Addressing substance abuse in pregnancy opportunity for change
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Addressing Substance Abuse in Pregnancy: Opportunity for Change. Jeanne Mahoney Director, Provider’s Partnership American College of Obstetricians and Gynecologists 2005. Overview. Why group tobacco and substance use together? Epidemiology / costs Interventions that work

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Addressing Substance Abuse in Pregnancy: Opportunity for Change

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Addressing Substance Abuse in Pregnancy:Opportunity for Change

Jeanne Mahoney

Director, Provider’s Partnership

American College of Obstetricians and Gynecologists



  • Why group tobacco and substance use together?

  • Epidemiology / costs

  • Interventions that work

  • Involving health care providers

Tobacco and Substance Use

  • Women unable to give up smoking during pregnancy are at great risk to use/abuse alcohol and other drugs

  • Tobacco is an addictive substance. Intervention for tobacco use similar to alcohol and drugs

  • Both issues best addressed in preconception period – distinct effects early in fetal development and through entire pregnancy

Smoking is the single most important modifiable cause of poor pregnancy outcomes in the United States(Orleans , 2000)

Prevalence of prenatal tobacco use

  • Varies by state

    • Highly dependent on tobacco taxes and regulations.

  • Varies by race/ethnicity

    • American and Alaskan natives greatest use

  • Varies by age

    • Teen rate highest rate in early pregnancy

    • Women over 35 highest rate of continued smoking

Public Health Results of Perinatal Tobacco Use

  • Annual smoking-attributable health care costs at delivery for problems caused by smoking during pregnancy - $366 million in 1996

  • 2/3 of these babies were born to mothers on Medicaid

  • About $704 per maternal smoker

    CDC, 2003

National Perinatal Tobacco Initiatives

  • Partnership to Help Pregnant Smokers Quit

  • Great Start Quitline

  • March of Dimes

  • Partnerships

  • ACOG Training Programs

Partnership to Help Pregnant Smokers Quit

  • Developed by SmokeFree Families and supported by RWJF

  • 60 national organizations involved

  • 6 work groups

  • Products:

    • Medicaid tool kit

    • Worksite tool kit

    • Legislative attention

    • Campaigns for Native American smokers

Great Start Quitline

  • Supported by American Legacy Foundation

  • Tied into state and (soon) national quitlines.

  • Does proactive and responsive counseling

  • Developing a postpartum relapse prevention program

March of Dimes

  • All chapters involved in perinatal tobacco initiatives

  • Most include hospital grand rounds, provider and OB staff training and public health fairs

  • Have developed medical briefs on perinatal smoking

Tobacco Partnership Initiatives

AMCHP, PPFA and ACOG state partnership teams – 10

  • Funded by CDC and WTPN

  • Involve team development and planning

  • Have succeed in state policy changes, provider training, resource identification and collaboration.

ACOG Tobacco Provider Partnership - Nevada

Example – Nevada Smoke Free Babies

Who - Public health and ACOG previous collaboration

Why – High rate of perinatal smoking

Catalyst - New Quit-line – Pending legislation

Result – Statewide diverse team, passed tax legislation, received grant funding for perinatal demonstration project

ACOG Materials

  • Tool kit for clinicians to counsel on perinatal smoking

  • Lecture guide/CD ROM to teach counseling

  • Chart stickers

  • Patient workbook

  • Pregnancy and Beyond – virtual clinic tutorial CD ROM (Dartmouth University)

Perinatal Substance Abuse

Fetal alcohol syndrome (FAS) is the most common preventable cause of mental retardation. It is 100% preventable.

Women rarely abuse single substances, those who abuse illicit substances frequently use alcohol and or tobacco.

FASD Prevention

  • Surgeon General’s Report

  • CDC’s stronger messages

  • Initiatives involving Women’s Health Care providers

Involving OB/GYNs in Tobacco and SA Initiatives


  • Direct access to patients

  • Strong legislative voice for policy change

  • It takes a physician to reach a physician


  • Schedule meetings early in AM, lunch time, evening

  • Patch in clinician on conference call

  • Tighten up process

  • Use clinician as an advisor

Contact information

Jeanne Mahoney

Director, Provider’s Partnership


409 12th Street, SW

Washington, DC 20024

202-314-2352 FAX 202-484-3917

[email protected]

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