Prenatal Care
Improves Birth
Outcomes

California hospital expressed their frustration with the lack of residential drug treatment programs and other programs that could provide a stable environment to a pregnant addict. When they are unable to place drug-addicted pregnant women in residential treatment they try alternatives, including battered women shelters or even nursing homes.

When both drug treatment and prenatal care services are provided for drug-addicted pregnant women, the results are dramatic. The three basic components of prenatal care are: (1) early and continued risk assessment, (2) health promotion, and (3) medical and psychosocial interventions and follow-up. One intervention program reported a significant drop in low-birth-weight babies born to drug-abusing mothers who had been provided with drug treatment and prenatal care.3 The incidence of low birth weight among infants born to drug-abusing mothers receiving such care dropped from 50 to 18 percent.

Appendix V

Percentage Distribution of Infants Exposed to Drugs, Including Cocaine

Appendix VI

Objectives, Scope, and Methodology

Hospital Selection
Criteria

Table VI.1: Comparison of Births at
Hospitals in GAO Study With Total Births
In the Respective Cities, 1988

To develop a national estimate of drug-exposed infants we obtained data from the National Hospital Discharge Survey conducted by HHS'S National Center for Health Statistics for the years 1980 to 1988. The National Hospital Discharge Survey is based on an annual survey of a representative sample of U.S hospitals. The survey collects information on the diagnoses associated with hospitalization of adults and newborns in all nonfederal short-stay hospitals. Newborn discharge data for 1986 and 1988 were used to calculate national estimates. Data before 1986 were considered nonreportable due to a small number of sample cases of newborns with a drug-related discharge diagnosis.

To determine the extent of drug-exposed infants we reviewed medical records at 2 hospitals in each of five cities-Boston, Chicago, Los Angeles, New York, and San Antonio. Mostly located in the inner city, 8 of these hospitals serve a high proportion of low-income patients likely to need federal assistance and supportive services. The remaining 2 hospitals did not serve a high proportion of low-income patients, but received referrals from other hospitals in their respective cities of potentially complicated births, including drug-using pregnant women. Our review of medical records at the 10 hospitals (2 hospitals in each of these cities) covered a representative sample of 44,655 births in 1989.

At these hospitals we conducted a detailed review of a random sample of medical records of mothers and their infants who were born between January 1 and June 30, 1989, to estimate the number of drug-exposed infants. We considered an infant to be drug-exposed if any of the following conditions were documented in the medical record of the infant or mother: (1) mother self-reported drug use during pregnancy, (2) urine toxicology results for mother or infant were positive for drug use, (3) infant diagnosed as having drug withdrawal symptoms, or (4) mother was diagnosed as drug dependent. We also interviewed hospital personnel to obtain their procedures for identifying drug-exposed infants.