Drug abuse in pregnancy. Detection and intervention

Drug abuse in the obstetric population of a large urban HMO is discussed. Marijuana metabolites were detected in 9.1% of urines submitted for routine pregnancy testing, while cocaine use was detected in 1.3%. A separate group of urines submitted for urine culture at the time of the first obstetric visit were tested and showed levels of 5.0% and 0.2%, respectively. Cocaine use was associated in an estimated 1-2% of all live births. The unexpected magnitude of this problem led to the creation of an outreach clinic and a process of care. The preliminary experience of our program forms the basis of this report.