Perinatal substance abuse in Nebraska: Physicians\u27 perceptions, practices and needs

There has been increasing concern about the risks of drug use during pregnancy. A review of the research literature reflects the severe effects of in utero drug exposure. Given the potential immediate and long term effects of perinatal substance abuse, it is important to consider the prevalence of drug use during pregnancy. While national and regional perinatal substance abuse data suggest that the problem is widespread, little research has been conducted looking at the number of drug exposed infants in Nebraska. However, official statistics collected from the birth certificate worksheets by the Nebraska Department of Health suggest that the use of substances during pregnancy, especially that of alcohol and illicit drugs, is not a prevalent or significant problem among women in Nebraska. Given the unique contact which physicians have with pregnant women, this study was designed to assess the perceptions of these health professionals as to the extent of substance use among pregnant women in Nebraska. There are also concerns expressed in the research literature about the potential underdiagnosis of substance abuse by physicians. Therefore, a second purpose of the study was to gather descriptive information regarding the demographics, practices, and training needs of health professionals concerning substance abuse among pregnant women. Surveys were sent to every licensed obstetrician, family practitioner, and general practitioner in Nebraska (n = 696). A parallel survey was sent to nurse practitioners (n = 49) and physician assistants (n = 224). Follow-up interviews were conducted with 30 subjects to further explore these issues. The results of this study suggest that the state perinatal drug exposure statistics based on birth certificate worksheets are underreported when compared to physicians\u27 perceptions of the problem. Another important finding was that practitioners primarily tend to use self-reports when evaluating substance use among pregnant women. Less than one-third of the health practitioners in this study received training on perinatal substance abuse during their schooling, with interviewees tending to report little continuing education in the area during the past five years. Additional research is called for to further explore the issue of substance abuse among pregnant women in Nebraska