"We know that drug-addicted pregnant women are still largely ignored or kept out of treatment programs" - Rep. Henry Waxman, 1991.

"Chemically dependent women are a highly stigmatized group; the stigma experienced by a pregnant women addicted to drugs or alcohol is even greater and more vitriolic in nature. Women who do seek treatment are frequently turned down for recovery services simply on the basis of their pregnancy or for having a newborn that they wish to be with in the treatment setting." - W. Chavkin, 1990.

Initially, studies reported that cocaine may be a teratogen, a substance imposing irreversible detrimental effects on the fetus and its development. This premise has not been consistently upheld within the literature, perhaps, mainly due to the confounding effects of polydrug use.

While deficits in fetal growth (lighter birth weight and smaller head circumference) have been a consistent finding within the literature, specific effects of prenatal cocaine exposure on pregnancy, developmental, or behavioral outcomes have not been definitive.

Among polydrug using women, alcohol is quite often used concurrently with other drugs of abuse, typically marijuana, cocaine and cigarettes.

The total number of pregnant women who consume alcohol has decreased since 1985, suggesting that public education is working. Unfortunately, no decline has occurred in the number of younger and less educated expectant women who drink.

Georgia ranks eighth in the nation in the number of teen pregnancies. In 1989, 27,920 girls age 10-19 became pregnant.

Teen mothers under age 17 are almost twice as likely as older women to deliver low birth weight babies, due to receiving less prenatal care.

The rate of breathing problems and Sudden Infant Death Syndrome (SIDS) is higher among babies of substance-abusing women (8.87 per 1,000 births) than the general population (1.22 per 1,000 births).

Comprehensive treatment programs for addicted pregnant women are shown to be effective. Comprehensive services include chemical dependence treatment, prenatal care and childbirth classes, parenting classes, nursing visits. Women's programs address the specific needs of women and the barriers to recovery experienced by women.

Infant mortality and health costs would be drastically reduced if poor pregnant women could more easily obtain prenatal care and nutrition assistance. One of every three pregnant women gets inadequate prenatal care. In Georgia, with one of the nation's highest infant mortality rates, 25% of pregnant women receive their only care from county health department, its. "These figures are frustrating because we really do know enough to turn them around." - Rep. J. Roy Rowland, MD, 1991.

Fear of prosecution for drug use during pregnancy, or fear of loss of custody of children, deters women from seeking prenatal care, or from giving their physicians accurate information about alcohol and drug use.

REFERENCES

Sally L. Davidson Ward, et al., "Sudden Infant Death Syndrome in Infants of Substance-abusing Mothers," "Journal of Pediatrics", 117:879-881, 1990.

Rep. Henry Waxman, Chairman of Subcommittee on Health and Environment, Remarks at Hearing on Reorganization of ADAMHA, June, 1991.

The Brown University Digest of Addiction Theory and Application, "Alcohol Consumption Drops among Pregnant Women," Report of CDC study, April 1991.

W. Chavkin, "Help. Don't Jail Drug-Addicted Mothers," The Oakland Tribune, July 19, 1989.

W. Chavkin, "Drug Addiction and Pregnancy: Policy Crossroads," American Journal of Public Health, April, 1990.

Georgia Department of Human Resources, Division of Public Health, "Adolescent Pregnancy in Georgia", 1990.

March of Dimes Birth Defects Foundation, "Cocaine Use During Pregnancy", Fact Sheet, 1989.

Rep. J. Roy Rowland, (D-Ga.), National commission to Prevent Infant Mortality, Remarks in Congressional hearing, April 1991.

Marty Jessup, R.N., M.S., "The Treatment of Perinatal Addiction: Identification, Intervention, and Advocacy," "The Western Journal of Medicine, May, 1990.

Ira J. Chasnoff, M.D. et al, "The Prevalence of Illicit-Drug or Alcohol Use During Pregnancy and Discrepancies in Mandatory Reporting in Pinellas County, Florida," The New England Journal of Medicine, April 26, 1990.