Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

The 4P's Plus© Screen for Substance Use in Pregnancy: Clinical Application and Outcomes

Journal of Perinatology volume 25, pages 368–374 (2005)Cite this article

Abstract

OBJECTIVE:

Determine the prevalence of substance use among pregnant women in five diverse communities utilizing the 4P's Plus© screen for alcohol, tobacco, and other drug use.

STUDY DESIGN:

Pregnant women enrolled in prenatal care clinics in five communities were screened for substance use with the 4P's Plus©. Those women with a positive screen underwent an assessment for substance use through a follow-up structured clinical interview conducted at the same prenatal visit.

RESULTS:

Among 7818 women in five communities, 2555 (32.7%) had a positive screen for substance use in pregnancy. Four of the communities conducted a follow-up assessment on all women with a positive screen (n=1548). Among these women, 717 (15% of the total population) had continued use after learning of the pregnancy. Overall, 21% of the pregnant women used alcohol prior to recognition of the pregnancy, and 11% continued use after knowledge of the pregnancy. Among the 512 women who continued to use alcohol, 2% were drinking daily, 7% were drinking 3 to 6 days per week, 27% were drinking 1 to 2 days per week, and 63% were drinking less than 1 day per week. The rates of marijuana use and other illicit drug use among the women were 7 and 2%, respectively, prior to knowledge of pregnancy and dropped to 3 and 1% after learning of the pregnancy.

CONCLUSION:

The 4P's Plus© identifies not only those pregnant women whose drinking or drug use is at a high enough level to impair daily functioning, but provides an opportunity for early intervention for the much larger group of women whose pregnancies are at risk from relatively small amounts of substance use.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Chasnoff IJ, Burns WJ, Schnoll SH, Burns KA . Cocaine use in pregnancy. N Engl J Med 1985;313:666–669.

    Article  CAS  Google Scholar 

  2. Shiono PH, Klebanoff MA, Nugent RP, et al. The impact of cocaine and marijuana use on low birth weight and preterm birth: a multicenter study. Am J Obstet Gynecol 1995;72:19–27.

    Article  Google Scholar 

  3. Armstrong MA, Osejo VG, Lieberman L, Carpenter DM, Pantoja PM, Escobar GJ . Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes. J Perinatol 2003;23:3–9.

    Article  Google Scholar 

  4. Frank DA, Bauchner H, Parker S, et al. Neonatal body proportionality and body composition after in utero exposure to cocaine and marijuana. J Pediatr 1990;117:622–626.

    Article  CAS  Google Scholar 

  5. Chasnoff IJ, Anson A, Hatcher R, Stenson H, Iaukea K, Randolph L . Prenatal exposure to cocaine and other drugs: outcome at four to six years. In: Harvey JA, Kosofsky BE, editors. Cocaine Effects On the Developing Brain. New York, NY: Annals of the New York Academy of Science; 1998. p. 314–328.

    Google Scholar 

  6. Fried PA, Watkinson B . 36- and 48-month neurobehavioral follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol. Dev Behav Pediat 1990;11(2):49–58.

    CAS  Google Scholar 

  7. Wekselman K, Spiering K, Hetteberg C, Kenner C, Flandermeyer A . Fetal alcohol syndrome from infancy through childhood: a review of the literature. J Pediatr Nurs 1995;10(5):296–303.

    Article  CAS  Google Scholar 

  8. Sood B, Delaney-Black V, Covington C, et al. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. Dose–response effect. Pediatrics 2001;108(e34):1–9.

    Google Scholar 

  9. Morse B, Gehshan S, Hutchins E . Screening for substance abuse during pregnancy: improving care, improving health. National Center for Education in Maternal and Child Health. 1997.

  10. Chasnoff IJ . Psychosocial Issues in Pregnancy. Washington, DC: American College of Obstetrics and Gynecology; 2002.

    Google Scholar 

  11. Ewing J . Detecting alcoholism: the CAGE questionnaire. JAMA 1984;252:1905–1907.

    Article  CAS  Google Scholar 

  12. Kitchens JM . Does this patient have an alcohol problem? JAMA 1994;272:1782–1787.

    Article  CAS  Google Scholar 

  13. Bottoms SF, Martier SS, Sokol RJ . Refinements in screening for risk drinking in reproductive-aged women: the “NET” results. Alcoholism 1989;13:339.

    Google Scholar 

  14. Sokol RJ, Martier SS, Ager JW . The T-ACE questions: practical prenatal detection of risk-drinking. Am J Obstet Gynecol 1989;160:863–868.

    Article  CAS  Google Scholar 

  15. Russsell M, Martier SS, Sokol RJ, et al. Screening for pregnancy risk-drinking: TWEAKing the tests. Alcsm Clin Exp Res 1991;15:368 abstract no. 338.

    Article  Google Scholar 

  16. Russell M, Martier SS, Sokol RJ, et al. Screening for pregnancy risk-drinking. Alcsm Clin Exp Res 1994;18:1156–1161.

    Article  CAS  Google Scholar 

  17. Chan AW, Pristach EA, Welte JW, Russell M . Use of the TWEAK test in screening for alcoholism/heavy drinking in three populations. Alcsm Clin Exp Res 1993;17:1188–1192.

    Article  CAS  Google Scholar 

  18. Howell E, Heiser N, Thornton C, Moreno L, Chasnoff IJ, Hill I . Third Annual Report: Evaluation of the Demonstration to Improve Access to Care for Pregnant Substance Abusers. Washington, DC: Mathematica Policy Research; 1996.

    Google Scholar 

  19. Chasnoff IJ, Hung WC . The 4P's Plus. Chicago: NTI Publishing; 1999.

    Google Scholar 

  20. Chasnoff IJ, Neuman K, Thornton C, Callaghan MA . Screening for substance use in pregnancy: a practical approach for the primary care physician. Am J Obstet Gynecol 2001;184:752–758.

    Article  CAS  Google Scholar 

  21. Chasnoff IJ, Hutchins E . Motivating Providers to Screen for Alcohol Use in Pregnancy. Philadelphia, PA: American Public Health Association; 2002.

    Google Scholar 

  22. Johnson BT . DSTAT: Software for the Meta-Analytic Review of Research Literatures. Hillsdale, NJ: Lawrence Erlbaum Associates; 1989.

    Google Scholar 

  23. National Institute on Drug Abuse. National Pregnancy and Health Survey: Drug Use among women Delivering Live Births: 1992. Rockville, MD: US Department of Health and Human Services; 1996.

  24. Chasnoff IJ, Landress HJ, Barrett ME . The prevalence of drug or alcohol use during pregnancy and discrepancies in mandory reporting in Pinellas County, Florida. N Engl J Med 1990;322:1202–1206.

    Article  CAS  Google Scholar 

  25. Clark CM, Li DC, Conry J, Loock R . Structural and functional brain integrity of Fetal Alcohol Syndrome in Nonretarded Cases. Pediatrics 2000;105:1096–1099.

    Article  CAS  Google Scholar 

  26. Larrson G . Prevention of fetal alcohol effects: an antenatal program for early detection of pregnancies at risk. Acta Obstet Gynecol Scand 1983;62:171–178.

    Article  Google Scholar 

  27. Chasnoff IJ, Griffith DR, MacGregor S, Dirkes K, Burns KA . Temporal patterns of cocaine use in pregnancy: perinatal outcome. JAMA 1989;261(12):1741–1744.

    Article  CAS  Google Scholar 

  28. Perl Harold I . Numerous studies demonstrate effectiveness of brief interventions. Frontlines, November NIAAA, 2000.

  29. U.S. Preventive Services Task Force Ratings: Strength of Recommendations and Quality of Evidence. Guide to Clinical Preventive Services, Third Edition: Periodic Updates, 2000–2003. Rockville, MD: Agency for Healthcare Research and Quality; http://www.ahrq.gov/clinic/3rduspstf/ratings.htm.

  30. ACOG Committee on Ethics. At-risk drinking and illicit drug use: Ethical issues in obstetric and gynecologic practice. ACOG Committee Opinion No. 294. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004;103:1021–1031.

Download references

Author information

Authors and Affiliations

  1. Children's Research Triangle, Chicago, IL, USA

    Ira J Chasnoff MD, Richard F McGourty PhD & Gregory W Bailey PhD

  2. Maternal Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Washington, DC, USA

    Ellen Hutchins ScD

  3. University of Chicago Comer Children's Hospital, Chicago, IL, USA

    Saundra O Lightfoot MPH

  4. Ventura County Medical Center, Ventura, CA, USA

    Leslie Lynn Pawson MD

  5. Ventura County Public Health, Ventura, CA, USA

    Cynthia Fahey RN, PHN

  6. Southern New Jersey Perinatal Coalition, Camden, NJ, USA

    Barbara May RN, MPH

  7. Southern Illinois Healthcare Foundation, East St. Louis, IL, USA

    Paula Brodie MSHPE & Larry McCulley MS

  8. San Luis Obispo County Public Health Department, Family Health Services Division, San Luis Obispo, CA, USA

    Jan Campbell RN, PHN

Authors
  1. Ira J Chasnoff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard F McGourty PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory W Bailey PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ellen Hutchins ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Saundra O Lightfoot MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leslie Lynn Pawson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cynthia Fahey RN, PHN
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Barbara May RN, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paula Brodie MSHPE
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Larry McCulley MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jan Campbell RN, PHN
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by grants to: Children's Research Triangle from Maternal Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services Number 1H51MC00013; San Luis Obispo County Public Health Department, Family Health Services Division from First 5 San Luis Obispo, San Luis Obispo, CA, USA; and Southern Illinois Healthcare Foundation Healthy Start from Maternal Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services Numbers 5H49MC00049-03 and 5H75MC00010-030

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chasnoff, I., McGourty, R., Bailey, G. et al. The 4P's Plus© Screen for Substance Use in Pregnancy: Clinical Application and Outcomes. J Perinatol 25, 368–374 (2005). https://doi.org/10.1038/sj.jp.7211266

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211266

This article is cited by

Search

Advanced search

Quick links