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Vermonters are healthy

% of pregnant women who abstain from marijuana use

92%2017

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Story Behind the Curve

Last Updated: July 2015

Author: Division of Maternal and Child Health, Vermont Department of Health

The state-level indicator is measured by the Pregnancy Risk Assessment Monitoring System (PRAMS) a project between the state departments of health and the Centers for Disease Control and Prevention, Division of Reproductive Health. The purpose of PRAMS is to collect state-specific, population-based data on maternal attitudes and experience before, during and shortly after pregnancy.

The vast majority of women in Vermont abstain from illicit drug use during pregnancy (94%, 2010), due to very successful national campaigns about the risk of harm to the baby. Likewise, obstetrical providers and midwives routinely screen for drug use and offer referral, counseling, and treatment, when required.

The Vermont Child Health Improvement Program's (VCHIP) Improving Care for Opioid-Exposed Newborns (ICON) project partners with the Division of Alcohol and Drug Abuse Programs (VDH - ADAP) and the UVM Children's Hospital to study the quality of care provided to Medicaid-eligible opioid-dependent women and their opioid-exposed newborns and implements various activities targeted to improving the care these populations receive across the State.

The ICON team trains and educates health professionals and others who provide services to VT Medicaid-eligible, opioid-dependent pregnant and parenting women and their infants. ICON convenes collaborative conference calls; provides training sessions for professionals; and provides tools and resources relating to substance abuse screening, treatment and service provision to partners across Vermont including but not limited to community hospital teams, primary care practitioners, non-profit organizations and MCH directors. ICON maintains a database relating to opioid-dependent pregnant women and their opioid-exposed infants. Through data collection and analysis, ICON follows several measures (e.g., length of stay for infants, percentage of infants receiving treatment, length of treatment, rate of prematurity, and developmental outcomes). These and other data provide the framework used to assess the impact of ICON's work, identify gaps in care and continuously improve our efforts. In addition to engaging in a project focusing on improving care delivered in UVM Children's Hospital's NeoMed Clinic, ICON recently identified eight "Potentially Better Practices" (PBPs) and disseminated them to community hospital teams statewide who care for Medicaid-eligible, opioid-dependent pregnant and parenting women and their infants. ICON offers quality improvement coaching to support the work of Vermont community hospital teams who have chosen a PBP to plan, implement and study.

Partners
  • Vermont Department of Health / Alcohol and Drug Abuse Programs
  • Vermont Child Health Improvement Program
What Works

The American Academy of Pediatrics recommends that the primary care pediatrician's role in addressing prenatal substance exposure includes prevention, identification of exposure, and recognition of medical issues for the exposed newborn infant, protection of the infant, and follow-up of the exposed infant.

Strategy
  • Ongoing quality improvement work related to Improving Care for Opioid-Exposed Newborns (ICON, described above).
  • Vermont's home visiting programs routinely screen pregnant women for illicit drug use. Home visitors provide needed education, referrals, and follow-up to women who screen positive.

Similar to statewide efforts, local partners are using data to drive local strategy. For regional data on Maternal and Infant Health indicators, check out our Public Health Data Explorer.

Why Is This Important?

Prenatal substance abuse continues to be a problem worldwide. Substance use during pregnancy can adversely affect a growing fetus. Early in pregnancy, fetal malformations may occur while, later in pregnancy, it is the developing fetal brain that is more vulnerable to injury. There is a growing body of research describing the adverse effects of substance use on fetal development, including malformations, abnormal brain development and growth retardation.

The American Academy of Pediatrics (AAP) technical report, "Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus," in the March 2013 Pediatrics (published online Feb. 25), provides information for the most common substances involved in fetal exposure: nicotine, alcohol, marijuana, opiates, cocaine and methamphetamines. http://pediatrics.aappublications.org/content/131/3/e1009

This indicator is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. Click here for more information.

Notes on Methodology

Data is updated as it becomes available and timing may vary by data source. For more information about this indicator, click here.

The PRAMS sample of women who have had a recent live birth is drawn from the state's birth certificate file. Each participating state samples between 1,300 and 3,400 women per year. Women from some groups are sampled at a higher rate to ensure adequate data are available in smaller but higher risk populations. Selected women are first contacted by mail. If there is no response to repeated mailings, women are contacted and interviewed by telephone. Data collection procedures and instruments are standardized to allow comparisons between states.

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