Development of clinical indicators for drugs in pregnancy services

Introduction and Aims: Women who use licit and/or illicit drugs during pregnancy are at increased risk of complications affecting both mother and infant. Clinical services have been developed to help these women to engage in antenatal health care and offer effective interventions to control use. The main aim of this study is to evaluate potential clinical indicators for substance use in pregnancy clinical services. Design and Methods: A data collection tool was developed at Royal Prince Alfred Hospital (RPAH) in 2004 and a modified version utilised across four maternity services in New South Wales. Data fields address drug and alcohol use, treatment utilisation, antenatal care and complications, gestational age at delivery, birth weight, and neonatal admissions or other complications. This data set has been compiled and analysed to identify clinical service predictors of outcome that can serve as clinical indicators. Results: The mean age of 304 pregnant women from four hospitals in NSW from 2004 to 2011 was 28.5 years. Among 256 women with Australian background, 86 (34.6%) of them were Aboriginal. The most frequent substance used was tobacco (82.6%), followed by opioids (68.6%), cannabinoids (43.8%) and amphetamines (19.4%) with a mean of three substance used per person. The mean birth weight was 2870 grams with 24% below 2500 grams. In women who used cannabinoids, birth weight was significantly lower than other groups (p = 0.004); however, birth weight in tobacco, benzodiazepine and amphetamines users was all lower than NSW population. Fetal distress, abruption, ante partum haemorrhage, IUGR, preterm and threatened preterm labour were the most frequent complications during pregnancy in these women. Breast feeding at discharge was remarkably low (30.9%) compared to NSW population (79.8%). Discussion and Conclusions: Further analysis of these data will identify predictors of clinical outcomes to yield valid clinical indicators. This cohort experience poor outcomes compared to the overall NSW population.