The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida

Article Abstract:

To determine the prevalence of illicit drug use (including alcohol) during pregnancy, pregnant women seeking prenatal care in Pinellas County, Florida, were studied. This county is a primarily urban area, with 860,000 inhabitants, and in fact is the most densely populated county in Florida. In March 1987, Florida adopted a policy requiring that mothers who used drugs or alcohol during pregnancy be reported to local health departments. A positive screening test during pregnancy or the period immediately after birth constitutes grounds for reporting, and other grounds are also applicable. To assess how this works in practice, urine samples were collected from 380 women enrolling for prenatal care at the five Pinellas County Health Unit clinics, and from 335 women starting prenatal care at any of 12 private obstetrical offices. The samples were subjected to toxicological screening, under conditions of absolute anonymity, since no name was attached to any sample. Age, race or ethnic group, and patient's ZIP code were marked on the sample containers. ZIP codes were used to rank patients' probable annual income as low (less than $12,000), middle ($12,000 to $25,000), or high (more than $25,000). Results showed differences between patients attending the two clinics in racial distribution and socioeconomic status, with a greater proportion of white non-hispanic women attending the private obstetrician and a greater proportion of black women attending the public clinic. The public clinic patients tended to be either low- (53.2 percent) or middle- (39.5 percent) income, while fewer private patients were low-income (21.5 percent) and more middle-income (71 percent). For the group as a whole, 14.8 percent has positive results for alcohol, cannabinoids (marijuana), cocaine, or opiates. If alcohol was removed from consideration, 13.3 percent of urine samples were still positive for an illicit drug, with no difference in prevalence of positive results for private vs public clinic patients. Particular substances had the same frequency in both groups, except cocaine, which was more often detected in urine from clinic patients. When results were broken down by race, 15.4 percent of tests for white women were positive, as compared with 14.1 percent of tests for black women. Black women tested positive for cocaine more often than white women, and white women for cannabinoids more often. During the study period (six months), 133 women were reported to health authorities in this country for drug abuse or alcohol use in pregnancy, of whom 48 were white, 85 black. These figures represented 1.1 percent of white women who delivered live infants, and 10.7 percent of black women. In other words, a black woman was 9.6 times as likely as a white woman to be reported for substance abuse while pregnant, although the actual incidence of abuse appeared the same. Possible explanations for such differential reporting are discussed. It seems clear, however, that determination of substance abuse by pregnant mothers, to avoid biases, must be based on medical criteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Florida, Surveys, Minorities, Mandatory drug testing, Drug testing, Drug abuse, Drug abuse in pregnancy

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Treating depression in pregnancy

Article Abstract:

It may be premature to ban the use of fluoxetine in pregnancy. Fluoxetine (Prozac) is the most widely prescribed antidepressant drug worldwide. It was not found to cause birth defects in animal studies, but there are few studies on its effects in humans. A 1996 study reported an increase in minor birth defects in the infants of women who took the drug during pregnancy. The researchers also found that women who took the drug during their third trimester had a higher incidence of neonatal complications. However, 5 other studies found no increase in birth defects or complications in pregnant women who took the drug.

Editorial, Complications and side effects, Risk factors, Birth defects, Fluoxetine, Prozac (Medication)

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Discrepancies between meta-analyses and subsequent large randomized, controlled trials

Article Abstract:

Meta-analysis may not reach the same conclusions as large, randomized controlled trials. Meta-analysis is a technique for combining data from multiple small trials. Researchers compared the outcomes of 12 large trials in which participants were randomly assigned to one treatment or another with 19 meta-analyses that considered the same issues. The results of the meta-analysis agreed with the randomized controlled trial two-thirds of the time. This means that based on the meta-analyses alone, doctors would have adopted ineffective treatment and rejected effective treatment one-third of the time.

Evaluation, Clinical trials, Meta-analysis

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