Objectives: This study describes the factors associated with self-reported substance use in pregnant young women attending a hospital clinic and evaluates 3 ways in its identification.
Methods: A cross-sectional study of 30 pregnant young adults who responded to a mail survey containing the CRAFFT screening tool. All completed a diagnostic interview that included self-report information on their use of alcohol and drugs before and during pregnancy, the T-ACE screening tool, and the contexts in which they would be likely to use. Medical records were reviewed.
Results: One-third of participants consumed alcohol, marijuana, or both while pregnant. Many had lifetime diagnoses of alcohol (23%) or cannabis (30%) use disorders, but only 1 met criteria for current diagnosis. Age, race, education, and children at home were not associated with either prenatal alcohol or cannabis use. Before pregnancy, alcohol drinking was associated with prenatal alcohol use (P = .02) and prenatal cannabis use (P = .06). Another trend of the before-pregnancy cannabis use being associated with prenatal cannabis use (P = .08) was observed. Most participants indicated little likelihood of substance use in convivial, intimate, or negative coping contexts while pregnant. However, participants with prenatal substance use had significantly higher convivial (P = .02) and intimate (P = .01) subscale scores of the Drinking Context Scale before pregnancy. Compared to the medical record and the T-ACE, the CRAFFT was best in identifying prenatal substance use (c-statistic = 0.9).
Conclusions: The CRAFFT screening instrument and asking about the contexts during which alcohol might have been consumed before pregnancy are promising approaches in the identification of prenatal substance use.
From the Department of Psychiatry (GC, JAJ, TB, SG), Department of General Medicine and Primary Care (EJO), and Department of Obstetrics and Gynecology (LWH), Brigham and Women's Hospital, Boston, MA; and Department of Psychiatry (GC), Department of Medicine (Biostatistics) (EJO), and Department of Obstetrics and Gynecology (LWH), Harvard Medical School, Boston, MA.
Send correspondence and reprint requests to Grace Chang, MD, MPH, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115. E-mail: Gchang@partners.org.
Supported by 2K24AA00289 and R01AA14678 (both GC).
Received February 04, 2011
Accepted February 04, 2011