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Re: screening for illicit drug use in pregnancyFrom: ainsron (ainsron@sbcglobal.net)Tue Oct 11 18:45:50 2005
The major problem with diagnosing drug use in pregnancy is what can you do, or what is available for the abusing patient. I have worked with a committee for the past three years in my county - including the health department, DA's office, Drug court, mental health, and many others to develop that type of program. We started by attending a 5d seminar at the Children's Research Triangle in Chicago. Ira Chasnoff is a world renowned researcher in this area and it was a great program to bring together clinicians and those provide treatment with community resources who fund the program as well as those who work with the legal side. The key to diagnosing and treating these women is not to do a urine drug screen on every patient in your office or in L&D. The key is to perform appropriate screening using a tool that has been researched and has a high degree of sensitivity and reproducibility in this group of pregnant women. The commonly used tools, such as the CAGE questionnaire, T-ACE questionnaire, MAST screening test - have not been evaluated for pregnancy. Dr. Chasnoff goes into the problems with most screening tools in his article in Am J Obstet Gynecol, V184, #4, pull it and read it if you want more information. It also does not benefit our patients if we screen them, identify a problem and then have nowhere to refer them for appropriate, gender specific treatment - inpatient or outpatient. Most treatment programs do not take pregnant or postpartum patients with their children, which is a major obstacle to this patients. Many counties in California are now using Dr. Chasnoff's screening protocol and have developed gender specific treatment programs and fast track programs to assist these patients as early as possible in pregnancy. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Theresa333@aol.com Sent: Tuesday, October 11, 2005 3:36 PM To: Multiple recipients of list OB-GYN-L Subject: screening for illicit drug use in pregnancy I believe in all socio-economic groups a certain percentage of pregnant patients struggle with drug dependency. Does any one out there use a protocol to triage patients? (for example test all babies with unexpected fetal distress, moms with unexplained tachycardia/ hypertension...) A perinatal center I trained at developed a protocol and tested all babies transferred to the NICU and noticed a 20% increase in diagnosis of illicit drug use. It helped identify babies that would need extra help. Does any state offer drug rehab for pregnant women? Any comments appreciated greatly. Theresa Bartos Holladay, DO, FACOOG Lakeside Women's Health Center Ludington, MI
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