Generations of Suffering: Experiences of a Treatment Program for Substance Abuse During Pregnancy
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222 Presentation GENERATIONS OF SUFFERING: EXPERIENCES OF A TREATMENT PROGRAM FOR SUBSTANCE ABUSE DURING PREGNANCY MERRILL SINGER, Ph.D. CHARLENE SNIPES Hispanic Health Council 98 Cedar Street Hartford, CT 06106 SUBSTANCE ABUSE DURING pregnancy has been recognized asa major national health problem for both women and children. Medical complications including anemia, cardiac disease, cellulitis, edema, hepatitis, phlebitis, and pneumonia, are seen in 40 to 50 percent of drug-dependent pregnant women, while drug exposure in utero is now known to be a primary source of developmental delays, birth defects, and fetal death.1 Major effects on the fetus can include overwhelming infection, chorioamnionitis, premature rupture of the membranes, poor fetal growth, mental retardation, and low-birthweight with associated complications.2 In addition, infants born to drug-abusing parents are at heightened risk for physical abuse and neglect, learning disabilities, lowered IQ, and behavioral problems. The longer-term emotional and behavioral effects of prenatal drug exposure are uncertain. However, a recent study by Dr. Judith Howard at UCLA, which compared a group of drug-exposed and unexposed 18-month-old toddlers from low-income families, found that the drug-exposed children exhibited notably less affect (pleasure, anger, distress), were more apt to scatter or batter their toys, were more nervous in handling toys, and were less attached to their caregivers. A number of substances have been implicated as sources of poor birth outcome. Since they were initially described in 19733, hundreds of cases of fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) have been documented in the medical literature. The long-term effects of FAS, including deficits in Journal of Health Care for the Poor and Underserved, Vol. 3, No. 1, Summer 1992 Singer & Snipes______________________223 learning skills that persist into adulthood, have been reported recently by researchers at the University of Washington.4 Most reported cases of FAS involve African-American and Native American mothers of low socioeconomic status.5 According to the Centers for Disease Control (CDC) Birth Defects Monitoring Program, the incidence of FAS per 10,000 total births is .9 for whites, 6.0 for African-Americans, and 29.9 for Native Americans.6 More recently, cocaine, the drug of choice of female drug users, has been identified as a growing contributor to birth defects, while significant increases in chromosome damage have been found among opiate users, as a result of interference with leukocyte repair of DNA damaged by environmental mutagens. The resulting reduction in immunocompetence may contribute to disease progression upon exposure to HIV disease and in utero transmission resulting in pediatric AIDS. There is growing evidence that drug use during pregnancy is a widespread and growing problem among the poor and underserved. In Hartford, Connecticut, where much of the data for this report originate, drug treatment personnel estimate that, depending on the neighborhood, seven to 50 percent of pregnant women use teratogenic mood-altering substances. These estimates are supported by two recent studies. In the first, urine screening for 1,000 consecutive maternity patients at the city's largest hospital found that while two percent of private patients were positive for drug exposure, 13 percent of clinic patients had used drugs within three days of screening. A study of meconium samples at another inner-city hospital in Hartford also found a 13 percent rate of drug exposure among clinic patients. Other studies in the city link drug use to poor prenatal care and poor birth outcomes. Among the 1,800 at-risk women who have participated in Hartford's Preterm Birth Prevention Project, 20 percent reported substance abuse. A study of 51 mothers of low-birthweight babies who were OB/G YN clinic patients at the city's largest hospital found that 65 percent reported substance use during pregnancy. Intravenous drug use is the primary source of new HIV infection in Hartford. Cases in women represent 20 percent of the adult caseload in Connecticut (twice the national average). Sixty percent of the female AIDS cases in the state are among intravenous (IV) drug users. Connecticut has the fourth highest cumulative incidence rate ( 10.5 / 100,000) for pediatric AIDS and the fifth highest newborn HPv7 seroprevalence rate (290/100,000) in the U.S. Despite...