substance misusing parent. There is a poor understanding of the demographics of pregnant substance misusers, of the patterns of antenatal service provision and little evidence about which service model is most effective at optimising care. The aim of this work is to inform clinical practice and further research by studying the health, social context and obstetric outcomes of substance misusing pregnant women.

    Design

    Retrospective case note analysis of medical records in 2002 and 2006.

    Setting

    Newcastle upon Tyne.

    Participants

    Pregnant women attending a specialist antenatal addiction clinic.

    Main Outcome Measures

    Information extracted on demographics, substance misuse histories and key obstetric outcomes.

    Results

    Between 2002 and 2006, there was an increase in average monthly referral rate to the clinic from 14 to 23 women. The age range of both cohorts was similar (17–39 years). In 2002, the primary drugs used were heroin (65%), alcohol (23%) and benzodiazepines (13%). In 2006, they were heroin (50%), alcohol (24%), stimulants (15%) and cannabis (11%). Mean gestational age at booking for opiate users improved from 18 to 16 weeks and from 28 to 15 weeks for non-opiate users. Between 2002 and 2006, there were fewer neonatal admissions to special care (26% to 20%) but similar rates of neonatal abstinence syndrome “NAS” (both 23%). In 2002, 22% women delivered before 37 weeks compared to 5% in 2006. In 2002, 95% babies born to alcohol and opiate users were below the 50th centile for birth-weight compared to 81% in 2006.

    Conclusion

    This study represents one of the first attempts to analyse changing demographics, substance misuse patterns and obstetric outcomes in pregnant substance misusers in the UK. Pregnant substance misusers presented earlier to the clinic and accessed more antenatal care. Preterm delivery rates and infant birth-weights were improved, highlighting the benefit of specialist antenatal care. Our data show an increasing variety of substances misused, however the limited work on substance use in pregnancy in the UK has focused on opiate misusers. If the needs of all pregnant substance users are to be effectively met by services it is important to understand and adapt to changing patterns of substance misuse.

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