Lifestyle behaviors such as cigarette smoking, weight gain during pregnancy, and use of other drugs play an important role in determining fetal growth. The relationship between lifestyle risk factors and low birth weight is complex and is affected by psychosocial, economic, and biological factors. Cigarette smoking is the largest known risk factor for low birth weight. Approximately 20% of all low birth weight could be avoided if women did not smoke during pregnancy. Reducing heavy use of alcohol and other drugs during pregnancy could also reduce the rate of low birth weight births. Pregnancy and the prospect of pregnancy provide an important window of opportunity to improve women's health and the health of children. The adoption before or during pregnancy of more healthful lifestyle behaviors, such as ceasing to smoke, eating an adequate diet and gaining enough weight during pregnancy, and ceasing heavy drug use, can positively affect the long-term health of women and the health of their infants. Detrimental lifestyles can be modified, but successful modification will require large-scale societal changes. In the United States, these societal changes should include a focus on preventive health, family-centered workplace policies, and changes in social norms. any of the known risk factors associated with low birth weight, such as socioeconomic status, ethnicity, genetic makeup, and obstetric history, are not within a woman's immediate control. However, there are things that a woman can do to improve her chances of having a normal, healthy child. Lifestyle behaviors, such as cigarette smoking, use of other drugs, and nutrition, play an important role in determining fetal growth. Detrimental habits can be modified, but successful modification requires more than just a dose of individual "self control." Stopping lifelong addictive behaviors is very difficult, and a woman who suffers from them requires support and assistance not only from family members and individuals close to her, but also from the health care system and society.

The Role of Lifestyle in Preventing Low Birth Weight

Pregnancy and addiction A comprehensive care model

Methadone offers significant therapeutic benefits to the population of pregnant, opiatedependent women and is currently the treatment of choice for this group. Yet the problem of women who elect to breastfeed while on methadone maintenance frequently vexes providers. Although breast milk offers advantages clearly beneficial to the general population of infants, there is debate about recommending breastfeeding to postpartum women receiving methadone maintenance. Although previous research has shown that amounts of methadone in breast milk appear to be very small, and therefore breastfeeding seems to be safe, women on methadone do not often breastfeed, for a variety of reasons. This article provides an overview of the issues facing providers in treating methadone-maintained women who elect to breastfeed. A comprehensive review of existing literature on the subject is offered, along with clinical advice for practitioners providing care to this population of women and children. J Hum Lact. 20(1):62-71.

Methadone maintenance and lactation: a review of the literature and current management guidelines.

Female drug users and their children have many medical and psychosocial problems, yet they often fail to follow through with prescribed treatments. The present study describes a specialized, case management program for children, birth through age 2, exposed to drugs in utero. Evaluation of program efficacy was examined by comparing 2-year outcomes for women who received different intensities of these child case management services. Mothers who received higher intensity care were more likely to be abstinent from illicit drugs and to have retained custody of their child(ren) at 2-year follow-up than those with lower intensity services. Study findings support clinical and economic efficacy of this model of care.

Effectiveness of Child Case Management Services for Offspring of Drug-Dependent Women

The problem of substance abuse in pregnancy is a major public health dilemma. Effective comprehensive care of drug addicted women has been shown to improve maternal and neonatal out- comes. The Center for Addiction and Pregnancy (CAP) combines the disciplines of pediatrics, substance abuse treatment, obstetrics~gynecology, and family planning in an effort to reduce the barriers to care often presenting in this subpopulation. For the first 100 CAP births, 82% were delivered vaginally, with a mean gestational age of 38 weeks. The Neonatal Intensive Care Unit admission rate was 10%, and the Bayley Scales of lnfant Development performed at 6 and 12 months revealed mean developmental indices within the normal range. In a comparison study, a group of CAP participants had nearly $5,000 savings in costs when compared to a matched cohort. The CAP model of care appears to be an effective mode of treatment for substance abusing pregnant women. Copyright © 1996 Elsevier Science Inc. Keywords-substance abuse; pregnancy; prenatal care; pediatrics; substance abuse treatment.

A Comprehensive Care Model

Cocaine use by pregnant women has increased dramatically in recent years, resulting in well-documented consequences for mothers and offspring. However, even a once weekly peer-oriented intervention can have a positive impact on pregnancy outcome for drug-using women.

T Feng

Papers

Pregnancy and addiction: outcomes and interventions.