Special Article
The Prevalence of Illicit-Drug or Alcohol Use during Pregnancy and Discrepancies in Mandatory Reporting in Pinellas County, Florida
N Engl J Med 1990; 322:1202-1206April 26, 1990
- Abstract
- Abstract
Florida is one of several states that have sought to protect newborns by requiring that mothers known to have used alcohol or illicit drugs during pregnancy be reported to health authorities. To estimate the prevalence of substance abuse by pregnant women, we collected urine samples from all pregnant women who enrolled for prenatal care at any of the five public health clinics in Pinellas County, Florida (n = 380), or at any of 12 private obstetrical offices in the county (n = 335); each center was studied for a one-month period during the first half of 1989. Toxicologic screening for alcohol, opiates, cocaine and its metabolites, and cannabinoids was performed blindly with the use of an enzyme-multiplied immunoassay technique; all positive results were confirmed.
Among the 715 pregnant women we screened, the overall prevalence of a positive result on the toxicologic tests of urine was 14.8 percent; there was little difference in prevalence between the women seen at the public clinics (16.3 percent) and those seen at the private offices (13.1 percent). The frequency of a positive result was also similar among white women (15.4 percent) and black women (14.1 percent). Black women more frequently had evidence of cocaine use (7.5 percent vs. 1.8 percent for white women), whereas white women more frequently had evidence of the use of cannabinoids (14.4 percent vs. 6.0 percent for black women).
During the six-month period in which we collected the urine samples, 133 women in Pinellas County were reported to health authorities after delivery for substance abuse during pregnancy. Despite the similar rates of substance abuse among black and white women in our study, black women were reported at approximately 10 times the rate for white women (P<0.0001 ), and poor women were more likely than others to be reported.
We conclude that the use of illicit drugs is common among pregnant women regardless of race and socioeconomic status. If legally mandated reporting is to be free of racial or economic bias, it must be based on objective medical criteria. (N Engl J Med 1990; 322: 1202–6.)
Media in This Article
Table 1
Demographic Characteristics and Drug-Use Patterns of Pregnant Women, According to Type of Health Care Provider.Table 2
Socioeconomic Status and Drug-Use Patterns of Black and White Women.Article Activity
- Article
PREVIOUS estimates of the frequency with which illicit drugs and alcohol are used by pregnant women have relied on data collected in hospital-based populations before, at the time of, or after delivery.1 2 3 In addition, the majority of hospitals involved in such studies have served urban populations composed largely of minority-group members of relatively low socioeconomic status. We undertook a population-based study of the prevalence of the use of illicit drugs and alcohol by pregnant women who received prenatal care in Pinellas County, Florida, either at public health clinics or in private obstetrical offices.
Pinellas County is an urbanized area with a population of 860,000. Located on a peninsula on the west coast of Florida, it is the most densely populated and most developed county in Florida, with over 3100 persons per square mile. Its major cities are St. Petersburg (population, 243,000) and Clearwater (population, 101,082). Pinellas County is contiguous with Hillsborough County, in which the major city is Tampa. The Tampa—St. Petersburg standard metropolitan statistical area has a population of 2 million people. The population of Pinellas County has increased approximately 18 percent per year since the 1980 census. The minority population has increased by 25 percent over the same 10-year period. Overall, minority groups currently make up 9 percent of county residents. Approximately 27 percent of the residents are 65 years of age or older, 55 percent are between 18 and 64, and 18 percent are 17 or younger.4
The major public-assistance programs that affect children in Pinellas County are Aid to Families with Dependent Children, the food-stamps program, and Medicaid. During the fourth quarter of 1988, an average of 6256 families per month were receiving Aid to Families with Dependent Children.5 Prenatal health care services are available for indigent women at five public clinics throughout the county. In addition, 49 physicians (46 M.D.s and 3 D.O.s) in the county provide private prenatal care in 20 individual or group practices. The birth rate in the county has remained steady. From January 1, 1989, until June 30, 1989, there were 5178 live births; 793 of these infants were born to black women, 38 to Asian women, 2 to American Indian women, 55 to Hispanic women, and 4290 to other white women (Cushing B, Pinellas County Health Unit, Pinellas County, Fla.: personal communication).
In March 1987, a statewide policy was adopted in Florida that required the reporting of births to mothers who used drugs or alcohol during pregnancy. Hospitals were required to notify local health departments when such cases were suspected. Chapter 415.503(8)(a)2 of the Florida Child Abuse Statutes defines reportable "harm" to a child's health or welfare as including "physical dependency of a newborn infant upon any... controlled drug." The Florida Department of Health and Rehabilitative Services (HRS) has developed regulations governing the reporting of the birth of infants to mothers suspected of "drug or alcohol involvement."6 These regulations specifically require reporting when there is an "admission by the mother of drug use during pregnancy, or positive maternal drug screen during pregnancy or the early postpartum period, or a positive newborn drug screen." Documentation of maternal drug abuse or drug addiction is not necessary for an infant to be included under the mandatory-reporting regulations. Thus, the regulations focus on the infant's exposure, not the mother's pattern of drug or alcohol use.
Special procedures have been adopted in Pinellas County to comply with these regulations. On referral of a newborn suspected of having been exposed in utero to an illicit drug or alcohol, community health nurses are required to make a home visit to determine the suitability of the home and whether further intervention is required; such intervention might include continued supervision by a community health nurse, the involvement of the state protective services, with the possibility of removing the child from the mother's custody, or the referral of the mother to specialized drug-treatment and intervention programs.
Methods
A urine sample was collected from every woman who enrolled for prenatal care during a one-month period at each of the five Pinellas County Health Unit clinics and from every woman who entered prenatal care during a one-month period at the offices of each of 12 private obstetrical practices in the county. All the samples were collected between January 1 and June 30, 1989. The 12 private practices that participated in the study provided prenatal and intrapartum care to 70 percent of all the pregnant women who obtained private health care in Pinellas County. The remaining 8 obstetrical practices did not differ from the 12 participating practices in terms of their location, hospital privileges, or university teaching affiliation. The institutional review board of the Pinellas County Health Department approved the protocols and procedures before the study began.
The urine sample was obtained at each woman's first prenatal visit. Because no personal identification was attached to the sample, so that the results could not be traced back to the individual woman, the woman's consent was not required. Each sample was labeled with the woman's age, her race or ethnic group, and the ZIP Code of her residence and was sent to the laboratories of Operation PAR, Inc. Operation PAR is a comprehensive substance-abuse agency with a nonprofit laboratory licensed by the State of Florida and accredited by the College of American Pathologists. The laboratory participates in blinded proficiency-testing programs sponsored by both the College of American Pathologists and the American Association of Bioanalysts and has consistently had a 100 percent proficiency rating.
Samples were assayed by personnel who had no knowledge of the site of origin or the characteristics of the mother. Toxicologic screening was performed with enzyme-multiplied immunoassay techniques; all positive samples were reanalyzed. The manufacturer's recommended cutoff levels were used to determine the presence of a drug or drug metabolites. Samples were tested for alcohol, opiates, cocaine and its metabolites, and cannabinoids (including tetrahydrocannabinol). The results were recorded according to the code number assigned to the mother.
For the same six-month period during which urine samples were collected for toxicologic analysis, we reviewed records from the Pinellas County Health Unit on women reported for drug or alcohol use during pregnancy and recorded the mother's ZIP Code, race or ethnic group, and drug-use pattern. These records included data on women reported to the Health Unit on the basis of alcohol or drug use identified by toxicologic analysis of urine samples obtained at the time of delivery or on the basis of the mother's disclosure of alcohol or drug use.
The mothers' ZIP Codes were used to assign the women to socioeconomic-status categories according to the median annual income of the families in each ZIP Code area. The three income levels used were low (<$12,000), middle ($12,000 to $25,000), and high (>$25,000).7 Demographic data on the mothers and the results of toxicologic testing of urine samples were analyzed by chi-square analysis for nonparametric data and t-tests for parametric data. A z-test was used to assess differences in the proportion of white and black women reported for substance abuse during pregnancy under the state's mandatory-reporting law. All directional P values were for two-tailed tests of significance.
Results
During the one-month study periods for the clinics and private practices, a total of 380 women entered one of the five Pinellas County health clinics for prenatal care, and 335 women entered private obstetrical care in one of the 12 practices we studied. Thus, a total of 715 urine samples were collected at the women's first prenatal visits. No woman's urine sample was lost, and an adequate volume of urine for analysis was available in all cases. There were significant differences in racial distribution and socioeconomic status between the public and private patients (P<0.0001; Table 1Table 1
Demographic Characteristics and Drug-Use Patterns of Pregnant Women, According to Type of Health Care Provider.). The mean ages of the two groups of women were also significantly different (P<0.001); the mean age (±SD) of the women who received care in public health clinics was 22.6±5.5 years, and that of the women cared for in private offices was 26.6±5.2 years.Of the 715 women, 14.8 percent had positive results on toxicologic screening of urine for alcohol, cannabinoids, cocaine, or opiates (Table 1). When alcohol was eliminated from the analysis, 13.3 percent of the urine samples were positive for an illicit drug. There was no significant difference in the prevalence of positive results between public and private patients. The prevalence of positive results of screening for the individual drugs was also similar in the two groups, with the exception of cocaine, which was identified more frequently in the urine samples from the women who received care from public clinics. Of the 106 urine samples with positive results on toxicologic analysis, evidence of more than one substance (alcohol or the various drugs) was found in those of 7 women who received care in the public clinics and 5 who received care from private physicians.
Demographic factors and drug-use patterns were evaluated for white and black women. There were too few Asian and Hispanic women in the total sample for us to analyze these groups separately. There was a significant difference between white and black women in the distribution according to socioeconomic status, for which we used the median family income in the woman's ZIP Code area as a measure (Table 2Table 2
Socioeconomic Status and Drug-Use Patterns of Black and White Women.). White women (mean age [±SD], 25.6±5.5 years) were significantly older than black women (21.7±5.4 years; P<0.001 ). The rate of positive results on toxicologic testing of urine samples was 15 percent among the black and white women combined; the rate for white women (15.4 percent) was slightly higher than that for black women (14.1 percent; Table 2). The results of testing for specific drugs indicated that more black women used cocaine than white women; the opposite was true for cannabinoids.When socioeconomic status, the type of health care provider, race or ethnic group, and age were entered as independent variables in a multiple regression analysis, with a positive result on screening for any drug as the dependent variable, the four independent variables accounted for only a small amount of the observed variance (R2 = 0.02). In particular, socioeconomic status and race or ethnic group did not predict a positive result on toxicologic testing.
During the six-month study period (January 1 to June 30, 1989) in which we collected urine samples, 133 women were reported to the health authorities in Pinellas County for drug or alcohol use in pregnancy; 48 were white, and 85 were black. There was no significant difference in socioeconomic status between the black and white women who were reported, although the women were more likely to be of low socioeconomic status than were the women with positive results on toxicologic testing of urine samples in our study. There was a higher rate of cocaine use among the reported black women and a higher rate of marijuana use among the white women (Table 3Table 3
Black and White Women Reported after Delivery for Substance Abuse.). This finding was consistent with the results of the urine tests, described above. The proportion of white women reported for any drug use (48 of 4290 who delivered live-born infants) was 1.1 percent, whereas the proportion of black women reported for any drug use (85 of 793) was 10.7 percent. Thus, a black woman was 9.6 times more likely than a white woman to be reported for substance abuse during pregnancy. This difference was evident despite the fact that in the population we surveyed the frequency of positive results on toxicologic testing of urine samples obtained at the first prenatal visit was similar for white women (15.4 percent) and black women (14.1 percent). By means of a test of difference between proportions, we found that the proportion of white and black women reported to public health authorities for the investigation of fetal or neonatal exposure to drugs or alcohol was significantly different (z = 8.67, P<0.0001); the rate of reports was 10 times higher among black women. This racial difference persisted when the reported women were analyzed according to the type of prenatal care they received (public or private). Among the women who received care at public health clinics, although black women made up 44 percent of the patient population, 67 percent of the women reported for substance abuse were black. In the private obstetricians' offices, black women made up less than 10 percent of the patient population but 55 percent of those reported for substance abuse during pregnancy.Discussion
A number of studies have now documented the harmful effects of the abuse of both licit and illicit substances on the outcome of pregnancy and delivery.2 , 3 , 8 9 10 11 12 13 14 Some states (such as Illinois and California) have passed child abuse—reporting laws requiring that any newborn with positive results on toxicologic testing of urine for licit or illicit drugs be reported to the state child-protection services or state health authorities. Minnesota passed a law in 1989 that required the reporting of pregnant women if they had positive results on urine testing. Florida requires that a woman with a history of using illicit drugs or alcohol during pregnancy be reported after delivery, even if her urine and the baby's are negative at delivery. The precise definition of fetal exposure to alcohol and drugs and the implications of reporting vary from state to state, but in some instances infants are taken from their mothers and placed in protective care.
Previous studies have not adequately evaluated the prevalence of the use of illicit drugs or alcohol during pregnancy among women who receive care from private obstetricians. In a study of women receiving prenatal care at Parkland Hospital in Dallas, Little et al.3 found that 10 percent reported cocaine use and 3 percent amphetamine use during pregnancy. Frank et al.2 found that among women enrolled in a comprehensive prenatal-assessment program at Boston City Hospital, 28 percent of urine samples screened by toxicologic testing were positive for marijuana and 17 percent were positive for cocaine or its metabolites. A survey of 36 selected hospitals found that 11 percent of newborns had been exposed to an illicit substance at some time during the pregnancy.1 Although the last study included three hospitals that served private obstetrical patients, all three of these studies relied primarily on hospital-based populations in urban areas with largely poor populations.
In the present study we surveyed women who received care from both public and private providers. The rapid changes in the population of Pinellas County, due in part to immigration, may make it unusual, but two important factors of general relevance emerge from our data. First, the overall prevalence of drug or alcohol use, documented by positive results on toxicologic testing of urine samples obtained at the first prenatal visit, was similar among women who received care from private physicians and those cared for at public health clinics. Second, the rate of substance use by pregnant women, as documented at the first prenatal visit, was similar for whites and blacks.
Toxicologic studies of urine samples are limited, in that a positive result reveals only that a particular substance was used within a specific period of time before testing. Such tests do not indicate the frequency of use or the amount used. The use of alcohol, because of its rapid metabolism and excretion in the urine, is very difficult to document by toxicologic testing of urine samples obtained eight or more hours after consumption; thus, the use of alcohol is almost certainly underreported in our data. We did not attempt to determine the prevalence of substance abuse but only the frequency with which evidence of substance use was observed in pregnant women, as documented by positive results on urine tests. The Florida reporting regulation does not require documentation of maternal addiction or drug abuse but only "reasonable cause to suspect" maternal drug or alcohol use, a vague requirement that can lead to variations in reporting.
Such variations in the reporting of women to public health authorities were evident in Pinellas County in the fact that a significantly higher proportion of black women than white women were reported, even though we found that the rates of substance use during pregnancy were similar. It could be postulated that white women were more likely than black women to cease using illicit drugs or alcohol on entering prenatal care and therefore less likely to be reported after delivery. However, several studies3 , 9 , 15 16 17 have shown that the use of drugs or alcohol during pregnancy rarely ceases unless intensive therapeutic intervention is instituted. The infants born to black women could have had more severe symptoms of drug exposure than the infants born to white women, especially since there was a higher rate of cocaine use among black women than white women. In addition, persons who are acutely intoxicated with cocaine are more readily identified than persons who have used marijuana. This difference may have prompted physicians to test black women and their infants more frequently than their white counterparts. It is also possible that physicians consider cocaine more damaging to the fetus than marijuana, the drug most commonly used by the white women. Nevertheless, several studies have demonstrated adverse effects of marijuana use during pregnancy 11 , 12 , 18 19 20
There may be a reluctance on the part of private obstetricians and hospitals to assess their patients' drug or alcohol use, either by history or by laboratory tests, for fear of adverse patient reactions and the loss of future referrals. Furthermore, private physicians often share the same social network, either directly or indirectly, as their patients. This fact could lead to a reluctance on the part of these physicians to identify and report substance use in private patients. Since a greater proportion of white women than black women were private obstetrical patients, a relative lack of assessment may explain the lower rate of reporting for white women.
Physicians who care for large numbers of minority patients tend to be located at teaching hospitals. Hospital faculty members may be more aware than private practitioners of current techniques to identify and refer infants with intrauterine drug or alcohol exposure and may therefore be more likely to find evidence of maternal substance use.
Finally, the preconception that substance abuse, especially during pregnancy, is a problem that affects minority groups, urban populations, and lower socioeconomic groups could bias physicians in identifying substance exposure in newborn infants. This would result in more frequent suspicion of intrauterine drug exposure and, thus, a higher rate of testing and reporting of infants born to black or poor women.
The present study cannot fully differentiate among the factors that could produce higher rates of reporting of black or poor women than of white or more affluent women. To clarify the influence of these factors, it will be necessary to undertake population-based studies in which urine samples obtained at delivery are tested and the reporting rates correlated with those results. However, even given its limitations, our study has important implications for states that are now developing child-protection laws covering substance use in pregnancy. It is clear that standards based on medical criteria for the identification of intrauterine drug or alcohol exposure must be an integral part of all state legislation, especially when the reporting of such cases is required by state law.
Supported by a grant from the Juvenile Welfare Board of Pinellas County, Florida.
We are indebted to Jeanne McCarthy, M.D., Ph.D., for her assistance in gaining the participation and cooperation of private obstetricians in Pinellas County.
Source Information
From the Northwestern University Medical School, Chicago (I.J.C.); Operation PAR, Inc., St. Petersburg, Fla. (H.J.L.); and the Addictions Research Institute of Illinois, Chicago (M.E.B.). Address reprint requests to Dr. Chasnoff at the National Association for Perinatal Addiction Research and Education, 11 E. Hubbard St., Suite 200, Chicago, IL 60611.
- References
References
1
Chasnoff
CrossRef | Web of Science | Medline2
Frank
Web of Science | Medline3
Little
Web of Science | Medline4
Florida State Data Center. Official April 1, 1989, population estimates. Tallahassee, Fla.: Office of Planning and Budgeting, Executive Office of the Governor, 1989.
5
Social indicator report. St. Petersburg, Fla.: Juvenile Welfare Board of Pinellas County, June 1989:22.
6
Mahan CS. Substance abused newboms. Regulation no. 150–6. Tallahassee, Fla.: Florida Department of Health and Rehabilitative Services, October 15, 1988:3.
7
Department of Commerce, Bureau of the Census. Current population reports. Series P-60. No. 161. Washington, D.C.: Government Printing Office, 1987.
8
Chasnoff
Full Text | Web of Science | Medline9
Chasnoff
CrossRef | Web of Science | Medline10
Oro
CrossRef | Web of Science | Medline11
Zuckerman
Full Text | Web of Science | Medline12
Fried
Medline13
Finnegan
CrossRef | Web of Science | Medline14
Jones
CrossRef | Web of Science | Medline15
Fried
CrossRef | Web of Science | Medline16
Fried
Web of Science | Medline17
Rosert
CrossRef | Web of Science18
Fried
Web of Science | Medline19
Greenland
Medline20
Fried
Web of Science | Medline
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CrossRef12
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CrossRef13
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CrossRef14
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CrossRef15
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CrossRef16
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CrossRef18
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CrossRef27
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CrossRef28
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CrossRef29
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CrossRef31
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CrossRef33
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CrossRef34
Michele J. Eliason, Stephan Arndt. (2004) Pregnant Inmates: A Growing Concern. Journal of Addictions Nursing 15:4, 163-170
CrossRef35
Joshua A. Bloomstone. (2003) The Drug-Abusing Parturient. International Anesthesiology Clinics 40:4, 137-150
CrossRef36
J BOLNICK, W RAYBURN. (2003) Substance use disorders in women: special considerations during pregnancy. Obstetrics and Gynecology Clinics of North America 30:3, 545-558
CrossRef37
L ROBERTS, L DUNN. (2003) Ethical considerations in caring for women with substance use disorders. Obstetrics and Gynecology Clinics of North America 30:3, 559-582
CrossRef38
R WELCH, V POULIN. (2003) Specific roles of the obstetrician-gynecologist. Obstetrics and Gynecology Clinics of North America 30:3, 601-615
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CrossRef40
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CrossRef46
Sue V. Rosser. (2002) An overview of women's health in the U.S. since the mid-1960 s. History and Technology 18:4, 355-369
CrossRef47
Brenda D Smith, Mark F Testa. (2002) The risk of subsequent maltreatment allegations in families with substance-exposed infants. Child Abuse & Neglect 26:1, 97-114
CrossRef48
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Antonio Addis, Myla E. Moretti, Fayyazuddin Ahmed Syed, Thomas R. Einarson, Gideon Koren. (2001) Fetal effects of cocaine: an updated meta-analysis. Reproductive Toxicology 15:4, 341-369
CrossRef50
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CrossRef51
Steven J Ondersma, Lorraine Halinka Malcoe, Sharon M Simpson. (2001) Child protective services’ response to prenatal drug exposure: results from a nationwide survey. Child Abuse & Neglect 25:5, 657-668
CrossRef52
Brian Karl Finch, William A Vega, Bohdan Kolody. (2001) Substance use during pregnancy in the state of California, USA. Social Science & Medicine 52:4, 571-583
CrossRef53
INGER SAGATUN-EDWARDS, COLEEN SAYLOR. (2000) A Coordinated Approach to Improving Outcomes for Substance-Abusing Families in Juvenile Dependency Court. Juvenile and Family Court Journal 51:4, 1-16
CrossRef54
David R. Williams, Ruth Williams-Morris. (2000) Racism and Mental Health: The African American experience. Ethnicity & Health 5:3-4, 243-268
CrossRef55
Laura A. Schmidt, Dennis McCarty. (2000) Welfare Reform and the Changing Landscape of Substance Abuse Services for Low-Income Women. Alcoholism: Clinical and Experimental Research 24:8, 1298-1311
CrossRef56
Irina Pollard. (2000) Substance Abuse and Parenthood: Biological Mechanisms-Bioethical Challenges. Women & Health 30:3, 1-24
CrossRef57
Inger Sagatun-Edwards, Coleen Saylor. (2000) Drug-exposed infant cases in juvenile court: risk factors and court outcomes. Child Abuse & Neglect 24:7, 925-937
CrossRef58
An‐Pyng Sun. (2000) Direct practice with substance abusing mothers in the child welfare system: A system perspective. Smith College Studies in Social Work 70:3, 441-457
CrossRef59
A. T. Geronimus. (2000) To mitigate, resist, or undo: addressing structural influences on the health of urban populations. American Journal of Public Health 90:6, 867-872
CrossRef60
Stephen J. Glatt, Carlos A. Bolaños, George H. Trksak, Christine Crowder-Dupont, Denise Jackson. (2000) Prenatal cocaine exposure alters behavioral and neurochemical sensitization to amphetamine in adult rats. Neuropharmacology 39:4, 599-610
CrossRef61
Joseph M. Miller,, Christina Goodridge. (2000) Antenatal marijuana use is unrelated to sexually transmitted infections during pregnancy. Infectious Diseases in Obstetrics and Gynecology 8:3-4, 155-157
CrossRef62
Caroline L. Burry, Lynne S. Noble. (1999) STAFF: An Innovative Training and Support Program for Adoptive Parents of Infants With Prenatal Substance Exposure. NHSA Dialog: A Research-to-Practice Journal for the Early Intervention Field 3:1, 153-158
CrossRef63
S Baraban. (1999) Hippocampal dysplasia in rats exposed to cocaine in utero. Developmental Brain Research 117:2, 213-217
CrossRef64
Bertis B. Little, Laura M. Snell, Kenneth J. Trimmer, Susan M. Ramin, Fred Ghali, Craig A. Blakely, Andrea Garret. (1999) Peripartum cocaine use and adverse pregnancy outcome. American Journal of Human Biology 11:5, 598-602
CrossRef65
Robert S. Byrd, Allyson M. Neistadt, Cynthia R. Howard, Carol Brownstein-Evans, Michael Weitzman. (1999) Why screen newborns for cocaine: service patterns and social outcomes at age one year. Child Abuse & Neglect 23:6, 523-530
CrossRef66
Embry M. Howell, Nancy Heiser, Mary Harrington. (1999) A Review of Recent Findings on Substance Abuse Treatment for Pregnant Women. Journal of Substance Abuse Treatment 16:3, 195-219
CrossRef67
James A. Farrow, D.Heather Watts, Marijane A. Krohn, Heather Carmichael Olson. (1999) Pregnant Adolescents in Chemical Dependency Treatment. Journal of Substance Abuse Treatment 16:2, 157-161
CrossRef68
Cynthia F. Bearer, Siemay Lee, Ann E. Salvator, Sonia Minnes, Alan Swick, Toyoko Yamashita, Lynn T. Singer. (1999) Ethyl Linoleate in Meconium: A Biomarker for Prenatal Ethanol Exposure. Alcoholism: Clinical and Experimental Research 23:3, 487-493
CrossRef69
Kimberly Andrews Espy, Paul M. Kaufmann, Martha L. Glisky. (1999) Neuropsychologic function in toddlers exposed to cocaine in utero: A preliminary study. Developmental Neuropsychology 15:3, 447-460
CrossRef70
Fiona Lyons, M. Milner, C. Davey, P. Bosi. (1999) Substance abuse in an Irish antenatal population. Journal of Obstetrics & Gynaecology 19:6, 609-611
CrossRef71
Sana Loue. (1998) Legal and epidemiological aspects of child maltreatment toward an integrated approach. Journal of Legal Medicine 19:4, 471-502
CrossRef72
John M. Wallace. (1998) Explaining Race Differences in Adolescent and Young Adult Drug Use: The Role of Racialized Social Systems. Drugs & Society 14:1-2, 21-36
CrossRef73
SaraJ Corse, Moon Smith. (1998) Reducing Substance Abuse During Pregnancy. Journal of Substance Abuse Treatment 15:5, 457-467
CrossRef74
Brian W. Weir, Michael J. Stark, David W. Fleming, Haiou He, Helen Tesselaar. (1998) Revealing Drug Use to Prenatal Providers: Who Tells or Who Is Asked?. Drugs & Society 13:1-2, 161-176
CrossRef75
MARIE-CECILE NASSOGNE, PHILIPPE EVRARD, PIERRE J. COURTOY. (1998) Selective Direct Toxicity of Cocaine on Fetal Mouse Neurons: Teratogenic Implications of Neurite and Apoptotic Neuronal Loss. Annals of the New York Academy of Sciences 846:1 COCAINE, 51-68
CrossRef76
Denise Paone, Julie Alperen. (1998) Pregnancy policing: Policy of harm. International Journal of Drug Policy 9:2, 101-108
CrossRef77
ZALMAN WEINTRAUB, YORAM BENTAL, ANITA OLIVAN, AVI ROTSCHILD. (1998) Neonatal withdrawal syndrome and behavioral effects produced by maternal drug use. Addiction Biology 3:2, 159-170
CrossRef78
Loring P. Jones. (1998) Social Class, Ethnicity, and Child Welfare. Journal of Multicultural Social Work 6:3-4, 123-138
CrossRef79
Lucky Jain. (1998) Maternal substance abuse. The Indian Journal of Pediatrics 65:2, 283-289
CrossRef80
Sarah E. Teagle, Claire D. Brindis. (1998) Substance use among pregnant adolescents: A comparison of self-reported use and provider perception. Journal of Adolescent Health 22:3, 229-238
CrossRef81
K DEVILLE, L KOPELMAN. (1998) MORAL AND SOCIAL ISSUES REGARDING PREGNANT WOMEN WHO USE AND ABUSE DRUGS. Obstetrics and Gynecology Clinics of North America 25:1, 237-254
CrossRef82
Linda Beth Tiedje. (1998) Ethical and Legal Issues in the Care of Substance-Using Women. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 27:1, 92-98
CrossRef83
Gale Berkowitz, Sara Peterson, Claire Brindis. (1998) Methodological Issues and Practices in Measuring Perinatal Alcohol and Other Drug Treatment Outcomes. Addiction Research & Theory 6:5, 435-452
CrossRef84
Roy Grant, S. Gail Gordon, Sue T. Cohen. (1997) An Innovative School-Based Intergenerational Model to Serve Grandparent Garegivers. Journal of Gerontological Social Work 28:1-2, 47-61
CrossRef85
Prasanna Nair, Maureen M. Black, Maureen Schuler, Virginia Keane, Laurel Snow, Betty Ann Rigney, Laurence Magder. (1997) Risk factors for disruption in primary caregiving among infants of substance abusing women. Child Abuse & Neglect 21:11, 1039-1051
CrossRef86
Rita Rhodes, Ann Johnson. (1997) A Feminist Approach to Treating Alcohol and Drug-Addicted African-American Women. Women & Therapy 20:3, 23-37
CrossRef87
Mel Anderson, Ronith Elk, Robert L. Andres. (1997) Social, ethical and practical aspects of perinatal substance use. Journal of Substance Abuse Treatment 14:5, 481-486
CrossRef88
Andrea Kovalesky, Susan Flagler. (1997) Child Placement Issues of Women With Addictions. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 26:5, 585-592
CrossRef89
Karen Bell, Darci Cramer-Benjamin, Jeane Anastas. (1997) Predicting length of stay of substance-using pregnant and postpartum women in day treatment. Journal of Substance Abuse Treatment 14:4, 393-400
CrossRef90
Michael D. Stein, Michele G. Cyr. (1997) WOMEN AND SUBSTANCE ABUSE. Medical Clinics of North America 81:4, 979-998
CrossRef91
John B. Schorling, David G. Buchsbaum. (1997) SCREENING FOR ALCOHOL AND DRUG ABUSE. Medical Clinics of North America 81:4, 845-865
CrossRef92
Sally Zierler, Nancy Krieger. (1997) REFRAMING WOMEN'S RISK:Social Inequalities and HIV Infection. Annual Review of Public Health 18:1, 401-436
CrossRef93
Linda M. Whiteford, Judi Vitucci. (1997) Pregnancy and addiction: Translating research into practice. Social Science & Medicine 44:9, 1371-1380
CrossRef94
Lorraine Namyniuk, Christiane Brems, Sheila Carson. (1997) Southcentral foundation—Dena A Coy: A model program for the treatment of pregnant substance-abusing women. Journal of Substance Abuse Treatment 14:3, 285-295
CrossRef95
Nora S. Gustavsson, Ann E. Maceachron. (1997) Poverty and Child Placement. Journal of Poverty 1:2, 81-93
CrossRef96
Amanda Noble, William A. Vega, Bohdan Kolody, Pat Porter, Jimmy Hwang, Gloria A. Merk, Anthony Bole. (1997) Prenatal Substance Abuse in California: Findings from the Perinatal Substance Exposure Study. Journal of Psychoactive Drugs 29:1, 43-53
CrossRef97
Claire D. Brindis, Zoe Clayson, Gale Berkowitz. (1997) Options for Recovery: California's Perinatal Projects. Journal of Psychoactive Drugs 29:1, 89-99
CrossRef98
William A. Vega, Bohdan Kolody, Pat Porter, Amanda Noble. (1997) Effects of Age on Perinatal Substance Abuse among Whites and African Americans. The American Journal of Drug and Alcohol Abuse 23:3, 431-451
CrossRef99
Eileen T. Breslin. (1997) Substance Abuse Among Women and Its Implications for Health Policy. Journal of Addictions Nursing 9:2, 42-49
CrossRef100
Suzanne Dixon, Donna Thal, Julie Potrykus, Trade Bullock Dickson, Jill Jacoby. (1997) Early language development in children with prenatal exposure to stimulant drugs. Developmental Neuropsychology 13:3, 371-396
CrossRef101
Zeev N. Kain, Linda C. Mayes, Cynthia A. Ferris, Juliana Pakes, Richard Schottenfeld. (1996) Cocaine-abusing Parturients Undergoing Cesarean Section. Anesthesiology 85:5, 1028-1035
CrossRef102
Catherine Mallouh. (1996) The Effects of Dual Diagnosis on Pregnancy and Parenting. Journal of Psychoactive Drugs 28:4, 367-380
CrossRef103
Lenore J. Olsen, Darlene Allen, Lenette Azzi-Lessing. (1996) Assessing risk in families affected by substance abuse. Child Abuse & Neglect 20:9, 833-842
CrossRef104
MARGARET E. SPRAUVE. (1996) Substance Abuse and HIV in Pregnancy. Clinical Obstetrics and Gynecology 39:2, 316-332
CrossRef105
Chandice Covington, Virginia Delaney-Black, Robert J. Sokol, Joel Ager, James Knoll, Thomas Templin. (1996) Development of an Instrument to Assess Problem Behavior in First-Grade Students Prenatally Exposed to Cocaine: Part I. Substance Abuse 17:2, 87-99
CrossRef106
Linda Beth Tiedje, Jane R. Starn. (1996) Intervention Model for Substance-Using Women. Journal of Nursing Scholarship 28:2, 113-118
CrossRef107
Kristi Messer, Kathryn Andersen Clark, Sandra L. Martin. (1996) Characteristics Associated with Pregnant Women's Utilization of Substance Abuse Treatment Services. The American Journal of Drug and Alcohol Abuse 22:3, 403-422
CrossRef108
Fretts, Ruth C., Schmittdiel, Julie, McLean, Frances H., Usher, Robert H., Goldman, Marlene B., . (1995) Increased Maternal Age and the Risk of Fetal Death. New England Journal of Medicine 333:15, 953-957
Full Text109
Marylou Behnke, Fonda Davis Eyler. (1995) Issues in prenatal cocaine use research: Problems in identifying users and choosing an appropriate comparison group. Infant Mental Health Journal 15:2, 146-157
CrossRef110
Linda C. Mayes. (1995) Neurobiology of prenatal cocaine exposure effect on developing monoamine systems. Infant Mental Health Journal 15:2, 121-133
CrossRef111
Marjorie Beeghly, Edward Z. Tronick. (1995) Effects of prenatal exposure to cocaine in early infancy: Toxic effects on the process of mutual regulation. Infant Mental Health Journal 15:2, 158-175
CrossRef112
Barry M. Lester, Edward Z. Tronick. (1995) The effects of prenatal cocaine exposure and child outcome. Infant Mental Health Journal 15:2, 107-120
CrossRef113
Frances Elizabeth Garrity-Rokous. (1995) Punitive legal approaches to the problem of prenatal drug exposure. Infant Mental Health Journal 15:2, 218-237
CrossRef114
Paula Kienberger Jaudes, Edem Ekwo, John Van Voorhis. (1995) Association of drug abuse and child abuse. Child Abuse & Neglect 19:9, 1065-1075
CrossRef115
Xiao-Hui Wang, Pat Levitt, Dennis R. Grayson, E. Hazel Murphy. (1995) Intrauterine cocaine exposure of rabbits: persistent elevation of GABA-immunoreactive neurons in anterior cingulate cortex but not visual cortex. Brain Research 689:1, 32-46
CrossRef116
Cynthia Chazotte, Joan Youchah, Margaret Comerford Freda. (1995) Cocaine use during pregnancy and low birth weight: The impact of prenatal care and drug treatment. Seminars in Perinatology 19:4, 293-300
CrossRef117
Alfreda Stadlin, Heung Ling Choi, Karl Wah Keung Tsim, David Tsang. (1995) Prenatal cocaine exposure revealed minimal postnatal changes in rat striatal dopamine D2 receptor sites and mRNA levels in the offspring. Molecular Neurobiology 11:1-3, 67-76
CrossRef118
Ronith Elk, Joy Schmitz, Ralph Spiga, Howard Rhoades, Robert Andres, John Grabowski. (1995) Behavioral treatment of cocaine-dependent pregnant women and TB-exposed patients. Addictive Behaviors 20:4, 533-542
CrossRef119
Bertis B. Little, Daniel A. Roe, R.William Stettler, Van R. Bohman, Kim L. Westfall, Sohrab Sobhi. (1995) A new placental enzyme in the metabolism of cocaine: An in vitro animal model. American Journal of Obstetrics and Gynecology 172:5, 1441-1445
CrossRef120
Hazel A. Jones. (1995) Issues in early childhood education: Implications and directions for higher education. Peabody Journal of Education 70:3, 112-124
CrossRef121
Hassan Webbeh, Roland P. Matthews, Sandra McCalla, Joseph Feldman, Howard L. Minkoff. (1995) The effect of recent cocaine use on the progress of labor. American Journal of Obstetrics and Gynecology 172:3, 1014-1018
CrossRef122
Lieberman, Ellice, . (1995) Low Birth Weight — Not a Black-and-White Issue. New England Journal of Medicine 332:2, 117-118
Full Text123
Linda M. Peterson, William J. Bums, Susan M. Wiidmayer. (1995) Developmental risk for infants of maternal cocaine abusers: Evaluation and critique. Clinical Psychology Review 15:8, 739-776
CrossRef124
John M. Weeman, Mary Anne Zanetos, Stephen J. DeVoe. (1995) Intensive Surveillance for Cocaine Use in Obstetric Patients. The American Journal of Drug and Alcohol Abuse 21:2, 233-239
CrossRef125
Inger J. Sagatun-Edwards, Coleen Saylor, Bethany Shifflett. (1995) Drug exposed infants in the social welfare system and Juvenile Court. Child Abuse & Neglect 19:1, 83-91
CrossRef126
Lynn Singer, Robert Arendt, Sonia Minnes, Kathleen Farkas, Toyoko Yamashita, Robert Kliegman. (1995) Increased psychological distress in post-partum, cocaine-using mothers. Journal of Substance Abuse 7:2, 165-174
CrossRef127
Ronith Elk, Joy Schmitz, Luisa Manfredi, Howard Rhoades, Robert Andres, John Grabowski. (1994) Cessation of cocaine use during pregnancy: A preliminary comparison. Addictive Behaviors 19:6, 697-702
CrossRef128
MARC GALANTER, SUSAN EGELKO, HELEN EDWARDS, MILAGROS VERGARAY. (1994) A treatment system for combined psychiatric and addictive illness. Addiction 89:10, 1227-1235
CrossRef129
Wei-Jung A. Chen, Kathleen H. Andersen, James R. West. (1994) Alcohol-induced brain growth restrictions (microencephaly) were not affected by concurrent exposure to cocaine during the brain growth spurt. Teratology 50:3, 250-255
CrossRef130
Jessie Harsham, Jenness Hayden Keller, Doris Disbrow. (1994) Growth patterns of infants exposed to cocaine and other drugs in utero. Journal of the American Dietetic Association 94:9, 999-1007
CrossRef131
Patricia K. Kokotailo, Rebecca E. Langhough, Narra Smith Cox, Susan R. Davidson, Michael F. Fleming. (1994) Cigarette, alcohol and other drug use among small city pregnant adolescents. Journal of Adolescent Health 15:5, 366-373
CrossRef132
Harris L. Cohen, James H. Sloves, Sheila Laungani, Leonard Glass, Patricia Demarinis. (1994) Neurosonographic findings in full-term infants born to maternal cocaine abusers: Visualization of subependymal and periventricular cysts. Journal of Clinical Ultrasound 22:5, 327-333
CrossRef133
Josephine M. Johns, Michael J. Means, E. Woodley Bass, Larry W. Means, Laura I. Zimmerman, Brian A. McMillen. (1994) Prenatal exposure to cocaine: Effects on aggression in sprague-dawley rats. Developmental Psychobiology 27:4, 227-239
CrossRef134
(1994) Perinatal Substance Exposures in California. New England Journal of Medicine 330:11, 794-794
Full Text135
Fonda Davis Eyler, Marylou Behnke, Michael Conlon, Nanci Stewart Woods, Barbara Frentzen. (1994) Prenatal cocaine use: A comparison of neonates matched on maternal risk factors. Neurotoxicology and Teratology 16:1, 81-87
CrossRef136
Mary R. Haack, Peter P. Budetti. (1994) Part II—Center for Health Policy and. Journal of Addictions Nursing 6:1, 2-12
CrossRef137
LINDA K. MATTI, VIRGINIA M. CASPERSEN. (1993) Prevalence of Drug Use Among Pregnant Women in a Rural Area. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 22:6, 510-514
CrossRef138
Mark G. Henderson, Brian A. McMillen. (1993) Changes in dopamine, serotonin and their metabolites in discrete brain areas of rat offspring after in utero exposure to cocaine or related drugs. Teratology 48:5, 421-430
CrossRef139
Vega, William A.Kolody, BohdanHwang, JimmyNoble, Amanda. (1993) Prevalence and Magnitude of Perinatal Substance Exposures in California. New England Journal of Medicine 329:12, 850-854
Full Text140
Deborah A. Frank, Barry S. Zuckerman. (1993) Children exposed to cocaine prenatally: Pieces of the puzzle. Neurotoxicology and Teratology 15:5, 298-300
CrossRef141
Daniel R. Neuspiel. (1993) Cocaine and the fetus: Mythology of severe risk. Neurotoxicology and Teratology 15:5, 305-306
CrossRef142
Barry M. Lester. (1993) Infants and their families at risk: Assessment and intervention. Infant Mental Health Journal 13:1, 54-66
CrossRef143
Paul M. Kunko, David Moyer, Susan E. Robinson. (1993) Intravenous gestational cocaine in rats: Effects on offspring development and weanling behavior. Neurotoxicology and Teratology 15:5, 335-344
CrossRef144
Janna C. Merrick. (1993) Maternal substance abuse during pregnancy. Journal of Legal Medicine 14:1, 57-71
CrossRef145
William H. Miller, Michael P. Resnick. (1993) Comorbidity in Pregnant Patients in a Psychiatric Inpatient Setting. The American Journal of Drug and Alcohol Abuse 19:2, 177-185
CrossRef146
Ellen R. Harrison, John Haaga, Toni Richards. (1993) Self-Reported Drug Use Data: What Do They Reveal?. The American Journal of Drug and Alcohol Abuse 19:4, 423-441
CrossRef147
Jeannine L. Gingras, Debra E. Weese-Mayer, Roderick F. Hume, Karen J. O'Donnell. (1992) Cocaine and development: mechanisms of fetal toxicity and neonatal consequences of prenatal cocaine exposure. Early Human Development 31:1, 1-24
CrossRef148
John G. Brooks, Peter J. Fleming, Peter J. Berry, Jean Golding. (1992) Evaluation of the Oxford and Sheffield SIDS risk prediction scores. Pediatric Pulmonology 14:3, 171-179
CrossRef149
T Joyce. (1992) The consequences and costs of maternal substance abuse in New York City A pooled time-series, cross-section analysis. Journal of Health Economics 11:3, 297-314
CrossRef150
Trena L. Pelham, Allan R. DeJong. (1992) Nationwide practices for screening and reporting prenatal cocaine abuse: A survey of teaching programs. Child Abuse & Neglect 16:5, 763-770
CrossRef151
Iris E. Smith, Donna Z. Dent, Claire D. Coles, Arthur Falek. (1992) A comparison study of treated and untreated pregnant and postpartum cocaine-abusing women. Journal of Substance Abuse Treatment 9:4, 343-348
CrossRef152
Josephine M. Johns, Larry W. Means, Michael J. Means, Brian A. Mcmillen. (1992) Prenatal exposure to cocaine I: Effects on gestation, development, and activity in Sprague-Dawley rats. Neurotoxicology and Teratology 14:5, 337-342
CrossRef153
S. K. Lam, W. K. To, S. J. Duthie, H. K. Ma. (1992) Narcotic Addiction in Pregnancy with Adverse Maternal and Perinatal Outcome. Australian and New Zealand Journal of Obstetrics and Gynaecology 32:3, 216-221
CrossRef154
CECELIA HITE, MICHAEL SHANNON. (1992) Clinical Profile of Apparently Healthy Neonates With In Utero Drug Exposure. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 21:4, 305-309
CrossRef155
Mindy Thompson Fullilove, E. Anne Lown, Robert E. Fullilove. (1992) Crack ‘Hos and Skeezers: Traumatic experiences of women crack users. Journal of Sex Research 29:2, 275-287
CrossRef156
Jane W. Schneider, Ira J. Chasnoff. (1992) Motor assessment of cocaine/polydrug exposed infants at age 4 months. Neurotoxicology and Teratology 14:2, 97-101
CrossRef157
Marc Galanter, Susan Egelko, George De Leon, Charles Rohrs, Hugo Franco. (1992) Crack/Cocaine Abusers in the General Hospital: Assessment and Initiation of Care. Journal of Addictions Nursing 4:4, 115-121
CrossRef158
William H. Miller, Mark C. Hyatt. (1992) Perinatal Substance Abuse. The American Journal of Drug and Alcohol Abuse 18:3, 247-261
CrossRef159
Mark E James, Claire D Coles. (1991) Cocaine abuse during pregnancy: Psychiatric considerations. General Hospital Psychiatry 13:6, 399-409
CrossRef160
(1991) Underdetection of Substance Abuse. New England Journal of Medicine 325:14, 1045-1046
Full Text161
Muin J. Khoury, Levy M. James, Michele C. Lynberg. (1991) Quantitative analysis of associations between birth defects and suspected human teratogens. American Journal of Medical Genetics 40:4, 500-505
CrossRef162
Marvin Dicker, Eldin A. Leighton. (1991) Trends in diagnosed drug problems among newborns: United States, 1979–1987. Drug and Alcohol Dependence 28:2, 151-165
CrossRef163
Thomas H. Shepard, Alan G. Fantel, Raj P. Kapur. (1991) Fetal coronary thrombosis as a cause of single ventricular heart. Teratology 43:2, 113-117
CrossRef164
Paul R. Marqites, A. James McKnight. (1991) Drug Abuse Risk among Pregnant Adolescents Attending Public Health Clinics. The American Journal of Drug and Alcohol Abuse 17:4, 399-413
CrossRef165
Brenda E. Millette, Nancy B. Fisk, Donna Theroux-Cole. (1991) Nurses″ Knowledge of and Attitudes Toward Perinatal Substance Abuse. Journal of Addictions Nursing 3:3, 73-75
CrossRef166
Michelle Harrison. (1991) Drug addiction in pregnancy: The interface of science, emotion, and social policy. Journal of Substance Abuse Treatment 8:4, 261-268
CrossRef167
(1990) Illicit Drug and Alcohol Use during Pregnancy. New England Journal of Medicine 323:15, 1071-1072
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