Pregnancy Outcomes Among Women in Substance Abuse Treatment

Purpose Pregnancy outcomes are powerfully influenced by what occurs long before pregnancy begins. Providing preconception care is a critical component to decreasing rates of adverse pregnancy and birth outcomes, as reflected in the Healthy People 2020 objectives. To help promote progress on these objectives, improvements in birth outcomes must be made in our highest risk and most disparate populations. Using self-reported reproductive history data from an ongoing cervical cancer prevention services project delivered to substance abusing women in treatment, we examined the reproductive history and frequency of pregnancy outcomes. Further analysis explored whether previous trauma and risky sexual activity were associated with adverse pregnancy outcomes. Methods Study participants included women aged ≥18 years attending our cancer prevention education seminars at Nexus Recovery Center – the largest female only substance abuse recovery center in DFW. Demographics, past trauma, risky sexual activity, and birth histories (preterm births, miscarriages, abortions, number of children) were collected using self-administered questionnaires. Chi-square tests were used to assess differences between birth outcomes, trauma, and risky sexual activity. Results A total of 286 women with a median age of 32 years were included in this study. The majority of women were white (68%). Two-thirds reported histories of physical abuse, 50% reported sexual abuse, and 42% sold sex for drugs. Nearly nine out of 10 women reported previously being pregnant. A total of 809 pregnancies were observed among 237 pregnant women. Among pregnancies reported, 506 (63%) ended with childbirth (437 full term delivery, 69 preterm delivery), 123 (15%) with miscarriage, 148 (18%) with abortion, while the outcome was unknown for 32 (4%). Pre-term births were higher among women with histories of physical abuse (p=0.02) and more miscarriages were reported among victims of sexual abuse (p=0.02). No differences in poor birth outcomes were observed with high risk sexual activity. Conclusion Our findings suggest adverse pregnancy outcomes are high for substance abusing women in treatment compared to the general population. An exceptional window of opportunity exists to integrate preconception care interventions within treatment recovery centers, but the key challenge will be determining the best delivery mechanism within the context of significant trauma histories.