Mary Anne Armstrong, MA¹, Veronica M. Osejo, BS¹, Leslie Lieberman, MSW², Bruce F. Folck¹, and Gabriel J. Escobar, MD¹. (1) Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, (510) 891-3501, Maryanne.Armstrong@kp.org, (2) Patient Care Services, Kaiser Permanente, 1814 Franklin, Oakland, CA 94612

The purpose of this pilot project was to study neonatal outcomes of women who had positive urine toxicology screening tests during pregnancy but denied substance use on screening questionnaires and did not take advantage of treatment opportunities in a group model health plan (“Deniers”). Treatment was available through Early Start (ES), an obstetric clinic-based perinatal substance abuse treatment program. From a cohort of 26,389 pregnant women who had toxicology screening tests in 1999-2000 and completed screening questionnaires, 141 Deniers were identified. They were compared to women who were screened, assessed and treated by ES (SAT, N=911) and controls with no evidence of substance abuse (N=25,337). Compared to controls, Deniers were younger (10% <19 years old vs. 5%, p=0.004) and less likely to be married (69% vs. 79%, p=0.004 ), have > high school education (56% vs. 69%, p=0.001) and income >$25,000 (71% vs. 80%, p=0.01). Most (75%) toxicology tests were positive for marijuana. The most common barriers to treatment were late to prenatal care, changing prenatal care clinic and language. Infants of Deniers had higher rates of assisted ventilation (4.3%), low birthweight (6.4%), and preterm delivery (8.5%) than infants of SAT (3.4%, 5.7%, 7.5% respectively) and control women (2.2% 4.3%, 6.2% respectively) but differences were not statistically significant. These results suggest that women who deny their substance use on screeners have worse prenatal outcomes than controls and women treated for their substance use. Larger studies of Deniers, including development of strategies for bringing these women in to care, are warranted.

Learning Objectives:

• At the conclusion of this presentation, the participant will be able to characterize pregnant substance abusing women who both deny their substance use and do not seek treatment and assess the effect of this denial on baby outcomes.

Keywords: Substance Abuse Treatment, Pregnancy Outcomes

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.