Revealing drug use to prenatal providers: Who tells or who is asked?

Objective: Health risks associated with prenatal drag use can be effectively reduced through targeted medical and counseling services. However, the delivery of these services depends on the providers knowing which women are using drugs. The purpose of this retrospective study is to determine factors associated with substance using women revealing their drug use to their prenatal providers. Methods: The study subjects were injection drug users (IDUs) or crack users, recruited in Portland, OR., from 3/92 to 12/95, as part of a National Institute on Drug Abuse-sponsored HIV risk reduction project. Women were eligible if during their last pregnancy they: (1) used cocaine, methamphetamines, or heroin; (2) had at least one prenatal visit; and (3) did not have an induced abortion. Of the 97 women meeting these criteria, the mean age at their last pregnancy was 28 years (range 19- 42); 45% were White and 44% were African American; 32% had less than a high school education; and 50% had their last pregnancy between 1990-95. Results: Only 52% of the respondents reported telling their prenatal providers of their drug use. Variables independently associated with revealing of prenatal drug use were: African American race (p < .01); less than a highschool education (p < .05); and older age at last pregnancy (p < .05). Conclusions: Prenatal providers are not identifying a large portion of their drug using clients. Furthermore, White or more educated women who do not fit the stereotype of a drug user are even less likely to be identified. By asking all pregnant clients about drug use, whether they look the 'type' or not, many more drug using women and their newborns can benefit from needed perinatal services.