Substance use among pregnant adolescents: A comparison of self-reported use and provider perception

doi:10.1016/S1054-139X(97)00170-5

Journal of Adolescent Health

Volume 22, Issue 3, March 1998, Pages 229-238

https://doi.org/10.1016/S1054-139X(97)00170-5 Get rights and content

Purpose:

This study describes, from both client and provider perspectives, the ethnic differences (African-American and white) in cigarette, alcohol, marijuana, and other drug (cocaine and crack) use among pregnant adolescents attending public prenatal clinics in one county.

Methods:

Client information was based on a cross-sectional survey of 248 consecutive adolescent, public prenatal clients. The sample represented 79% of pregnant adolescents in the country at the time of the study. Ethnic groups were compared through the use of appropriate bivariate statistics regarding (a) number, type(s), and frequency of substance(s) used; (b) mean age of first use; (c) change in use 6 months prior to pregnancy and first trimester; and (d) use among family and friends. Provider information was based on open-ended interviews among 23 individuals (91% of all providers) covering the same themes.

Results:

The majority of clients were African-American (61%), single (81%), and primaparous (72%). Many reportedly used at least one substance prior to pregnancy (79%) and during their first trimester (49%). The most common substances were cigarettes and alcohol. Overall, use of each substance during both time periods was higher among whites; yet African-Americans were more likely to report discontinued use. Substance use was common among adolescents' family members and friends. The provider survey revealed a wide range of perceptions about substance use among pregnant adolescents.

Conclusions:

Pregnant adolescents' self-reported substance use patterns differed by ethnicity, and providers' perceptions of substance use among their adolescent prenatal population differed from what was obtained from patients' self-reports. Additional research is needed to understand the role ethnicity plays in high-risk behaviors among adolescent prenatal clients, as well as its role in client—provider communication.

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Cited by (22)

Underreporting of use of cocaine and marijuana during the third trimester of gestation among pregnant adolescents
2010, Addictive Behaviors
Citation Excerpt :
However, hair analysis provides a window of detection that extends over a period of time that is longer than for any other way. Estimates of substance use among pregnant adolescents range from 11% to as high as 52%, similar to those for nonpregnant adolescent females (Teagle & Brindis, 1998; Ebrahim & Gfroerer, 2003). The relevance of identification of this use in the third trimester is shown by that: recent users are frequent users (Kuhn, Kline, Ng, Levin, & Susser, 2000), pregnant adolescent underreport substance use and exposure to cocaine, (Kokotailo et al., 1994).
The aim of this study is to check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair.
Hair analysis detected the use of cocaine and/or marijuana in the third trimester of pregnancy in 60 (6%) patients. 40 (4%) patients used only marijuana, 17 (1.7%) used only cocaine, and 3 (0.3%) used both drugs. None of the patients had reported the use of these substances in their interviews with healthcare professionals.
Although the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drug use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions can be implemented for the mothers as well as for their children.
Alcohol and Drug Screening of Newborns: Would Women Consent?
2009, Journal of Obstetrics and Gynaecology Canada
To examine the conditions under which mothers would consent to alcohol and drug screening of their infants, and to identify predictors of screening consent.
A cross-sectional survey was administered in person by trained research assistants on the postpartum units of three hospitals in a large Canadian urban centre over four months. The survey was administered to 1509 mothers (78.4% of those eligible) who were fluent in English and had given birth within the preceding 48 hours.
Mothers indicated that they would consent to screening of their newborn (1369/1460, 93.8%), and thought all mothers should consent if infants at risk would be more likely to receive effective treatment (1440/1476, 97.6%). Respondents believed that they would consent to screening if they were provided the following information: what would happen if the infant sample was positive for prenatal exposure (1431/1476, 97%); who would have access to the information (1377/1476, 93.4%); how effective medical care would be for the child (1435/1476, 97.4%); and the likelihood that a baby with a positive screen would have a problem (1444/1476, 98.1%). Self-reported alcohol use did not decrease willingness to consent. In a multivariate model, belief that universal screening would not make women feel discriminated against was a significant predictor of consent (adjusted OR 5.9; 95% CI 3.3–10.6).
Mothers would support a universal newborn alcohol and drug screening program if there was evidence that screening could lead to effective treatment for the mother and baby, and if appropriate resources were available.
Examiner les conditions en vertu desquelles les mères consentiraient à la tenue d’un dépistage visant l’alcool et les drogues chez leur nouveau-né, et identifier les facteurs prédictifs du consentement au dépistage.
Un sondage transversal a été administré en personne, par des adjoints à la recherche formés, auprès des unités postpartum de trois hôpitaux d’un important centre urbain canadien, et ce, sur une période de quatre mois. Ce sondage a été administré à 1 509 mères (78,4 % des candidates admissibles) qui étaient en mesure de parler anglais avec aisance et qui avaient accouché dans les 48 heures précédentes.
Les mères ont indiqué qu’elles consentiraient au dépistage de leur nouveau-né (1 369/1 460, 93,8 %) et estimaient que toutes les mères devraient y consentir, puisque les nouveau-nés exposés à des risques seraient alors plus susceptibles de bénéficier d’un traitement efficace (1 440/1 476, 97,6 %). Les répondantes estimaient qu’elles consentiraient au dépistage si on leur offrait les renseignements suivants : les conséquences de l’obtention d’un résultat positif quant à l’exposition prénatale du nouveau-né (1 431/1 476, 97 %); l’identité des personnes qui auraient accès à cette information (1 377/1 476, 93,4 %); l’efficacité des soins médicaux qui seraient alors offerts au nouveau-né (1 435/1 476, 97,4 %); et la probabilité selon laquelle un nouveau-né obtenant un résultat positif au dépistage pourrait en venir à connaître des problèmes (1 444/1 476, 98,1 %). L’autosignalement de la consommation d’alcool n’entraînait pas une baisse de la volonté de consentir au dépistage. Dans le cadre d’un modèle multivarié, l’opinion selon laquelle les femmes n’auraient pas l’impression de faire l’objet de discrimination si l’on avait recours au dépistage universel constituait un facteur prédictif considérable du consentement (RC corrigé, 5,9; IC à 95 %, 3,3–10,6).
Les mères appuieraient un programme universel de dépistage visant l’alcool et les drogues chez les nouveau-nés, si les données indiquaient que le dépistage pourrait mener à l’offre d’un traitement efficace à la mère et à l’enfant, et si les ressources appropriées étaient disponibles.
Adolescent pregnancy
2003, Pediatric Clinics of North America
The child abuse potential inventory and pregnancy outcome in expectant adolescent mothers
2001, Child Abuse and Neglect
Objective: The study explores the prenatal Child Abuse Potential (pCAP) scores derived from the Child Abuse Potential Inventory administered to expectant adolescent mothers. The aim of the study was to assess the association of the pCAP scores with maternal negative prenatal behaviors, and evaluate the contribution of the pCAP scores to neonatal morbidity.
Method: The pCAP scores, demographic data, and self-report on prenatal behaviors were obtained during the second half of the pregnancy in a sample of 45 poor single adolescent mothers. A pediatrician blind to the prenatal data reviewed the neonatal records to assess neonatal morbidity. Maternal prenatal records were reviewed for obstetric risk assessment by an obstetrician who was blind to the rest of the data. The relations among the pCAP scores, prenatal behaviors, and neonatal morbidity were analyzed.
Results: In the prenatal period, the pCAP scores were positively correlated with self-reported prenatal smoking and substance use. The multiple linear regression analysis showed that the pCAP scores significantly contributed to neonatal morbidity independently of obstetric risk factors.
Conclusions: The Child Abuse Potential scores obtained during pregnancy in poor single adolescent mothers reflect domains of maternal functioning that are associated with negative prenatal behaviors and appear to be important for predicting neonatal morbidity. Further studies are warranted to validate the prenatal use of the Child Abuse Potential Inventory.
Objectif: Cette étude explore les scores au “prenatal Child Abuse Potential” (pCAP) dérivé du “Child Abuse Potential Inventory” administré à de futures mères adolescentes. Le but de l’étude était d’évaluer l’association des scores au pCAP avec les comportements maternels négatifs et d’évaluer la contribution des scores pCAP à la morbidité prénatale.
Méthode: Les scores au pCAP, les données démographiques et un rapport spontané sur les comportement prénataux ont été obtenus pendant la seconde moitié de la grossesse auprès d’un échantillon de 45 mères adolescentes pauvres et vivant seules. Un pédiatre qui ne connaissait pas les données prénatales fit la revue de dossiers néonataux pour évaluer la morbidité néonatale. Les dossiers maternels prénataux furent examinés du point de vue du risque obstétrical par un obstétricien ignorant le reste des données. Les relations entre les scores pCAP, les comportements prénataux et la morbidité néonatale ont été analysés.
Résultats: Dans la période prénatale, les scores pCAP étaient en corrélation positive avec le fait de fumer et d’utiliser des drogues dont il était fait état spontanément. L’analyse par régression multiple linéaire a montré que les scores pCAP ont contribué significativement à la morbidité néonatale indépendamment des facteurs de risque obstétricaux.
Conclusions: Les scores pCAP obtenus pendant la grossesse chez de jeunes mères adolescentes démunies reflètent des domaines du fonctionnement maternel associés avec des comportements prénataux négatifs et semblent avoir de l’importance pour prédire la morbidité néonatale. Il serait justifié de faire d’autres études pour valider l’utilisation pendant la grossesse du “Child Abuse Potential Inventory.”
Objetivo: El estudio explora las puntuaciones prenatales de potencial de maltrato infantil derivadas de la administración del Inventario de Potencial de Maltrato a adolescentes embarazadas. El objetivo del estudio fue evaluar la asociación de las puntuaciones del potencial de maltrato con conductas prenatales negativas y evaluar la contribución de dichas puntuaciones en la morbilidad neonatal.
Método: Las puntuaciones de potencial de maltrato, los datos demográficos y el autoinforme sobre conductas prenatales fueron obtenidas durante la segunda mitad del embarazo en una muestra de 45 adolescentes solteras de nivel económico bajo. Un pediatra desconocedor de los datos prenatales revisó los registros neonatales para evaluar la morbilidad neonatal. Los registros maternos prenatales fueron revisados para evaluar el riesgo obstétrico por un médico especialista en obstetricia desconocedor del resto de los datos. Se analizaron las relaciones entre las puntuaciones de potencial de maltrato, las conductas prenatales y la morbilidad neonatal.
Resultados: En el periodo prenatal, las puntuaciones de potencial de maltrato correlacionaron positivamente con el consumo autoinformado de tabaco y drogas. Los análisis de regresión linear múltiple mostraron que las puntuaciones de potencial de maltrato contribuyeron significativamente a la morbilidad neonatal independientemente de los factores de riesgo obstétrico.
Conclusiones: Las puntuaciones de potencial de maltrato infantil obtenidas durante el embarazo en madres adolescentes solteras de nivel económico bajo reflejan ámbitos del funcionamiento materno que están asociados con conductas prenatales negativas y parecen ser importantes para predecir la morbilidad neonatal. Se necesitan otros estudios para validar la utilización prenatal del Inventario de Potencial de Maltrato.
Poor adolescent expectant mothers: Can we assess their potential for child abuse?
2001, Journal of Adolescent Health
Purpose: To explore the correlates of high scores on the Child Abuse Potential Inventory in adolescent expectant mothers.
Methods: Child Abuse Potential scores and data on demographics, pregnancy desire, history of maltreatment, psychological functioning, and perceived social support were obtained by self-report and semi-structured interview. The sample consisted of 50 poor single adolescents recruited from prenatal clinics during the second half of the pregnancy. The relationships among the variables were assessed using Pearson product-moment correlation and multiple regression strategies.
Results: Higher Child Abuse Potential scores were associated with higher maternal psychological distress, maternal history of psychiatric diagnosis, and lack of perceived support by the father of the baby. Older pregnant teenagers were more likely to report childhood history of maltreatment, higher psychological distress, and perceived and expected less support by the maternal mother. Expectant mothers who were raised by a single parent were more likely to have a history of childhood maltreatment, less likely to live with the father of the baby during their pregnancy and to expect less support from him.
Conclusions: Child Abuse Potential scores, obtained during pregnancy in a sample of poor single adolescents provide a marker of maternal prenatal functioning and perceived social support. Further studies are warranted to validate prenatal use of the Child Abuse Potential Inventory (CAPI), which may help identify populations at particularly high risk for child abuse during pregnancy and inform strategies for early preventive interventions. Adolescent education on family planning, child rearing, and social support programs should address the importance of the fathers’ role.
Latent growth trajectories of substance use among pregnant and parenting adolescents
2010, Psychology of Addictive Behaviors

View all citing articles on Scopus

: This article is based on a presentation made at the annual meeting of the Southern Society for Pediatric Research, New Orleans, Louisiana, February 1996. Dr. Brindis's work is supported in part by a grant from the Maternal and Child Health Bureau, MCJ06A80, Health Resources and Services Administration, Public Health Service, U.S. Department of Health and Human Services.

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Original articleSubstance use among pregnant adolescents: A comparison of self-reported use and provider perception

Purpose:

Methods:

Results:

Conclusions:

J Adolesc Health

J Adolesc Health

Press Release on Findings from NIDA's National Pregnancy and Health Survey

Neurobehavioral dose response effects of prenatal alcohol exposure in humans from infancy to adulthood

Annals NY Acad Sci

Epidemiology and health consequences of drug abuse among pregnant women

Semin Perinatol

Prenatal exposure to drugs of abuse: What we know and don't know about developmental outcome

Newslett Clearinghouse Drug Exposed Child

Maternal cocaine use during pregnancy and perinatal outcomes

Epidemiol Rev

Involuntary smoking and children's health

Future Child

Association between post-partum substance use and depressive symptoms, stress, and social support in adolescent mothers

Pediatrics

Young maternal age and adverse neonatal outcomes

Am J Dis Control

Adolescent sexual behavior

Am Psychol

Patterns of weight gain in adolescent pregnancy: Effects of birth weight and preterm delivery

Obstet Gynecol

Adolescent pregnancy and its consequences

JAMA

Adolescent sexual behavior and childbearing

Dev Clin Psychol Psychiatry

Drug use among pregnant adolescents

J Consult Clin Psychol

Facts in Brief Teenage Reproductive Health in the United States

Pregnancy and medical cost outcomes of a self-help prenatal smoking cessation program

Public Health Rep

Targeting special populations with drug abuse problems: Pregnant women

National Institute on Drug Abuse, Drug Abuse Research Series

Relation of the content of prenatal care to the risk of low birth weight: Maternal reports of health behavior advice and initial prenatal care procedures

JAMA

Prevalence of emotional and behavioral disorders during childhood and adolescence

Drinking patterns and correlates of drinking among pregnant teenagers

Alcohol Clin Exp Res

Original article
Substance use among pregnant adolescents: A comparison of self-reported use and provider perception