This study examined the effect of support from trained peer counselors on breastfeeding initiation, duration, and exclusivity among low-income urban women. Training of counselors, under the supervision of a registered nurse certified in lactation, adapted education techniques from Paulo Freire to provide information about lactation management and other health care issues. The study compared infant feeding practices of women who planned to breastfeed and received support from counselors (counselor group, N = 59) to women who requested counselors but, owing to inadequate numbers of trained counselors, did not have a counselor (No-counselor group, N = 43). Women in the counselor group had significantly greater (p < .05) breastfeeding initiation (93 percent vs. 70 percent), exclusivity (77 percent vs. 40 percent), and duration (mean of 15 weeks vs. mean of 8 weeks) than women in the no-counselor group. The findings suggest that peer counselors, well-trained, and with on-going supervision, can have a positive effect on breastfeeding practices among low-income urban women who intend to breastfeed.

The relation between maternal cocaine use and perinatal outcomes was investigated among 17,466 non-Asian singleton deliveries in 1988 from the University of Illinois Perinatal Network data base in the metropolitan Chicago area. Elevated adjusted relative risks (RR) of low birth weight (RR = 2.8, 95% confidence interval (CI) 2.2-3.7), prematurity (RR = 2.4, 95% CI 1.9-3.1), abruptio placentae (RR = 4.5, 95% CI 2.4-8.5), and perinatal death (RR = 2.1, 95% CI 1.1-4.0) were observed for "any" cocaine users (n = 408) compared with women who did not use cocaine or any other drugs or alcohol (n = 17,058). There was an increased (although unstable) risk of intrapartum placenta previa not previously reported (RR = 2.3, 95% CI 1.0-5.1). The relative risk of small-for-gestational-age births for cocaine users who did not smoke (RR = 3.4, 95% CI 1.8-6.5) was greater than that for cocaine users who did (RR = 2.1, 95% CI 1.1-4.1). Irrespective of smoking status, cocaine use during pregnancy increased the risk of small-for-gestational-age births.

In order to provide additional data and perspective to current clinical, policy, and legal debates surrounding the prenatal use of cocaine in the USA, a retrospective cohort study was conducted to examine effects of cocaine on selected perinatal outcomes, and to compare the relative risks of adverse perinatal outcomes among users of cocaine and users of cigarettes. Using data from a large urban perinatal registry, relative risks of selected perinatal outcomes were determined for maternal cocaine users who were non-smokers of cigarettes, and used no marijuana, heroin, amphetamines, or alcohol (n = 64), and for cigarette smokers who do not use illicit drugs or alcohol during pregnancy (n = 3209). When compared with women with no recorded prenatal exposure to drugs or cigarettes (n = 13,043), cocaine users had higher risks than smokers for the following adverse outcomes: low birthweight [Relative Risk (RR) 5.3, 95% Confidence Interval (CI) 3.0-9.3], small-for-gestational age (SGA) [RR 4.2, 95% CI 2.4-7.3], prematurity [RR 4.0, 95% CI 2.3-7.0], abruptio placentae [RR 10.0, 95% CI 3.5-29.0], placenta praevia [RR = 2.4, 95% CI 0.3-17.8] and perinatal death [RR = 5.3, 95% CI 1.9-15.2]. Smokers who did not use any drugs experienced most of the same adverse perinatal outcomes as cocaine users, but the magnitude of risk was greater in cocaine users than in smokers for all outcomes. However, given the greater numbers of cigarette smokers than cocaine users in the population the numbers of infants in the population suffering these adverse outcomes is likely to be greater among offspring of cigarette smokers. The data support the current concern about the risk of cocaine, and current efforts to provide treatment to pregnant cocaine users. The data also underline the continued substantial risks of cigarette smoking to large numbers of pregnant women.

Many factors are associated with low breast-feeding rates among black low-income women. This study examines whether, despite such factors, health professionals' prenatal education of black poor women is assoicated with increased breast-feeding rates. Black women born in the United States who attended a midwives prenatal clinic (N = 159) were randomly assigned to two types of prenatal education or were followed up in a control group. All women were interviewed on entry into the study and after delivery of their infants. Women assigned to group classes attended at least one session discussing myths, problems, and benefits of breast-feeding. Women assigned to individual prenatal counseling spoke with a pediatrician or nurse practitioner, who discussed breast-feeding topics similar to those covered in the classes. Women in the control group received no additional prenatal education. The three study groups had significantly different percentages of women who breast-fed (controls 22%, classes 46%, individual sessions 53%). Higher percentages of women in the study groups carried out their prenatal plans to breast-feed (controls 50%, classes 86%, individual sessions 62%) or breast-fed despite prenatal plans to bottle-feed (controls 10%, classes 26%, individual sessions 48%). After multivariable analysis controlling for age, prenatal pians to breast-feed, prior breast-feeding experience, perceived support for breast-feeding, education, gravidity, and employment plans, women in intervention groups had a higher likelihood of breast-feeding than control subjects. These findings suggest that an increase in relatively simple, not-too-time-consuming educational efforts in institutions and offices serving black low-income women might yield significant narrowing of the gap in breast-feeding rates between white affluent women and black low-income women.

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