Drug addiction and pregnancy: policy crossroads.

Abstract

The medical and lay press have lately written extensively about drug use by pregnant women. Evidence suggests a significant increase in maternal drug use during pregnancy during this decade. In New York City, for example, the proportion of birth certificates indicating maternal illicit substance use tripled between 1981 and 1987.* Prevalence data indicate that, at least in certain hospitals, many women have used illicit drugs within hours of delivery. Anonymous urine toxicology surveys of women in labor and of neonates in several New York City inner-city hospitals revealed 11-20 percent positive for illicit drugs (mostly cocaine/ crack).l'**, *** The medical consequences for mother and infant can be severe. In addition to the well-known roster of ills related to intravenous administration such as hepatitis B, endocarditis, abcesses, etc., illicit drugs have become increasingly associated with sexually transmitted diseases2,3 and AIDS.4 The sequelae for infants can include abstinence symptoms, low birthweight, developmental problems, and increased risk of infant death.5.6 Society has responded to this problem in three different ways: criminal prosecution of the mother; allegations of child neglect against the mother with interruption of maternal custody; and drug treatment. The purpose of this article is to explore each of these policy approaches in an effort to ascertain whether each furthers the goal of reducing drug use during pregnancy and improving maternal and infant health and well-being.