Substance Use During Pregnancy Bibliography

Annotation: This fact sheet provides information about state policies on substance abuse during pregnancy. A chart provides detail on state-by-state definitions of abuse and what guidance is recommended.

Contact: Guttmacher Institute, 125 Maiden Lane, New York, NY 10038, Telephone: (212) 248-1111 Secondary Telephone: (800) 355-0244 Fax: (212) 248-1951; Washington, D.C. Office (202) 223-5756 E-mail: guttmacher@guttmacher.org Web Site: http://www.guttmacher.org Available from the website.

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Keywords: Child abuse, Child neglect, State legislation, Substance abuse, Substance abuse treatment services, Substance abusing pregnant women

Annotation: This report describes opportunities to avert or ameliorate the outcome of neonatal abstinence syndrome (NAS) along a continuum of care spanning timeframes in the mother's and infant's life and the role of state health agencies. Topics include surveillance for NAS-affected infants and the sources of maternal opiate use; reimbursement for using screening protocols to detect substance abuse early in pregnancy and withdrawal signs in newborns; development of measures to ensure follow-up with opioid-dependent women and receipt of comprehensive services; and collaborative efforts to strengthen clinical standards for identification, management, and follow-up with NAS-affected infants and their families. A state index of resources is included.

Contact: Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA 22202, Telephone: (202) 371-9090 Fax: (571) 527-3189 Web Site: http://www.astho.org Available from the website.

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Keywords: Comprehensive health care, Intervention, Neonatal abstinence syndrome, Neonatal addiction, Newborn infants, Opiates, Population surveillance, Primary prevention, Screening, State health agencies, Substance use

Annotation: This document provides guidance to hospitals, health care providers and affiliated professionals about maternal drug screening, laboratory testing, and reporting of drug-exposed newborns delivered in Washington State. Contents include indicators for testing, hospital policy, newborn and maternal risk indicators, consent issues for testing, newborn drug testing, management of a newborn with positive drug toxicology, and reporting to Children's Administration. Appendices include references and resources, guidelines for obtaining consent, a sample letter, neonatal abstinence syndrome scoring system, and information on Washington's Children's Administration prenatal substance abuse policy.

Contact: Washington State Department of Health, P.O. Box 47890, Olympia, WA 98504-7890, Telephone: (800) 525-0127 Secondary Telephone: (360) 236-4030 Web Site: http://www.doh.wa.gov Available from the website.

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Keywords: Drug use during pregnancy, Guidelines, Hospital services, Infant health, Neonatal abstinence syndrome, Neonatal screening, Newborn infants, State initiatives, State social service agencies, Substance abusing pregnant women, Substance use screening, Washington

Annotation: This fact sheet summaries research findings related to substance use during pregnancy. It discusses the prevalence of substance use among pregnant women; examines the social and psychological issues; and looks at the biological and developmental effects of in-utero drug exposure on children. The effects from using tobacco, alcohol, marijuana, cocaine, heroine, methamphetamine, and prescription drugs each are discussed. The fact sheet also explores the societal impact of prenatal substance exposure and the various interventions for pregnant and parenting substance abusers and newborn infants. Relevant public policies are also discussed. An online training tutorial on this topic is also available.

Contact: National Abandoned Infants Assistance Resource Center, Center for Child & Youth Policy , University of California, Berkeley, 1950 Addison Street, Suite 104, , Berkeley, CA 94720-7402, Telephone: (510) 643-8390 Fax: (510) 643-7019 E-mail: aia@berkeley.edu Web Site: http://aia.berkeley.edu/ Available from the website.

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• Online Tutorial

Keywords: Environmental exposure, Infant health, Newborn infants, Policy, Pregnant women, Prenatal development, Research, Substance abuse, Substance abusing pregnant women, Training

Annotation: This tutorial presents an overview of the prevalence and nature of substance abuse among pregnant women in the United States and discusses factors that often contribute to substance abuse. It reviews the potential impact of prenatal exposure to various substances on infant development and well-being. The tutorial also examines interventions for the prevention and treatment of substance abuse during pregnancy, from identification and education to individual and family-based services. Interventions proven to promote the safety and well-being of affected newborns, such as family treatment drug courts and father involvement, are also discussed. In addition, the tutorial explores relevant federal and state policies.

Contact: National Abandoned Infants Assistance Resource Center, Center for Child & Youth Policy , University of California, Berkeley, 1950 Addison Street, Suite 104, , Berkeley, CA 94720-7402, Telephone: (510) 643-8390 Fax: (510) 643-7019 E-mail: aia@berkeley.edu Web Site: http://aia.berkeley.edu/ Available from the website.

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• Tutorial References

Keywords: Education, Family support services, Fathers, Health promotion, Infant development, Infant health, Intervention, Public policy, Risk factors, Substance abuse, Substance abuse prevention, Substance abuse treatment, Substance abusing pregnant women

Annotation: This booklet describes the role of health professionals in screening and identifying pregnant women with substance abuse issues. Contents include guidelines for screening and follow-up, sample screening tools, recommendations related to drug testing of pregnant women and newborns, and referral resources. [Funded by the Maternal and Child Health Bureau]

Contact: Health Education Resource Exchange, Washington State Department of Health, P.O. Box 47833, Olympia, WA 98504-7833, Telephone: (360) 236-3736 Fax: (360) 664-4500 E-mail: here@doh.wa.gov Web Site: http://here.doh.wa.gov Available from the website.

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Keywords: Guidelines, Newborns, Pregnant women, Screening, Substance abuse, Substance abuse treatment services, Tests

Annotation: This paper addresses aspects of substance abuse and addiction in women of childbearing age, with an emphasis on the potential adverse effects of substance use and substance use disorders during pregnancy. The paper details mechanisms of harm from alcohol and other substances during pregnancy. Policy recommendations are included.

Contact: American Society of Addiction Medicine, 4601 North Park Avenue, Upper Arcade, Suite 101, Chevy Chase, MD 20815, Telephone: (301) 656-3920 Fax: (301) 656-3815 E-mail: email@asam.org Web Site: http://www.asam.org Available from the website.

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Keywords: Alcohol abuse, Alcohol consumption behavior, Alcohol use during pregnancy, Infant health, Public policy, Substance abuse, Substance abusing pregnant women, Women's health

Annotation: This practice brief, which is geared toward practitioners who work with pregnant and parenting women who abuse substances, outlines specific engagement and retention strategies to decrease noncompliance and increase participation among this population. Topics include (1) client barriers and service barriers to engagement and retention and (2) tactics for assessing and addressing agency barriers.

Contact: National Abandoned Infants Assistance Resource Center, Center for Child & Youth Policy , University of California, Berkeley, 1950 Addison Street, Suite 104, , Berkeley, CA 94720-7402, Telephone: (510) 643-8390 Fax: (510) 643-7019 E-mail: aia@berkeley.edu Web Site: http://aia.berkeley.edu/ Available from the website.

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Keywords: Mothers, Pregnant women, Programs, Social services, Substance abuse, Substance abuse prevention, Substance abuse treatment, Substance abusing pregnant women

Annotation: This fact sheet provides information about fetal alcohol spectrum disorders (FASD). The fact sheet discusses progress in understanding, preventing, and treating the problem since alcohol's ability to cause birth defects was first recognized over three decades ago. Steps for health professionals and women who are pregnant or who are considering becoming pregnant to take to prevent FASD are provided. Research geared toward better preventing and treating FASD in the future is also discussed.

Contact: National Institute on Alcohol Abuse and Alcoholism, , 5635 Fishers Lane, MSC 9304, Bethesda, MD 20892-9304, Telephone: (301) 443-3860 Fax: (301) 780-1726 E-mail: NIAAAweb-r@exchange.nih.gov Web Site: http://www.niaaa.nih.gov Available from the website.

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Keywords: Alcohol use during pregnancy, Birth injuries, Chronic illnesses and disabilities, Fetal alcohol effects, Fetal alcohol syndrome, Infant health, Prevention, Reproductive heath, Research, Treatment, Trends

Annotation: This report identifies community-level fetal alcohol spectrum disorder (FASD) interventions and policies that can prevent fetal alcohol-exposed pregnancies (AEDs) and reduce the prevalence of physical, mental, behavioral, and learning disabilities due to prenatal alcohol exposure. Topics also include an epidemiological overview, screening for women at risk, current evidence, prevention interventions, and recommendations and future research directions.

Contact: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, Telephone: (800) 232-4636 Secondary Telephone: (888) 232-6348 E-mail: cdcinfo@cdc.gov Web Site: http://www.cdc.gov/ncbddd Available from the website.

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Keywords: Alcohol, Early intervention, Fetal alcohol effects, Fetal alcohol syndrome, Fetal development, Pregnant women, Prenatal care, Prevention, Screening, Substance abusing pregnant women

Annotation: This report highlights ten recommendations to improve and expand efforts regarding early identification, diagnostic services, and quality research on interventions for individuals with fetal alcohol spectrum disorders (FASDs) and their families. Also included are action steps, accomplishments of the Task Force, an overview of the strategic plan, an overview of the Center for Excellence, and information about the Interagency Coordinating Committee on fetal alcohol syndrome.

Contact: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, Telephone: (800) 232-4636 Secondary Telephone: (888) 232-6348 E-mail: cdcinfo@cdc.gov Web Site: http://www.cdc.gov/ncbddd Available from the website.

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Keywords: Early intervention, Federal initiatives, Fetal alcohol effects, Fetal alcohol syndrome, MCH research, Prevention, Strategic plans, Substance abusing pregnant women

Annotation: This purpose of this curriculum development guide is to enhance the knowledge and skills of health care providers to recognize and prevent fetal alcohol spectrum (FAS) disorders by aiding in the development of educational programs and materials. The guide is organized by three types of learning outcomes: competencies, learning goals, and learning objectives, allowing educators or trainers to select goals and objectives appropriate for participants' learning needs and skill levels, along with university or organization criteria. Chapter contents include seven competency topics: foundation; screening and brief interventions; models of addiction; biological effects of alcohol on the fetus; screening, diagnosis, and assessment of FAS; treatment across the lifespan for persons with FASDs; and ethical, legal, and policy issues.

Contact: Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, Telephone: (800) 232-4636 Secondary Telephone: (888) 232-6348 E-mail: cdcinfo@cdc.gov Web Site: http://www.cdc.gov Available from the website.

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Keywords: Alcohol use during pregnancy, CD-ROMs, Fetal alcohol effects, Fetal alcohol syndrome, Fetal development, Prenatal addiction, Prenatal care, Professional education, Resources for professionals, Screening, Substance abusing pregnant women

Annotation: This site provides access to the September 21, 2006 webcast focusing on fetal alcohol spectrum disorders (FASD). Five PowerPoint presentations are provided in addition to the agenda and the audio file. The presentations include: (1) prevention, education, intervention, and advocacy; (2) emerging issues about FASD in Michigan; (3) emerging issues about FASD in Detroit, Michigan; (4) Detroit Department of Health and Wellness promotion; and (5) the presentation from the National Organization on Fetal Alcohol Syndrome. [Funded by the Maternal and Child Health Bureau]

Contact: CityMatCH, University of Nebraska Medical Center, Department of Pediatrics, 982170 Nebraska Medical Center, Omaha, NE 68198-2170, Telephone: (402) 552-9500 E-mail: citymch@unmc.edu Web Site: http://www.citymatch.org Available from the website.

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Keywords: Advocacy, Conferences, Early intervention, Fetal alcohol syndrome, Infant health, Michigan, Multimedia, Prevention, Substance abusing pregnant women

Annotation: This report focuses on the Alcohol Screening Assessment in Pregnancy (ASAP2) project during the period October 1,2002, through September 30, 2005.The purpose of this project was to build on the success of the original Massachusetts ASAP Project (ASAP1) by addressing lessons learned and expanding the project to include two additional screening times during pregnancy, futher development of brief intervention protocols and tools, and patient follow-up procedures. The report , which includes an abstract, is divided into the following sections: (1) purpose of the project, (2) goals and objectives, (3) methodology, (4) evaluation, (5) results and outcomes, (6) publications and products, (7) dissemination and utilization of results, (8) future plans and follow-up, and (9) type and amount of support and resources needed to replicate. References are included. The report includes seven appendices, which encompass a pregnancy questionnaire written in several languages, screening questions, flow charts, a screening tool, marketing materials, a list of ASAP2 providers, and evaluation materials. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Library at Georgetown University, Box 571272, Washington, DC 20057-1272, Telephone: (202) 784-9770 E-mail: mchgroup@georgetown.edu Web Site: https://www.mchlibrary.org

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Keywords: Alcohol use during pregnancy, Assessment, Final reports, Intervention, Massachusetts, Pregnant women, Screening, Substance abuse

Annotation: This paper highlights recent findings from academic literature concerning the debate about the consequences of prenatal substance exposure for infants and young children. The paper discusses the prevalence of substance abuse during pregnancy; research limitations; and child growth and development in the following areas: motor development, cognitive development, language skills, behavior, attachment, school performance, and physical growth. Intervention strategies, including overarching programmatic recommendations and successful service interventions for health family development, are also discussed. A conclusion and references are included.

Contact: National Abandoned Infants Assistance Resource Center, Center for Child & Youth Policy , University of California, Berkeley, 1950 Addison Street, Suite 104, , Berkeley, CA 94720-7402, Telephone: (510) 643-8390 Fax: (510) 643-7019 E-mail: aia@berkeley.edu Web Site: http://aia.berkeley.edu/ Available from the website.

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Keywords: Academic achievement, Attachment behavior, Child behavior, Child development, Child health, Cognitive development, Families: Intervention, Infant development, Infant health, Language development, Motor development, Research, Substance abuse, Substance abusing pregnant women

Annotation: The print and CD editions of this program manual contain pretested research-based plans, strategies, and communications tools to develop public awareness about the dangers of alcohol consumption to the developing fetus. Chapter contents include partnership mobilization and program planning, provider involvement, materials dissemination, program evaluation, and pilot program descriptions. Appendices include materials and images, a glossary of terms, contact information, and references. The CD edition also provides four case studies that describe how the program was implemented and adapted by four pilot communities; links directly to Web-based resources; and provides PDF files of the communications tools. The CD supplement provides production source sfiles for the communications tools to allow graphic designers and commercial printers to create additional materials.

Contact: U.S. Substance Abuse and Mental Health Services Administration, One Choke Cherry Road, Rockville, MD 20857, Telephone: (877) SAMHSA-7 Secondary Telephone: (877) 726-4727 E-mail: Web Site: http://www.samhsa.gov Available at no charge. Document Number: HHS Pub. No. SMA-4013.

Keywords: Alcohol use during pregnancy, CD-ROMs, Fetal alcohol effects, Fetal alcohol syndrome, Pregnant women, Program development, Public awareness materials, Spanish language materials, Training materials

Annotation: This report describes a Healthy Start program in Ford Heights and Chicago Heights, Illinois, from 2001-2004 to improve access to quality maternal and child health services in order to reduce the high rate of infant mortality and reduce health disparities in this medically underserved area. It discusses isk factors for poor perinatal outcomes including mothers who smoke, drank, or used street drugs during their pregnancy, as well as other behavioral risk factors and pregnancy during adolescence. Report contents include an overview of racial and ethnic disparities focused on by the project; descriptions of project implementation, management and governance, and accomplishments; the impact of the project on systems of care, the community and the state, and the role of local government. A local evaluation report addressing issues of infant mortality, first trimester prenatal care, adequacy of prenatal care, well-child exams, and initial postpartum exams is included. Appendices include service tables and project data as well as samples of products produced during the project. [Funded by the Maternal and Child Health Bureau]

Contact: Maternal and Child Health Library at Georgetown University, Box 571272, Washington, DC 20057-1272, Telephone: (202) 784-9770 E-mail: mchgroup@georgetown.edu Web Site: https://www.mchlibrary.org Available from the website.

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Keywords: Access to health care, Adolescent pregnancy, Alcohol use during pregnancy, Barriers, Drug use during pregnancy, Final reports, Healthy Start, Illinois, Infant mortality, MCH services, Prenatal care, Prevention programs, Racial factors, Substance abuse

Annotation: This report presents information from the summit, Hope for Women in Recovery: Understanding and Addressing the Impact of Prenatal Alcohol Exposure, held on July 21-22, 2005, in Raleigh, North Carolina. The summit was designed to educate women of childbearing age in recovery and substance abuse treatment center staff about fetal alcohol spectrum disorders. The report includes information from presentations held at the summit, including personal stories of women in recovery and presentations by health professionals.

Contact: SAMHSA Fetal Alcohol Spectrum Disorders Center for Excellence, 2101 Gaither Road, Suite 600, Rockville, MD 20850, Telephone: (866) 786-7327 E-mail: patricia.getty@samhsa.hhs.gov Web Site: http://www.fasdcenter.samhsa.gov/ Available from the website.

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Keywords: Alcohol consumption during pregnancy, Education, Fetal alcohol syndrome, Perinatal addiction, Perinatal health, Personal narratives, Prenatal addiction, Recovering addicts, Recovering alcoholics, Substance abuse treatment, Substance abusing pregnant women, Women's health

Annotation: This fact sheet discusses results from the National Survey on Drug Use and Health on illicit drug use among pregnant and nonpregnant women ages 15 to 44. The fact sheet, which includes results in brief, also discusses illicit drug use, alcohol use, cigarette use, and substance use during the year after giving birth. Statistical information is presented in figures throughout the fact sheet. Endnotes are included.

Contact: U.S. Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 1 Choke Cherry Road, Room 7-1044, Rockville, MD 20857, Telephone: (240) 276-1212 Web Site: http://www.oas.samhsa.gov/ Available from the website.

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Keywords: Alcohol consumption behavior, Illicit drugs, MCH research, Postpartum women, Smoking, Substance abuse, Substance abusing mothers, Substance abusing pregnant women, Substance use behavior, Surveys, Women's health

Annotation: This brief summarizes the Washington state program Safe Babies, Safe Moms (formerly the Comprehensive Program Evaluation Project, or CPEP) implemented to improve the health and welfare of substance abusing mothers and their young children and provides an update to the October 2003 evaluation report with additional outcome measures and longer periods of follow-up. Measures tracked include demonstrated behavior change in the use of more effective family planning methods, reduced levels of parenting stress, decreased arrest rates, a reduction in low birth weight infants for those pregnant women enrolled in the program before delivery, decreased accepted referrals for child abuse or neglect for mothers enrolled before delivery, and higher employment rates for non-substance abusing Medicaid women than substance abusers.

Contact: Washington State Department of Social and Health Services, Research and Data Analysis Division, P.O. Box 45204, Olympia, WA 98504-5204, Telephone: (360) 902-0707 Fax: (360) 902-0705 E-mail: ellswnm@dshs.wa.gov Web Site: http://www.dshs.wa.gov/rda Available from the website.

• Fact Sheet
• Related Publications

Keywords: Case management, Drug affected infants, High risk mothers, Housing programs, Program evaluation, State programs, Substance abuse treatment services, Substance abusing mothers, Substance abusing pregnant women, Surveys, Washington, Young children

Annotation: This book, which is geared toward parents who have a child with fetal alcohol syndrome (FAS) or with brain damage due to alcohol exposure, provides information about FAS. The book provides an overview of FAS; describes how FAS may affect infants, children, and adolescents during different developmental periods; discusses how to care for and advocate for a child with FAS; discusses issues associated with school for children with FAS; and provides resources.

Contact: Organization of Teratology Information Specialists, 5034A Thoroughbred Lane, Brentwood, TN 37027, Telephone: (866) 626-6847 Secondary Telephone: (615) 649-3087 E-mail: ngreer@otispregnancy.org Web Site: http://otispregnancy.org Available from the website.

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Keywords: Adolescent development, Advocacy, Child development, Consumer education materials, Fetal alcohol effects, Fetal alcohol syndrome, Infant development, School adjustment

Annotation: This primer promotes public education to all Minnesotans who need to know that: (1) there is no known safe time to use any type or amount of alcohol during pregnancy, and (2) alcohol, tobacco, and other drugs have immediate and long-term effects on women's and children's health. The primer provides information, educational resources, and tools in various formats about women's substance abuse, addiction, and its consequences; risk factors associated with women's substance use including sexual and domestic abuse, depression, and other mental health issues; and how to engage a wide range of community members to take action in helping women who abuse substances, particularly during pregnancy. Resources include books, brochures, pamphlets, and other print media; counseling and information phone lines; curricula; Internet resources; prevention planning and resource guides; reports; resource centers; services for children and families, as well as women; and videos for purchase or loan. Resources are identified throughout the primer for African American, Asian American, Latino, and Native American cultures and for lesbian, gay, bisexual, and transgender persons, in addition to general audiences. Appendices include information on selecting and pre-testing educational materials; selecting health information on the Web; community prevention strategies; effective strategies to reduce drinking during pregnancy; facts about women who drink during pregnancy; substance use and the harm to women and children; recognizing and treating alcohol abuse and alcoholism; and a calendar of community events and national health observances. References conclude the primer.

Contact: Minnesota Prevention Resource Center, 38460 Lincoln Trail, Box 549, North Branch, MN 55056, Telephone: (651) 674-4085 Secondary Telephone: (877) 935-4426 Fax: (651) 277-4085 E-mail: mprc@cpyf.org Web Site: http://www.emprc.org/ $10.00 in-state; $12.00 out of state .

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Keywords: Alcohol use during pregnancy, Drug use during pregnancy, Fetal alcohol syndrome, Fetal tobacco syndrome, Minnesota, Perinatal health, Prenatal health, Resource materials, Smoking during pregnancy, State initiatives, Substance abuse prevention, Substance abuse prevention programs, Substance abusing pregnant women, Women's health

Annotation: This primer discusses the problem of substance use, including alcohol, tobacco, and other drugs, in women and girls in Minnesota, especially during pregnancy; and describes how community education can address this problem, with information about specific groups including African Americans, American Indians, Latinos, and college students. The majority of the primer lists and describes resources in a wide variety of formats tohelp understand and educate others about these problems. Formats include printed materials, videos, Internet resources, resource centers, and services. Addresses of vendors are included. The primer includes eight appendices covering topics such as selecting information, community prevention strategies, recognizing and treating alcohol abuse and addiction, and a calendar of health observances.

Contact: Minnesota Prevention Resource Center, 38460 Lincoln Trail, Box 549, North Branch, MN 55056, Telephone: (651) 674-4085 Secondary Telephone: (877) 935-4426 Fax: (651) 277-4085 E-mail: mprc@cpyf.org Web Site: http://www.emprc.org/ Available from the website.

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Keywords: Addiction, Adolescent females, Alcohol consumption behaviors, Bibliographies, Cigarette smoking, Communities, Depression, Directories, Domestic violence, Mental health, Minnesota, Pregnancy, Prevention, Public health, Risk factors, Sexual abuse, Substance abuse, Women's health

Annotation: This report describes the evaluation of the Washington state program Safe Babies, Safe Moms (formerly the Comprehensive Program Evaluation Project, or CPEP) to: (1) develop and implement comprehensive programs for alcohol- and drug-abusing women and their young children, (2) increase the availability of chemical dependency treatment, (3) implement new services called Targeted Intensive Case Management, and (4) enhance housing support services. Report contents include a summary and introduction to the need for the program and its services, client needs and services provided, a program description, methods used for the evaluation, and findings. Survey results and findings are summarized in charts and tables throughout the report and a bibliography is included.

Contact: Washington State Department of Social and Health Services, Research and Data Analysis Division, P.O. Box 45204, Olympia, WA 98504-5204, Telephone: (360) 902-0707 Fax: (360) 902-0705 E-mail: ellswnm@dshs.wa.gov Web Site: http://www.dshs.wa.gov/rda Available from the website.

• Fact Sheet
• Related Publications

Keywords: Case management, Drug affected infants, High risk mothers, Housing programs, Program evaluation, State programs, Substance abuse treatment services, Substance abusing mothers, Substance abusing pregnant women, Surveys, Washington, Young children

Annotation: This book summarizes a workshop convened on October 2-3, 2001, to look at issues surrounding the impact of environmental exposure on the fetus in the uterus, risks of premature birth, as well as child health and well-being throughout life. In addition the role of social and behavioral factors such as stress, anxiety, depression, drug use, alcohol use, and tobacco smoking is discussed. Chapters include: (1) preterm birth and its consequences, (2) labor and delivery, (3) preterm birth and a brief summary of biological pathways, (4) preterm birth and gene-environment interactions, (5) the social implications of preterm birth, and (6) future directions for research. The book also contains abstracts of 18 relevant articles and references. Three appendices contain the workshop agenda, a list of speakers and panelists, and a list of workshop participants.

Contact: National Academies Press, 500 Fifth Street, N.W., Keck 360, Washington, DC 20001, Telephone: (202) 334-3313 Secondary Telephone: (888) 624-8373 Fax: (202) 334-2451 E-mail: customer_service@nap.edu Web Site: http://www.nap.edu Available from the website. Document Number: ISBN 0-309-09065-2.

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Keywords: Childbirth, Conferences, Environment, Environmental exposure, Environmental influences, Genes, Labor, Maternal fetal exchange, Maternal health, Maternal mental health, Prematurity, Preterm birth, Research, Substance abusing mothers, Substance abusing pregnant women