Wright, T.E., Schuetter, R., Fombonne, E., et al. – 2012
Describes the Perinatal Addiction Treatment Clinic of Hawaii, a program providing services for pregnant substance-abusing women, built on the harm reduction model. Reports on the prevalence of methamphetamine abuse among women in Hawaii. Explains the reasons women use meth, including self-medication for co-occurring mental health disorders, weight loss, energy, and low cost. Summarizes current research on the effects of methamphetamine exposure on the fetus. Discusses the implementation and content of harm reduction programs for pregnant women. Provides an overview of the history, mission, and services of the clinic, noting the different approaches used. An analysis of data on program participants reveals high rates of interpersonal violence and histories of trauma and abuse. Methamphetamine is the primary drug of choice for 86% of the women, while 24% are poly-drug users. Almost all of the women decreased use or became abstinent, and a small percentage of the infants tested positive for drugs. A large percentage of the women smoked during pregnancy, but few were able to quit. The number of pregnancy complications and infant abnormalities was relatively low. Positive outcomes are particularly associated with residential treatment and prenatal care. Compared to other drug-exposed infants, babies in the program had lower rates of preterm delivery and higher birth weights. The women experienced lower rates of postpartum depression. High rates of cigarette smoking (and associated health problems) is cited as an area of concern. Authors suggest that a harm reduction approach that addresses the multiple difficulties of substance-abusing pregnant women can engage them in prenatal care and improve birth outcomes.