What do we know about how to enroll and retain pregnant drug users in prenatal care?

The purpose of the study was to determine if the literature describes specific strategies that have been shown to be successful in enrolling and retaining pregnant drug-abusing women in prenatal care and drug treatment. An integrated literature review was performed by searching medical, nursing, public health, social science, dissertation, and governmental databases to identify the studies relevant to this topic. Studies were chosen if they contained (1) data from evaluation of a prenatal care program or drug treatment program for pregnant drug abusers or (2) recommendations by experts in the field on recruitment and retention strategies. Although there is much literature on the subject of substance use in pregnancy and information is available about goals and objectives of demonstration projects across the United States, there are few published studies that actually evaluate outcome measures for intervention programs for pregnant substance users. Three such studies were found. One demonstrated that multiple services assembled in one program can attract and retain clients, generating positive outcomes. Two others demonstrated decreased low birthweight and pregnancy complications in programs designed specifically for pregnant drug users. In these successful programs, there were some commonalities that could be incorporated into the design of future programs. The plethora of research published concerning drug-using pregnant women has been directed at the effect of the drug on the fetus. Few studies evaluate programs successful at enrolling and retaining women, but recommendations by experts in the field present a case for comprehensive programs offering services most needed by women at one site. Randomized control trials of protocols that assist pregnant women to enroll in and continue with prenatal care are needed to answer the urgent questions concerning how to optimize pregnancy outcome.