THE MOTHERISK ALCOHOL AND SUBSTANCE USE HELPLINE: 10 YEARS OF EXPERIENCE AND COUNTING
Main Article Content
Keywords
Alcohol, pregnancy, fetal alcohol spectrum disorder, substance use, childbearing age
Abstract
The Motherisk Alcohol and Substance Use Helpline at The Hospital for Sick Children in Toronto, Canada, is a unique telephone service providing evidence-based information on the negative effects associated with alcohol and substance use in pregnancy and lactation. We describe the characteristics of the service, the demographics of the callers, and the inquiries made during its first ten years of service.
Since its inception in November 1998 until November 2008, almost 20,000 calls had been received with 60% of calls initiated by pregnant and breastfeeding women, the remainder from various health care providers. Most women exposed to alcohol and substances were of Caucasian descent (80%), employed (65%), and married (46%) with some level of post-secondary education (52%). The demographics of the callers deviate from the well-documented cohort of women at risk of engaging in alcohol and substance use in pregnancy and lactation, confirming that a selective group of women is more likely to use the services offered by the Motherisk program. Thus, further efforts are required to reach out to the subgroup of women at high risk of continuing their harmful behaviors during pregnancy and lactation.
References
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29. Sarkar M, Burnett M, Carriere S, Cox LV, Dell CA, et al. Screening and recording of alcohol use among women of child-bearing age and pregnant women. Can J Clin Pharmacol 2009;17(1):242-63.
30. Gfroerer JC, Hughes AL. The feasibility of collecting drug abuse data by telephone. Public Health Report 1991;106(4): 384-93.
31. Novick G. Is there a bias against telephone interviews in qualitative research? Research in Nursing and Health 2008;31:391-8.
32. Shannon EE, Mathias CW, Marsh DM, Dougherty DM, Liguori A. Teenagers don’t always lie: characteristics and correspondence of telephone and in-person reports of adolescent drug use. Drug Alcohol Depend 2007; 90(2):288-91.
33. Lewis LN, Hickey M, Doherty DA, Skinner SR. How do pregnancy outcomes differ in teenage mothers? A Western Australian study. MJA 2009;190(10):537-41.
34. Ziebe S, Loft A, Petersen JH, et al. Embryo quality and developmental potential is compromised by age. Acta Obset Gynecol Scand 2001;80(2): 169-74.
35. Berenson AB, Stiglich NJ, Wilkinson GS, Anderson GD. Drug abuse and other risk factors for physical abuse in pregnancy among white non-Hispanic, black and Hispanic women. Am J Obstet Gynecol 1991;164(1):1491-6.
36. El Mohandes A, Herman AA, El-Khorazaty M, et al. Prenatal care reduces the impact of illicit drug use on perinatal outcome. J Perinatal 2003; Jul-Aug:23(5);354-60.
37. Knight EM, James H, Edwards CH, et al. Relationships of serum illicit drug concentrations during pregnancy to maternal nutritional status. J Nutr 1994;124:973-80.
38. Tuten M, Jones HE. A partner’s drug-using status impacts women’s drug treatment outcome. Drug and Alcohol Dependence 2003; 70(3):327-30.
39. Chambliss LR. Intimate partner violence and its implication for pregnancy. Clin Obstet and Gynecol 2008;51(2): 385-97.
40. Quinlivan JA, Evans SF. Impact of domestic violence and drug abuse in pregnancy on maternal attachment and infant temperament in teenage mothers in the setting of best clinical practice. Arch Womens Ment Health 2005;8:191-9.
41. Chander G, McCaul ME. Co-occuring psychiatric disorders in women with addictions. Obstet Gynecol Clin North Am 2003;30(3):469-81.
42. Mitsuhiro SS, Chalem E, Barros MM, Guinsburg R, Laranjeira R. Teenage pregnancy: use of drugs in the third trimester and prevalence of psychiatric disorders. Rev Bras Psiquiatr 2006;28(2): 122-5.
43. Fitzsimons HE, Tuten M, Vaidva V, Jones HE. Mood disorders affect drug treatment success of drug-dependent pregnant women. J of Substance Abuse Treat 2007;32:19-25.
44. Zapata LB, Hillis SD, Marchbanks PA, Curtis KM, Lowry R. Methamphetamine use is independently associated with recent risky sexual behaviors and adolescent pregnancy. J Sch Health 2008;78 (12):641-8.
45. De Genna NM, Cornelius MD, Cook RL. Marijuana use and sexually transmitted infections in young women who were teenage mothers. Women’s Health Issues 2007; 17(5):300-9.
46. Bell J, Harvey-Dodds L. Pregnancy and injecting drug use. BMJ 2008;336:1303-5.
47. Rubak S, Sandboek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. British J of Gen Practice 2005;55(513): 305-12.
48. Covington SS. Gender-responsive services. Presentation at the meetings of the United Nations Office on Drugs and Crime entitled “Women’s Drug Treatment: Lessons Learned”, Vienna, Austria, 15-17. December 2003.
49. Polygenis D, Wharton S, Malmberg C, Sherman N, Kennedy D, Koren G, Einarson TR. Moderate alcohol consumption during pregnancy and the incidence of fetal malformations: a meta-analysis. Neurotoxicol Teratol 1998;20(1):61-7
50. Nulman I, Rover J, Kennedy D, Wasson C, Gladstone J, Fried S, Koren G. Binge alcohol consumption by non-alcohol dependent women during pregnancy affects child behaviour, but not general intellectual functioning; a prospective controlled study. Archives of Women’s Mental Health 2004; 7(3):173-81.
51. Koren G, Nulman I, Rovet J, Greenbaum R, Loebstein M, Einarson T. Long term neurodevelopmental risks in children exposed in utero to cocaine: the Toronto adoption study. Ann N Y Acad Sci 1998;846:306-13.
52. Koren G. Drinking alcohol while breastfeeding. Will it harm my baby? Can Fam Physician 2002;48:39-41.
53. Sarkar M, Djulus J, Koren G. When a cocaineusing mother wishes to breastfeed: proposed guidelines. Ther Drug Monit 2005;27(1):1-2.
54. Djulus J. Marijuana use and breastfeeding. Canadian Family Physician 2005;51:349-50.
55. Glatstein MM, Garcia-Bournissen F, Finkelstein Y, Koren G. Methadone exposure during lactation. Can Fam Physician 2008; 54(12):1689-90.
56. Births Statistics Canada. Health Statistics Division. Pregnancy Outcomes 2005;82-224- XWE.
57. Harrison PA, Sidebottom AC. Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation. Matern Child Health J 2009;13: 386-94.
58. Cornelius MD, Goldschmidt L, Day NL, Larkby C. Alcohol, tobacco and marijuana use among pregnant teenagers: 6-year follow-up of offspring growth effects. Neurotox Teratol 2002;24(6):703-10.
59. Chambers CD, Kavteladze L, Joutchenko L, Bakhireva LN, Jones KL. Alcohol consumption patterns among pregnant women in Moscow region of the Russian Federation. Alcohol 2006;38(3): 133-7.
60. CAMH Population Studies eBulletin. Trends in Cannabis, Cocaine and Ecstasy use among Ontario Adults, 1977-2003. Nov/Dec 2004. Vol. 5, No.6
61. Racine N, Motz M, Leslie M, Pepler D. Breaking the Cycle pregnancy outreach program: reaching out to improve the health and well-being of pregnant substance involved mothers. Journal of the Ass. for Research on Mothering. 2009:11(1):279-290.
62. Draper JC, McCance-Katz EF. Medical illness and comorbidities in drug users: implications for addiction pharmacotherapy treatment. Substance Use and Misuse 2005;40(13):1899- 1921.
2. Health Canada. Canadian Tobacco Use Monitoring Survey. Ottawa: Health Canada. 2005. http://hc-sc.gc.ca/hc-ps/tobactabac/ research-recherche/stat/_ctumsesutc_ 2005/ann_summary-sommaire-eng.php (Accessed on June 10, 2009 )
3. Matteson KA, Peipert JF, Allsworth J, Phipps MG, Redding CA. Unplanned pregnancy: does past experience influence the use of a contraceptive method? Obstetrics and Gynecology 2006; 107(1): 121-7.
4. Martino SC, Collins RL, Ellickson PL, Klein DJ. Exploring the link between substance use and abortion: the roles of unconventionality and unplanned pregnancy. Perspectives on Sexual and Reproductive Health 2006; 38(2): 66-75.
5. Naimi TS, Lipscomb LE, Brewer RD, Gilbert BD. Binge drinking in the preconception period and the risk of unintended pregnancy: implications for women and their children. Pediatrics 2003;111: 1136-41.
6. Bell J, Harvey-Dodds L. Pregnancy and injecting drug use. BMJ 2008;336(7656): 1303-5.
7. Shankaran S, Lester BM, Das A, Bauer CR, Bada HS, Lagasse L, et al. Impact of maternal substance use during pregnancy on childhood outcome. Semin Fetal Neonatal Med 2007; 12(2):143-50.
8. Bauer CR, Shankaran S, Bada HS, Lester B, Wright LL, Krause-Streinrauf H, et al. The maternal lifestyle study: drug exposure during pregnancy and short-term maternal outcomes. American Journal of Obst and Gynecol 2002; 186:487-95.
9. Curet LB, His AC. Drug abuse during pregnancy. Clinical Obstet and Gynecol 2002; 45:73-88.
10. Nash K, Sheard E, Rovet J, Koren G. Understanding fetal alcohol spectrum disorder (FASD): toward identification of a behavioral phenotype. The Scientific World Journal 2008; 8: 873-882.
11. Windham, GC, Hopkins B, Fenster L, Swan SH. Prenatal active or passive tobacco smoke exposure and the risk of preterm delivery or low birth weight. Epidemiology 2000;11:427- 433.
12. Pollack H, Lantz PM, Frohna JG. Maternal smoking and adverse birth outcomes among singletons and twins. Am J Public Health 2000; 90:395-400.
13. Office of the Surgeon General. Women and smoking: a report of the Surgeon General; Department of Health and Human Services: Washington, DC, USA, 2002; Available online: http://www.cdc.gov/mmwr/preview/mmwrhtm l/rr5112a4.htm (Accessed on June 26, 2009).
14. Rogers JM. Tobacco and pregnancy. Birth Def Res C Embryo Today 2008;84(1):1-15.
15. Fantuzzi G, Aggazzotti G, Righi E, Facchinetti F, Bertucci E, Kanitz S, et al. Preterm delivery and exposure to active and passive smoking during pregnancy: a case–control study from Italy. Paediatr Perinat Epidemiol 2007; 21(3):194–200.
16. Kennare R, Heard A, Chan A. Substance use during pregnancy: risk factors and obstetric and perinatal outcomes in South Australia. Australian and New Zealand. Journal of Obstetrics and Gynaecology 2005;45:220-25.
17. Kelly JJ, Davis PG, Henschke PN. The drug epidemic: effects on newborn infants and health resource consumption at a tertiary perinatal centre. J Paediatr Child Health 2000; 36:262-4.
18. Covington CY, Nordstrom-Klee B, Ager J, Sokol R, Delaney-Black V. Birth to age 7 growth of children prenatally exposed to drugs a prospective cohort study. Neurotox and Teratol 2002;24: 489-96.
19. Abdel-Latif ME, Bajuk B, Lui K, Oei J. Short term outcomes of infants of substance-using mothers admitted to neonatal intensive care units in New South Wales and the Australian Capital Territory. Journal of Paediatrics and Child Health 2007;43:127-33.
20. Nulman I, Rovet J, Altmann D, Bradley C, Einarson T, Koren G. Neurodevelopment of adopted children exposed in utero to cocaine. Can Med Assoc J 1994:151(11):1591-7.
21. Day NL, Richardson GA, Goldschmidt L, Robles N, Taylor PM, Stoffer DS, Cornelius MD, Geva D. Effect of prenatal marijuana exposure on the cognitive development of offspring at age three. Neurotox and Teratol 1994:16(2):169-75.
22. Koren G, Chan D, Klein J, Karaskov T. Estimation of fetal exposure to drugs of abuse, environmental tobacco smoke, and ethanol. Ther Drug Monit. 2002;24:23-25.
23. Lester BM, Soghly M, Wright LL. The maternal lifestyle study: drug use by meconium toxicology and maternal self report. Pediatrics 2001;107:309-17.
24. Pegues DA, Engelgau MM, Woernle CH. Prevalence of illicit drugs detected in the urine of women of childbearing age in Alabama public health clinics. Public Health Report 1994;109:530-8.
25. Deikman ST, et al. A survey of obstetriciangynecologists on their patients’ alcohol use during pregnancy. Obstetrics and Gynecol 2000;95(5):756-63.
26. Miner KJ, Holtan N, Braddock ME, Cooper H, Kloehn D. Barriers to screening and counseling pregnant women for alcohol use. Minnesota Medicine 1996;79:43-7.
27. Nanson JL, Bolaria R, Snyder RE, Morse BA, Weiner L. Physician awareness of fetal alcohol syndrome: a survey of pediatricians and general practitioners. Canadian Medical Association Journal 1995;152(7):1071-6.
28. Nevin AC, Parshuram C, Nulman I, Koren G, Einarson A. A survey of physician’s knowledge regarding awareness of maternal alcohol use and the diagnosis of FAS. BMC Fam Pract 2002;3(1):2.
29. Sarkar M, Burnett M, Carriere S, Cox LV, Dell CA, et al. Screening and recording of alcohol use among women of child-bearing age and pregnant women. Can J Clin Pharmacol 2009;17(1):242-63.
30. Gfroerer JC, Hughes AL. The feasibility of collecting drug abuse data by telephone. Public Health Report 1991;106(4): 384-93.
31. Novick G. Is there a bias against telephone interviews in qualitative research? Research in Nursing and Health 2008;31:391-8.
32. Shannon EE, Mathias CW, Marsh DM, Dougherty DM, Liguori A. Teenagers don’t always lie: characteristics and correspondence of telephone and in-person reports of adolescent drug use. Drug Alcohol Depend 2007; 90(2):288-91.
33. Lewis LN, Hickey M, Doherty DA, Skinner SR. How do pregnancy outcomes differ in teenage mothers? A Western Australian study. MJA 2009;190(10):537-41.
34. Ziebe S, Loft A, Petersen JH, et al. Embryo quality and developmental potential is compromised by age. Acta Obset Gynecol Scand 2001;80(2): 169-74.
35. Berenson AB, Stiglich NJ, Wilkinson GS, Anderson GD. Drug abuse and other risk factors for physical abuse in pregnancy among white non-Hispanic, black and Hispanic women. Am J Obstet Gynecol 1991;164(1):1491-6.
36. El Mohandes A, Herman AA, El-Khorazaty M, et al. Prenatal care reduces the impact of illicit drug use on perinatal outcome. J Perinatal 2003; Jul-Aug:23(5);354-60.
37. Knight EM, James H, Edwards CH, et al. Relationships of serum illicit drug concentrations during pregnancy to maternal nutritional status. J Nutr 1994;124:973-80.
38. Tuten M, Jones HE. A partner’s drug-using status impacts women’s drug treatment outcome. Drug and Alcohol Dependence 2003; 70(3):327-30.
39. Chambliss LR. Intimate partner violence and its implication for pregnancy. Clin Obstet and Gynecol 2008;51(2): 385-97.
40. Quinlivan JA, Evans SF. Impact of domestic violence and drug abuse in pregnancy on maternal attachment and infant temperament in teenage mothers in the setting of best clinical practice. Arch Womens Ment Health 2005;8:191-9.
41. Chander G, McCaul ME. Co-occuring psychiatric disorders in women with addictions. Obstet Gynecol Clin North Am 2003;30(3):469-81.
42. Mitsuhiro SS, Chalem E, Barros MM, Guinsburg R, Laranjeira R. Teenage pregnancy: use of drugs in the third trimester and prevalence of psychiatric disorders. Rev Bras Psiquiatr 2006;28(2): 122-5.
43. Fitzsimons HE, Tuten M, Vaidva V, Jones HE. Mood disorders affect drug treatment success of drug-dependent pregnant women. J of Substance Abuse Treat 2007;32:19-25.
44. Zapata LB, Hillis SD, Marchbanks PA, Curtis KM, Lowry R. Methamphetamine use is independently associated with recent risky sexual behaviors and adolescent pregnancy. J Sch Health 2008;78 (12):641-8.
45. De Genna NM, Cornelius MD, Cook RL. Marijuana use and sexually transmitted infections in young women who were teenage mothers. Women’s Health Issues 2007; 17(5):300-9.
46. Bell J, Harvey-Dodds L. Pregnancy and injecting drug use. BMJ 2008;336:1303-5.
47. Rubak S, Sandboek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. British J of Gen Practice 2005;55(513): 305-12.
48. Covington SS. Gender-responsive services. Presentation at the meetings of the United Nations Office on Drugs and Crime entitled “Women’s Drug Treatment: Lessons Learned”, Vienna, Austria, 15-17. December 2003.
49. Polygenis D, Wharton S, Malmberg C, Sherman N, Kennedy D, Koren G, Einarson TR. Moderate alcohol consumption during pregnancy and the incidence of fetal malformations: a meta-analysis. Neurotoxicol Teratol 1998;20(1):61-7
50. Nulman I, Rover J, Kennedy D, Wasson C, Gladstone J, Fried S, Koren G. Binge alcohol consumption by non-alcohol dependent women during pregnancy affects child behaviour, but not general intellectual functioning; a prospective controlled study. Archives of Women’s Mental Health 2004; 7(3):173-81.
51. Koren G, Nulman I, Rovet J, Greenbaum R, Loebstein M, Einarson T. Long term neurodevelopmental risks in children exposed in utero to cocaine: the Toronto adoption study. Ann N Y Acad Sci 1998;846:306-13.
52. Koren G. Drinking alcohol while breastfeeding. Will it harm my baby? Can Fam Physician 2002;48:39-41.
53. Sarkar M, Djulus J, Koren G. When a cocaineusing mother wishes to breastfeed: proposed guidelines. Ther Drug Monit 2005;27(1):1-2.
54. Djulus J. Marijuana use and breastfeeding. Canadian Family Physician 2005;51:349-50.
55. Glatstein MM, Garcia-Bournissen F, Finkelstein Y, Koren G. Methadone exposure during lactation. Can Fam Physician 2008; 54(12):1689-90.
56. Births Statistics Canada. Health Statistics Division. Pregnancy Outcomes 2005;82-224- XWE.
57. Harrison PA, Sidebottom AC. Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation. Matern Child Health J 2009;13: 386-94.
58. Cornelius MD, Goldschmidt L, Day NL, Larkby C. Alcohol, tobacco and marijuana use among pregnant teenagers: 6-year follow-up of offspring growth effects. Neurotox Teratol 2002;24(6):703-10.
59. Chambers CD, Kavteladze L, Joutchenko L, Bakhireva LN, Jones KL. Alcohol consumption patterns among pregnant women in Moscow region of the Russian Federation. Alcohol 2006;38(3): 133-7.
60. CAMH Population Studies eBulletin. Trends in Cannabis, Cocaine and Ecstasy use among Ontario Adults, 1977-2003. Nov/Dec 2004. Vol. 5, No.6
61. Racine N, Motz M, Leslie M, Pepler D. Breaking the Cycle pregnancy outreach program: reaching out to improve the health and well-being of pregnant substance involved mothers. Journal of the Ass. for Research on Mothering. 2009:11(1):279-290.
62. Draper JC, McCance-Katz EF. Medical illness and comorbidities in drug users: implications for addiction pharmacotherapy treatment. Substance Use and Misuse 2005;40(13):1899- 1921.