Underdetection of Substance Abuse

To the Editor: The use of intoxicants during pregnancy is recognized as being harmful to both the mother and the fetus.¹–⁴ Detecting such use in order to intervene should be part of routine prenatal care. In the study by Chasnoff et al. in the April 26, 1990, issue,⁵ discrepancies related to race and economic status were identified in the reporting of substance and alcohol use. In another report,⁶ Chasnoff promotes a type of prenatal care in which basic clinical skills are used to evaluate lifestyle and to diagnose and intervene in substance abuse during pregnancy. To determine whether a model.