This annual report - Taranaki District Health Board

Alcohol and Other DrugsNational and international guidelines recommend that alcohol, tobacco and recreationaldrug use is discussed with pregnant women at first contact with a health professional, andadvice given; and that this is repeated through the pregnancy [185,224,258,259]. Thissection discusses interventions aimed at pregnant women with alcohol and or other drugproblems.Antenatal care for women who misuse substancesThe NICE guidance on pregnancy and complex social factors includes a systematic reviewaddressing service provision for women who misuse substances [139]. The reviewexamined access to antenatal services, barriers to care, maintaining contact, additionalsupports and information requirements for young women. Evidence from retrospectivestudies supported the use of a drug liaison midwife to case manage and coordinate careand the provision of substance misuse and support services. Common barriers were: theattitudes of staff; the lack of integrated care from different services; women‘s feelings ofguilt about their misuse of substances and the potential effects on their baby; and women‘sconcern about the potential involvement of children‘s services. Staff training wasrecommended to help address these barriers. No good quality evidence was identified thatinvestigated the effects on pregnancy outcomes of providing additional consultations andsupport to pregnant women misusing substances, their partners and families. However,good liaison between different agencies, with good inter-agency communication and jointcare planning, was recommended.Routine screening for alcohol and other drug useAlcohol use is widespread in society and a number of universal prevention strategies havebeen used, including media advertising campaigns, school and community-basedprogrammes, warning posters, and labelling of alcoholic beverages, although theevidence-base for their effectiveness is limited [180]. Among pregnant women, acombination of verbal guidance and printed information may reduce alcohol consumptionlevels during pregnancy [180,260]. However, there are a number of barriers to ascertainingan accurate alcohol history, including under-reporting due to embarrassment and shameand a lack of reliable biological markers [180]. Two screening tools, the T-ACE andTWEAK questionnaires have been recommended for detecting alcohol misuse amongpregnant women [259,261,262]. In prenatal settings, brief interventions have been shownto be an effective method of reducing or stopping alcohol consumption during pregnancy inwomen who are nondependent and who consume alcohol at low to moderate levels [263].Interventions for alcohol and drug use in pregnancyInterventions to improve outcomes for pregnant women with established alcohol and otherdrug problems have been assessed in a number of systematic reviews, but the evidencebasefor effective interventions remains limited. Two Cochrane reviews, examining theeffectiveness of pharmacologic interventions and psychosocial interventions aimed atimproving birth and neonatal outcomes, maternal abstinence and treatment retention inpregnant women enrolled in alcohol treatment programmes, failed to identify any eligibleRCTs for inclusion [264,265]. Terplan and Lui examined the effectiveness of psychosocialinterventions for pregnant women enrolled in illicit drug treatment programmes on a varietyof outcomes including retention in treatment and birth outcomes [266]. Nine RCTs wereincluded in the review, with 546 participants, assessing contingency management (CM) ormanual-based interventions such as motivational interviewing (MI). CM is based on theprinciple of positive reinforcement and uses reinforcement techniques in an attempt tomodify behaviour in a positive and supportive manner. Most of the studies included appliedCM in the form of monetary vouchers. CM was associated with better retention intreatment, although results could not be pooled due to heterogeneity, while MI wasassociated with a non-significant reduction in treatment retention (RR 0.93, 95% CI 0.81 to1.06). There was a minimal reduction in illicit drug use with CM. Birth outcomes were onlyreported in two studies, which found no differences in birth or neonatal outcomes. Whilethere is some support for CM in retaining pregnant women in treatment, the numbers aresmall, and it was not possible to assess the effects on obstetric and neonatal outcomes.In-Depth Topic: Adversity in Pregnancy - 298