West Virginia health care professionals hope to learn more about how many pregnant women use drugs or alcohol and what kind of substance abuse occurs so they can provide earlier and better care for mothers and newborns.
A study of umbilical cord tissue of babies born in the state and uniform maternal health screening of expectant women are among initiatives of the West Virginia Perinatal Partnership, which includes hospitals, health care organizations, medical schools, state agencies and churches. Partnership members and state lawmakers have been working to develop universal maternal screening methods to better identify high risk pregnancies from drug, tobacco or alcohol use, hypertension, diabetes and other factors that can cause poor birth outcomes.
"When we get the information after the baby is born, it's too late," said Dr. Stefan Maxwell, chief of pediatrics at Charleston Area Medical Center and chairman of the partnership's Committee on Drug Use During Pregnancy. "The effects are long lasting."
Maxwell and other partnership members want confidentiality to be part of the screening process, so that pregnant women are more willing to report substance abuse.
"If you're using cocaine or heroin you don't particularly want to tell anyone about it because it's illegal," Maxwell said. There should be some kind of protection from legal prosecution so pregnant women will come forward early and get treatment, partnership project director Nancy Tolliver said.
"As long as she comes in early, tells the doctor, the midwife, that she's using some drugs then she's protected," Tolliver said. "This does not protect her after the birth, only during the pregnancy when she's getting treatment."
"We do not have adequate abilities to manage substance abuse during pregnancy... We don't have enough available resources to detoxify and protect these children after birth."
Dr. Robert Nerhood, professor of obstetrics and gynecology at Marshall University
Early intervention is key because critical development takes place during the first few months of pregnancy, Tolliver said.
"If a woman becomes pregnant she has a very strong desire to be off the drugs because she knows it's harmful," Tolliver added. "That is one of the best times to try and help."
Senate Bill 307 would create an advisory council to help develop a uniform maternal risk screening tool.
Meanwhile, the partnership was working on guidelines for medical practitioners to address issues with drug or alcohol use during pregnancy. Partnership members also want to get a more detailed picture of the prevalence of drug abuse among pregnant women so they can develop educational programs about the most used and most damaging drugs.
"We think that the most effective way of determining the prevalence of drug use among pregnant women in West Virginia is to conduct a cord tissue study so samples of the umbilical cord can be sent away to a laboratory and tested for drugs that have been used by the mother," Tolliver said. "Many of those babies have to be de-toxed after birth, which means they are suffering from withdrawal," Tolliver said. "They have feeding problems, they have breathing problems and problems bonding with the parent because their brain that helps them bond and form relationships is not functioning properly."
Premature delivery is another risk, and later there may be learning and attention disabilities in childhood related to substance abuse during pregnancy, said Dr. Robert Nerhood, who conducted a study of babies with neonatal abstinence syndrome, or drug withdrawal, at Cabell Huntington Hospital. The study, published earlier this year in the West Virginia Medical Journal, showed that 34 out of 2,549 babies born at Cabell Huntington were diagnosed with neonatal abstinence syndrome in 2005. Another 14 babies with NAS were transferred to Cabell Huntington, bringing the total count to 48, according to the study.
"This is a serious and widespread problem," said Nerhood, professor of obstetrics and gynecology at Marshall University and past chairman of the Perinatal Partnership. "We do not have adequate abilities to manage substance abuse during pregnancy... We don't have enough available resources to detoxify and protect these children after birth."
The study was conducted after hospital staff observed seeing more addicted mothers and babies with drug withdrawal, Nerhood said. It confirmed that drug abuse exists across the entire socioeconomic spectrum, he added.
"Drug abuse sees no boundaries," Nerhood said. "Our particular concern is that the newborns don't have any say in whether or not they're being exposed to these drugs and they are suffering significant issues as a consequence."
The partnership has conducted studies as well, Tolliver said. A 2006 West Virginia Health Care Authority review showed increased rates of newborns treated for drug withdrawal at hospitals in the state.
A 2007 survey of obstetrical nurse managers in the state showed that 85 percent felt the most common drug found in newborns was marijuana. A 2007-2008 study that added questions about drug use to the West Virginia Birth Score data collection for new mothers showed that in about 5 percent of 17,349 deliveries over a year, mothers indicated they had used drugs, alcohol or other substances during pregnancy.
"We asked nurses, looked at discharge data and asked the women themselves," Tolliver said. "That's why we need to do the cord tissue study. We know the situation is probably more significant than we thought it was but we also need to know what drugs or alcohol they are using so we can gear prevention activities in that direction."
Some studies have limitations, partnership members said, because pregnant women may be unwilling to report illegal drug abuse and because routine testing of the mother's and newborn's urine and the baby's meconium is difficult to obtain and reflects only drug use several days prior to delivery. Cord tissue testing has a universally available source and can detect drugs from over a much longer period of time.
"It reflects not just the moment when the cord is cut but what's happened in the month or so prior to that," Nerhood said. "It gives us a bigger window to look at."
Partnership members hope to conduct a pilot study sometime over the next year at about 10 different hospitals in West Virginia. The samples would be taken anonymously. "It will give us a snapshot of what people are doing or using," Maxwell said.
Maxwell hopes drawing more attention to the issue can help bring in more funding for resources and rehabilitation programs. Such resources are important after babies are born as well, Nerhood said.
"Unfortunately drug abuse is something that lends itself to relapse," Nerhood said. "We have to have an ability to monitor what's going on to protect the children after birth."