UCSF Fresno Family and Community Medicine Research Focuses Attention on Substance Use Among Pregnant Women

Pregnant women are amongst the most vulnerable to adverse health effects from substance use, but the prevalence of the use of tobacco, alcohol and other drugs during pregnancy has not been widely studied in the San Joaquin Valley. Now, preliminary data from a UCSF Fresno research project shows perinatal substance use may be higher in Fresno County than the national average.

L to R: Dan V. Tran, DO; Keerat K. Singh, DO, MPH; and M. Shoaib Khan, MD

The UCSF Fresno Department of Family and Community Medicine retrospective study, “Prevalence of Perinatal Substance Use in a Large Tertiary Care Hospital,” found 16.7% of deliveries had some kind of substance that was not prescribed during the delivery process. According to a 2020 report by the National Institute of Drug Abuse, nationwide, about 5% of pregnant women use one or more addictive substances.

For the study, a team of residents at UCSF Fresno Family and Community Medicine that included third-year residents Keerat K. Singh, DO, MPH, and Dan Vy Tran, DO, reviewed medical charts of individuals who delivered at Community Regional Medical Center (CRMC) from Jan. 1, 2021, to Dec. 31, 2022. The residents collected data on the prevalence of substance use, types of substances used and the risk-ratio of infants requiring admission to the Neonatal Intensive Care Unit (NICU).

Drs. Singh and Tran said the preliminary results of their retrospective study were surprising and concerning. They were not expecting the rate of substance use among individuals delivering at CRMC to be about three times higher than the national average.

“We know that substance use is an issue in our community but it’s an even more important issue during pregnancy,” said Dr. Singh. Substance use during pregnancy can lead to poor outcomes for both the mother and baby, she said. The preliminary results of the study found the risk of NICU admission is 2.2 times higher in infants of mothers with perinatal substance use. The research showed the most common substances used were marijuana, methamphetamine, tobacco, alcohol, and methadone.

The perinatal substance use retrospective study was one of 15 poster presentations presented in February 2024 at the 27th Annual UCSF Fresno Family and Community Medicine Research Expo.

Residents in the Department of Family and Community Medicine are asked to conduct research during their three years of residency. The department has been building addiction services and learning around addiction care into the curriculum for the past four years and residents are encouraged to choose projects that address the core issues around addiction and substance use, said M. Shoaib Khan, MD, MSPH, who is the director of research and scholarly activity in the department.

Family and Community Medicine residents provide prenatal care in their continuity clinics and rotate at CRMC to help in the delivery of low-risk births. Seeing obstetrical patients with substance use gave the residents motivation to look at the prevalence of substance use, said Dr. Khan, who is board certified in Family Medicine and Addiction Medicine, and is the physician lead for Family and Community Medicine’s obstetrics service at CRMC.

The UCSF Fresno Department of Obstetrics and Gynecology residency program is also based at CRMC and provides the full spectrum of OB-GYN care, including high-risk prenatal services to high-risk deliveries. The Family and Community residents’ preliminary research results have been shared with UCSF Fresno OB-GYN physicians, as well as with nursing and other staff at CRMC.  “We’re collaborative. We are all working together on this – all working to improve the care for patients living with addiction.,” Dr. Khan said.

Drs. Khan, Singh and Tran caution the results of the substance use study are preliminary and because the study focused on substance use at delivery in a tertiary care hospital, the prevalence rate in the community could be higher.

Further research is needed to determine the true prevalence of perinatal substance use, Dr. Khan said. The substance use project will continue next year. Two residents, currently in their second year of training, will finish the project.

Drs. Singh and Tran hope the research’s preliminary results will create momentum for obstetricians to implement validated screening for substance use during the first prenatal care visit. “And for those who screen positive, we should have resources available for the moms to go where they can be safe because that will help prevent complications during pregnancy, such as preterm delivery, and that can help the baby as well,” Dr. Tran said.

Dr. Singh is hopeful the research sheds light on perinatal substance use – and on a nationwide scale. Once the study’s results are final and are published there may be other areas of the country that become motivated to implement validated screening for substance use at the first prenatal visit, she said.

“At the end of the day, this is about advocacy,” Dr. Khan said of the UCSF Fresno perinatal substance use research. “This is about getting people into care and finding ways to enhance resources for treatment options.”