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Prenatal Care--A Wise Investment : The cost of preventive medicine is small compared to the resources required to treat a drug-impaired baby.

July 18, 1993|DR. NORMAN B. DUERBECK | Dr. Norman B. Duerbeck, 38, is director of maternal-fetal medicine at White Memorial Medical Center, where he has practiced since last year. He is the newly appointed perinatologist at the hospital and a specialist in fetal development

When a child is born dependent on drugs or alcohol, it enters the world at a disadvantage it may never overcome. Mothers who ingest alcohol, cocaine, marijuana, heroin or other controlled substances subject these miniature addicts to withdrawal symptoms, learning and social disabilities--even retardation.

What enters the mother's bloodstream enters the baby's. It's that simple.

In the last decade, there has been a dramatic increase in drug use by women of childbearing age. A survey conducted by the House Select Committee on Children, Youth and Families of 18 primary public hospitals in 15 major cities found a three- to four-fold increase in the number of infants exposed to dangerous drugs.

An average of 21,500 babies are born in Los Angeles each year. In 1991, almost 12%--or 2,551--exhibited symptoms of exposure to drugs or alcohol. The 1992 figures reflect a 2% increase to 2,973 infants.

The number of babies born addicted to drugs or alcohol at White Memorial Medical Center is well below average, but the increase in drug-exposed infants from 1991 to 1992 is significant. In 1991, 43 of the more than 5,000 babies delivered at White Memorial exhibited damage from dangerous drugs. Last year 67 were born with these symptoms--an increase of 56%.

The increase in drug use by pregnant women reflects a dangerous lack of comprehensive prenatal care. These figures represent more than 2,000 casualties in Los Angeles that could have been avoided with information on the dangers of drug use during pregnancy.

Alcohol consumption during pregnancy is the leading cause of birth defects and mental retardation. During pregnancy, most drugs taken by the mother cross the placenta and enter the bloodstream of the developing fetus. Alcohol impairs cell functions and affects tissue and organ development. Chronic exposure can interfere with the passage of amino acids--protein "building blocks"--from the mother to the fetus.

Fetal alcohol syndrome describes the condition of infants born addicted to alcohol. They are typically underweight at delivery, and during infancy demonstrate dysfunctional brain development. Up to half of the children born to mothers who consumed alcohol during pregnancy will exhibit fetal alcohol syndrome. No clear-cut level of safe alcohol consumption has been determined.

Cocaine use during pregnancy is another prominent cause of birth defects. The drug constricts the blood vessels that lead to the uterus, depriving the fetus of oxygen and nutrients. Newborns who have been exposed to cocaine often have stunted growth, seizures and other brain abnormalities and impaired response skills. These babies also run an increased risk of abnormal development.

Aggressive prenatal care education supports the healthy development of newborns. At the University of California, Davis, urine samples revealed that 25% of 800 women in labor had used cocaine, amphetamines or heroin during pregnancy. Yet many of these women had discontinued their use of prescribed medications because of fetal risk.

Outreach to all mothers, especially to drug-dependent women, is essential for healthy babies. The portion of the health-care dollar consumed by preventive education programs like prenatal care is inconsequential in comparison to the resources required to care for a drug-impaired infant.

The problems these babies have often demand special care and extended hospitalization at costs of more than $1,500 per day. The average stay for a drug- or alcohol-impaired infant is 14 days in neonatal intensive care, which costs about $21,000. If each of the 2,973 drug- or alcohol-dependent babies born in Los Angeles last year required the same hospitalization, the state, insurance companies and hospitals would absorb a $62-million bill.

Hospital-sponsored prenatal care programs, which cost only a few dollars for the hospital and are free for the mother, not only rescue the developing fetus but open the door for treatment and rehabilitation of addicted mothers.

To support preventive education, the state Comprehensive Perinatal Services Program provides free prenatal care at any program-approved clinic. The program is designed to give every baby a healthy start and lower health-care costs by preventing catastrophic and chronic illness in infants and children.

The White Memorial OB-GYN group has a program-approved clinic that will provide a schedule for prenatal care classes beginning in late summer. With an aggressive community outreach and extensive education options, only 1.12% of babies born at White Memorial in 1992 demonstrated signs of exposure to drugs or alcohol, compared to a Los Angeles average of 14%.

Prenatal care programs make a difference by reducing the economic strain on our overextended health care delivery system, by encouraging rehabilitation of addicted mothers, and most importantly, by improving the lives of thousands of infants each year.

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