Frequency of Prenatal Drug Abuse: Assessment, Obstacles, and Policy Implications
Norton-Hawk, Maureen A., Journal of Drug Issues
The scope of interventions into social problems is based on an accurate assessment of the nature of that problem. An accurate, biased or ambiguous analysis has serious consequences for the efficacy of social interventions. This may indeed be the case with studies on the prevalence of prenatal drug use. This paper examines 23 studies conducted since 1980 and finds that the data have a number of serious methodological issues that compromise their utility in determining the breadth and characteristics of the problem.
Numerous studies have attempted to determine the prevalence and sociodemographic characteristics of drug-using pregnant women. Researchers argue that these figures have significance for determining the breadth of services needed (National Association for Perinatal Addiction Research and Educationl 992; Ostrea 1992), as well as identifying high risk populations so that prevention and intervention efforts can be effective and efficient (Nalty et al. 1991; Pegues et al. 1994). Studies that have attempted an analysis of these data encounter a number of methodological issues that compromise their accuracy, and thus, their usefulness.
Through an extensive review of the literature, twenty three studies, conducted since 1980, are identified, summarized and critiqued. They include prevalence rates based on maternal report, biological measures, and existing sources of data.
Using routine or structured interviews, seven studies assessed prevalence rates of drug use in pregnancy (table 1). Rayburn et al. (1982) interviewed pregnant women prenatally and postnatally regarding their use of marijuana, other illicit drugs, and tobacco. Of the 245 women (the majority being white), 13% used marijuana, 2% used other illicit drugs, and 44% used tobacco.
Two maternal report studies examined a white, married, rural population in Missouri. Kruse et al. (1986) surveyed 255 women 3 to 12 months postnatally and found that 23.5% admitted alcohol use and 22.7% smoked cigarettes. Sloan et al. (1992) examined 181 prenatal records and found fewer admissions of alcohol consumption than the Kruse study (15%), but a greater prevalence of tobacco use (46%).
Three self-report studies examined low income, minority, and urban populations. Two of these studies involved a prenatal clinic at Boston City Hospital (BCH). Frank et al. (1988) interviewed 679 pregnant women at BCH clinic. Alcohol (59%) use and tobacco (44%) use were most prevalent. Marijuana was the most often used illicit drug (24%), followed by cocaine (13%) and opiates (4%). Zuckerman et al. (1989) interviewed 412 pregnant and post partum adolescents regarding their use of marijuana and cocaine. The rate of adolescent marijuana usage was 19% and cocaine usage was 6.3%. Zambrana et al. (1991) studied a low income, urban minority population analyzing drug-use patterns of Mexican-American, Mexican-immigrant, and African-American women at seven Los Angeles clinics. Face-to-face interviews indicated that during pregnancy, prescription and over-the-counter medications were the most prevalent (3.4% each). Alcohol was used by 3.2% of the women, marijuana and "hard drugs" were used by 3% each.
The final maternal report study was a National Institute of Drug Abuse (NDA) sponsored survey that was based on a probability sample of 2,613 women who delivered in 52 metropolitan and non-metropolitan hospitals between October 1992 and August 1993. Initial estimates indicate that 5.5% used any illicit drug, 2.9% used marijuana, 1.1% used cocaine, 18.8% used alcohol and 20.4% used tobacco (Finnegan,1994).
Comparison of prevalence rates across the seven studies indicates that, with the exception of tobacco, the population served by Boston City Hospital admits a higher prevalence of drug use. Although marijuana and cocaine use is less likely in rural areas, this population has the highest rate of tobacco use. …