Identifying Targets to Improve Antenatal Care for Substance Misuse in Pregnancy: An Observational Study

Background: Substance misuse in pregnancy contributes to increased maternal and fetal morbidity and mortality. Women who misuse drugs are, however, less likely to attend antenatal care. An observational study of the women who attended our substance misuse antenatal clinic was undertaken to identify targets for improving antenatal care for substance misuse in pregnancy derived from trends in maternal profiles, pregnancy outcomes and childhood consequences. Methods: Data were retrospectively analysed from computer records and patient notes of the women who attended substance misuse antenatal clinic (n=100) and children born from these pregnancies (n=99). Results: The women presented with complex heterogeneous substance misuse patterns. Attendance to the clinic was “good” in 73% with poor attendance in a sub-population with high alcohol use. Special care baby unit admissions (14% vs 6%, p=0.14) and length of hospital stay were greater than the non-substance misusing group (5.3 ± 7.4 vs 1.2 ± 1.3 days, p<005). More premature infants in the substance-misuse group had birth-weights less than the tenth centile (86% vs 0%, p<0.05). At five years, a higher percentage of children in substance-misuse group had an ocular diagnosis compared with the control (22% vs 4%, p=0.0029), and increased social service involvement and out-of-home care. Conclusions: We suggest better sexual health education for women in high-risk groups. This could be achieved by better integration between services. Antenatal care should target high-risk groups with earlier intervention and longer-term follow-up of children born to substance-misusing mothers.