A decade of DOVE: multidisciplinary experience from an obstetric addiction clinic

Aim 

To review a decade of attendances at an obstetric addiction clinic and compare with the general hospital population.

Methods 

Retrospective study of activity between 2009 and 2018. Metrics were reviewed and compared with outcomes for the entire Rotunda Hospital population. Linear regression analyses and Chi square analyses were used as appropriate.

Results 

The rate of attendance has remained stable over the decade studied, 12/1000births. Opioid addiction has significantly (p=0.04) declined and other addictions have increased (p<0.001). Comparing the addiction and non-addiction populations, caesarean section rates are equivalent while unassisted birth is higher (62.2% vs 49.9%, p<0.0001) and instrumental birth is lower (7.4% vs 17.4%, p<0.0001). Prematurity & Fetal growth restriction are more common in the population with addiction. Neonatal abstinence syndrome (NAS) and positive maternal virology have fallen over the decade.

Discussion 

This limited retrospective review of women with addiction in pregnancy identifies a changing profile of attendances. It acknowledges the important role of the drug liaison midwife. It highlights increased risks for this population regarding prematurity and growth restriction, and it is important that these are reflected in care pathways and patient education. Further prospective multivariate analysis is advised to drive responsive service planning to optimise care of pregnant women with addiction.