Drug use in pregnancy: obstetric perspectives.

The incidence of perinatal chemical use is undoubtedly much higher than the rate of use detected at any single point during pregnancy. As the prevalence is likely to be 10% or greater in any community, obstetricians need to employ measures to detect chemical use, similar to measures taken to detect birth defects, gestational diabetes, syphilis, gonorrhea, and preeclampsia. The use of screening protocols must be accompanied by an awareness of the need for intervention and treatment resources. Identification of perinatal chemical use should be for purposes of medical and social intervention, not criminal prosecution. Obstetric management should focus on the prevention of preterm delivery and intrauterine growth retardation. It should be recognized that pregnancy provides a unique opportunity for the encouragement of positive health behaviors. Programs that include such components may be able to achieve more lasting effects.