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Tran EL, England LJ, Park Y, Denny CH, Kim SY. Systematic Review: Polysubstance Prevalence Estimates Reported during Pregnancy, US, 2009-2020. Matern Child Health J 2023; 27:426-458. [PMID: 36752906 PMCID: PMC10521102 DOI: 10.1007/s10995-023-03592-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The objective of this systematic review is to describe polysubstance studies and their prevalence estimates among pregnant people in the US. METHODS This review was not subject to protocol preparation or registration with the International Prospective Register of Systematic Reviews (PROSPERO) because outcome data were not reported. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist was followed. Four scientific literature databases were used to identify articles published from January 1, 2009 to June 3, 2020 reporting prenatal exposure to two or more substances in the US. A standardized process of title and abstract screening followed by a two-phase full-text review was used to assess study eligibility. RESULTS A total of 119 studies were included: 7 case-control studies, 7 clinical trials, 76 cohort studies, and 29 cross-sectional studies. Studies varied with respect to study design, time period, region, sampling and participant selection, substances assessed, and method of exposure ascertainment. Commonly reported polysubstance prevalence estimates among studies of pregnant people included combinations with alcohol, marijuana, and/or tobacco/nicotine. The range of prevalence estimates was wide (alcohol 1-99%; marijuana 3-95%; tobacco/nicotine 2-95%). DISCUSSION Polysubstance use during pregnancy is common, especially with alcohol, marijuana, and/or tobacco/nicotine. Future research to assess polysubstance use during pregnancy could help better describe patterns and ultimately help mitigate its effects on maternal and infant health outcomes.
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Affiliation(s)
- Emmy L Tran
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA.
- Eagle Global Scientific, LLC, 2835 Brandywine Rd, Suite 200, Atlanta, GA, 30341, USA.
| | - Lucinda J England
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Youngjoo Park
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Clark H Denny
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
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Nguyen RH, Knapp EA, Li X, Camargo CA, Conradt E, Cowell W, Derefinko KJ, Elliott AJ, Friedman AM, Khurana Hershey GK, Hofheimer JA, Lester BM, McEvoy CT, Neiderhiser JM, Oken E, Ondersma SJ, Sathyanarayana S, Stabler ME, Stroustrup A, Tung I, McGrath M. Characteristics of Individuals in the United States Who Used Opioids During Pregnancy. J Womens Health (Larchmt) 2023; 32:161-170. [PMID: 36350685 PMCID: PMC9940795 DOI: 10.1089/jwh.2022.0118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental Influences on Child Health Outcomes (ECHO) Program, and determined which characteristics were associated with opioid use during pregnancy. Materials and Methods: Cross-sectional data obtained from 21,905 pregnancies of individuals across the United States enrolled in the ECHO between 1990 and 2021 were analyzed. Medical records, laboratory testing, and self-report were used to determine opioid-exposed pregnancies. Multiple imputation methods using fully conditional specification with a discriminant function accounted for missing characteristics data. Results: Opioid use was present in 2.8% (n = 591) of pregnancies. The majority of people who used opioids in pregnancy were non-Hispanic White (67%) and had at least some college education (69%). Those who used opioids reported high rates of alcohol use (32%) and tobacco use (39%) during the pregnancy; although data were incomplete, only 5% reported heroin use and 86% of opioid use originated from a prescription. After adjustment, non-Hispanic White race, pregnancy during the years 2010-2012, higher parity, tobacco use, and use of illegal drugs during pregnancy were each significantly associated with opioid use during pregnancy. In addition, maternal depression was associated with increased odds of opioid use during pregnancy by more than two-fold (adjusted odds ratio 2.42, 95% confidence interval: 1.95-3.01). Conclusions: In this large study of pregnancies from across the United States, we found several factors that were associated with opioid use among pregnant people. Further studies examining screening for depression and polysubstance use may be useful for targeted interventions to prevent detrimental opioid use during pregnancy, while further elucidation of the reasons for use of prescription opioids during pregnancy should be further explored.
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Affiliation(s)
- Ruby H.N. Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Emily A. Knapp
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elisabeth Conradt
- Department of Psychology, Pediatrics, Obstetrics/Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Whitney Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Karen J. Derefinko
- Department of Preventative Medicine and Pharmacology, Addictive Science, and Toxicology, University of Tennessee, Memphis, Tennessee, USA
| | - Amy J. Elliott
- Department of Pediatrics, Avera Research Institute, School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Alexander M. Friedman
- Department of Obstetrics and Gynecology, School of Medicine, Columbia University, New York, New York, USA
| | - Gurjit K. Khurana Hershey
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio, USA
| | - Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barry M. Lester
- Department of Psychiatry and Pediatrics, Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Jenae M. Neiderhiser
- Department of Psychology, Penn State University, University Park, Pennsylvania, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Steven J. Ondersma
- Division of Public Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, Michigan State University, Flint, Michigan, USA
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Meagan E. Stabler
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Annemarie Stroustrup
- Department of Pediatrics and Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Irene Tung
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Gaalema DE, Snell LM, Tidey JW, Sigmon SC, Heil SH, Lee DC, Bunn JY, Park C, Hughes JR, Higgins ST. Potential effects of nicotine content in cigarettes on use of other substances. Prev Med 2022; 165:107290. [PMID: 36208817 PMCID: PMC10275576 DOI: 10.1016/j.ypmed.2022.107290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
A national nicotine reduction policy has the potential to reduce cigarette smoking and associated adverse health impacts among vulnerable populations. However, possible unanticipated adverse effects of reducing nicotine content in cigarettes, such as increasing the use of alcohol or other abused substances, must be examined. The purpose of this study was to evaluate the effects of exposure to varying doses of nicotine in cigarettes on use of other substances. This was a secondary analysis (n = 753) of three simultaneous, multisite, double-blind, randomized-controlled trials examining 12 weeks of exposure to study cigarettes varying in nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco) among daily smokers from three vulnerable populations: individuals with affective disorders (n = 251), individuals with opioid use disorder (n = 256), and socioeconomically-disadvantaged women of reproductive age (n = 246). Effect of study cigarette assignment on urine toxicology screens (performed weekly) and responses to drug and alcohol use questionnaires (completed at study weeks 6 and 12) were examined using negative binomial regression, logistic regression, or repeated measures analysis of variance, controlling for sex, age, and menthol status. The most common substances identified using urine toxicology included tetrahydrocannabinol (THC; 44.8%), cocaine (9.2%), benzodiazepine (8.6%), and amphetamines (8.0%), with 57.2% of participants testing positive at least once for substance use (27.3% if excluding THC). No significant main effects of nicotine dose were found on any of the examined outcomes. These results suggest that reducing nicotine content does not systematically increase use of other substances, even among individuals at increased risk of substance use. ClinicalTrials.gov Identifiers: NCT02232737, NCT2250664, NCT2250534.
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Affiliation(s)
- Diann E Gaalema
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America.
| | - L Morgan Snell
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Stacey C Sigmon
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Dustin C Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University, Baltimore, MD, United States of America
| | - Janice Y Bunn
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Claire Park
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - John R Hughes
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
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White O, Roeder N, Blum K, Eiden RD, Thanos PK. Prenatal Effects of Nicotine on Obesity Risks: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159477. [PMID: 35954830 PMCID: PMC9368674 DOI: 10.3390/ijerph19159477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022]
Abstract
Nicotine usage by mothers throughout pregnancy has been observed to relate to numerous deleterious effects in children, especially relating to obesity. Children who have prenatally been exposed to nicotine tend to have lower birth weights, with an elevated risk of becoming overweight throughout development and into their adolescent and adult life. There are numerous theories as to how this occurs: catch-up growth theory, thrifty phenotype theory, neurotransmitter or endocrine imbalances theory, and a more recent examination on the genetic factors relating to obesity risk. In addition to the negative effect on bodyweight and BMI, individuals with obesity may also suffer from numerous comorbidities involving metabolic disease. These may include type 1 and 2 diabetes, high cholesterol levels, and liver disease. Predisposition for obesity with nicotine usage may also be associated with genetic risk alleles for obesity, such as the DRD2 A1 variant. This is important for prenatally nicotine-exposed individuals as an opportunity to provide early prevention and intervention of obesity-related risks.
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Affiliation(s)
- Olivia White
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (O.W.); (N.R.)
- Department of Psychology, University at Buffalo, Buffalo, NY 14203, USA
| | - Nicole Roeder
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (O.W.); (N.R.)
- Department of Psychology, University at Buffalo, Buffalo, NY 14203, USA
| | - Kenneth Blum
- Division of Addiction Research, Center for Psychiatry, Medicine & Primary Care (Office of Provost), Western University Health Sciences, Pomona, CA 91766, USA;
| | - Rina D. Eiden
- Department of Psychology, Social Science Research Institute, The Pennsylvania State University, University Park, PA 16801, USA;
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions (BNNLA), Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (O.W.); (N.R.)
- Department of Psychology, University at Buffalo, Buffalo, NY 14203, USA
- Correspondence: ; Tel.: +1-(716)-881-7520
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English F, Greyson D. "You still have that fear": Policy constraints on informed decision making about legalized cannabis use during pregnancy and lactation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103774. [PMID: 35772267 DOI: 10.1016/j.drugpo.2022.103774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cannabis is the most commonly used drug during pregnancy, excluding alcohol and tobacco, in the United States. Cannabis consumption during pregnancy is increasing along with greater legal and social acceptance. METHODS We conducted a qualitative content analysis of 23 in-depth interviews with pregnant and lactating people in Massachusetts, a state that legalized cannabis for adult use in 2016. Our aim was to explore how policy constrains or facilitates people's ability to make informed decisions about cannabis use during pregnancy and lactation. Our analysis was conducted using an ecosocial approach, recognizing that the implementation and interpretation of cannabis policy can be understood at multiple levels, which interact with each other and shape the health and experiences of individuals. Additionally, this analysis was informed by a harm reduction approach in which we acknowledge the complexity surrounding cannabis use during pregnancy and lactation, while attempting to identify ways to reduce potentially harmful consequences. RESULTS Findings revealed that, despite the legal status of cannabis, there continues to be a lack of clarity for pregnant and lactating people regarding the legal implications of cannabis use. Inconsistent state and institutional policies about drug testing of mothers and newborns leave a cloud of fear hanging over the experiences of people who use cannabis and inhibit their ability to obtain expert advice from healthcare providers. CONCLUSION Decision makers in public and institutional policy should work to clarify and update policies regarding substance use during pregnancy following legalization of a new substance, and ensure that pregnant and lactating people are afforded the same legal protections as the general population.
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Affiliation(s)
- Faith English
- Department of Health Promotion and Policy 325 Arnold House, School of Public Health & Health Sciences, University of Massachusetts Amherst, 715 North Pleasant St. Amherst, MA, 01003, USA.
| | - Devon Greyson
- Department of Communication N308 Integrative Learning Center 650 N. Pleasant St. University of Massachusetts Amherst, Amherst, MA, 01003, USA.
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Tavella RA, DE Abreu VOM, Muccillo-Baisch AL, DA Silva JÚnior FMR. Prevalence of Illicit Drug Use During Pregnancy: A Global Perspective. AN ACAD BRAS CIENC 2020; 92:e20200302. [PMID: 33295578 DOI: 10.1590/0001-3765202020200302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
The World Drug Report 2019 presented an alarming figure to the world: more than 5% of the world's population has been using some type of illicit drug, and that number is growing every year. While its use increases, its abuse during pregnancy has become a global public health problem, resulting in medical and social challenges related to maternal and child health. In this context, the objective of this review was to determine the prevalence of illicit drug use during gestation across the globe, alongside with a critical review of the evaluated studies. Research was performed by simultaneously searching terms ("pregnant woman OR pregnant" OR "gestation" OR "pregnancy" AND "illicit drugs" OR "street drugs") in the databases of the Scientific Electronic Library Online, PubMed, and Web of Science. Comparisons between studies were performed in software Statistica 10.0. The data presented worrying results in relation to the variation in prevalence of illicit drug use during pregnancy, when comparing studies based on interviews or questionnaires (self-reported) (1.65%) and studies based on toxicological analysis (12.28%). In addition, we emphasize the high prevalence (5.16%) of illicit drug use among adolescent pregnant women and the low number of studies on this population. This study reveals worrying data about pregnant drug-user population, mainly the underestimation of prevalence in studies that use only questionnaires or similar methods in comparison to studies that use toxicological analysis of biological matrices. This scenario reveals necessity for health systems in different countries to establish specific public health policies for this population.
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Affiliation(s)
- Ronan A Tavella
- Universidade Federal do Rio Grande, Instituto de Ciências Biológicas, Campus Carreiros, Av. Itália, Km 8, 96203-900 Rio Grande, RS, Brazil
| | - VictÓria O M DE Abreu
- Universidade Federal do Rio Grande, Faculdade de Medicina, Campus Saúde, Rua General Osório, s/n, 96201-900 Rio Grande, RS, Brazil
| | - Ana Luiza Muccillo-Baisch
- Universidade Federal do Rio Grande, Centro Regional para Estudos, Prevenção e Recuperação de Dependentes Químicos, Campus Saúde, Rua General Osório, s/n, 96201-900 Rio Grande, RS, Brazil
| | - FlÁvio M R DA Silva JÚnior
- Universidade Federal do Rio Grande, Instituto de Ciências Biológicas, Campus Carreiros, Av. Itália, Km 8, 96203-900 Rio Grande, RS, Brazil
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Kurti AN. Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control. Exp Clin Psychopharmacol 2020; 28:501-516. [PMID: 31855002 PMCID: PMC8168442 DOI: 10.1037/pha0000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tobacco use has unique, adverse health consequences for reproductive-aged women, particularly should these women become pregnant. Thus, successful efforts to reduce tobacco use among this population have strong potential to improve public health and reduce health disparities. The present review examines contributions to reducing tobacco use among women of childbearing age spanning the domains of tobacco regulatory science and tobacco control from the passage of the Family Smoking Prevention and Tobacco Control Act in 2009 through September 2019. In the domain of tobacco regulatory science, such efforts include research conducted by various National Institutes of Health/Food and Drug Administration (FDA)-supported Tobacco Centers of Regulatory Science, epidemiological surveillance studies, as well as studies examining the potential impact of tobacco regulatory policies currently under consideration by the FDA (e.g., reduced nicotine content cigarettes, health warning labels). Tobacco control efforts within this same 10-year timeframe include developments in pharmacological and psychosocial approaches to promoting tobacco cessation, mHealth interventions, and tobacco control policy. Emerging issues pertinent to ongoing efforts to reduce tobacco use within the domains of both tobacco regulatory science and tobacco control are also reviewed, including e-cigarettes, comorbid health conditions, course of tobacco and other drugs of abuse, and obstacles to the dissemination and implementation of evidence-based treatment and policy. Although the past decade has seen numerous important contributions to reducing tobacco use among reproductive-aged women within both domains, existing obstacles must be surmounted to continue reducing tobacco use and protecting health among this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Acquavita SP, Talks A, Fiser K. Facilitators and Barriers to Cigarette Smoking While Pregnant for Women With Substance Use Disorders. Nicotine Tob Res 2017; 19:555-561. [DOI: 10.1093/ntr/ntw268] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/28/2016] [Indexed: 01/10/2023]
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Palmer KL, Wood KE, Krasowski MD. Evaluating a switch from meconium to umbilical cord tissue for newborn drug testing: A retrospective study at an academic medical center. Clin Biochem 2017; 50:255-261. [DOI: 10.1016/j.clinbiochem.2016.11.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 11/27/2022]
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Washio Y, Cassey H. Systematic Review of Interventions for Racial/Ethnic-Minority Pregnant Smokers. J Smok Cessat 2016; 11:12-27. [PMID: 26925170 PMCID: PMC4764131 DOI: 10.1017/jsc.2014.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Large disparities exist in smoking rates during pregnancy by racial/ethnic status. AIMS The current review examined controlled studies that predominantly included racial/ethnic-minority pregnant smokers for providing smoking cessation treatment. METHODS Two authors independently conducted the literature searches in the standard databases using a combination of the keywords with minority, pregnancy, smoking, and cessation identifiers. RESULTS The searches identified nine articles that met the inclusion criteria. Only two studies exclusively targeted specific minority groups. Most of them provided some form of brief smoking cessation counseling, with two combining with incentives and one combining with pharmacotherapy. Two studies provided intensive cognitive interventions. Pregnant smokers of American Indian or Alaska Native, Hispanic subgroups, and Asian or Pacific Islander are under-studied. CONCLUSIONS Future studies to treat minority pregnant smokers could target under-studied minority groups and may need to directly and intensely target smoking behavior, address cultural and psychosocial issues in an individualized and comprehensive manner, and analyze cost-benefit of an intervention.
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Affiliation(s)
- Yukiko Washio
- Treatment Research Institute, Philadelphia PA, 19106, U.S.A
| | - Heather Cassey
- Temple University, Department of Psychological, Organizational, and Leadership Studies, Philadelphia PA, 19122, U.S.A
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Higuera-Matas A, Ucha M, Ambrosio E. Long-term consequences of perinatal and adolescent cannabinoid exposure on neural and psychological processes. Neurosci Biobehav Rev 2015; 55:119-46. [PMID: 25960036 DOI: 10.1016/j.neubiorev.2015.04.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/30/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
Marihuana is the most widely consumed illicit drug, even among adolescents and pregnant women. Given the critical developmental processes that occur in the adolescent and fetal nervous system, marihuana consumption during these stages may have permanent consequences on several brain functions in later adult life. Here, we review what is currently known about the long-term consequences of perinatal and adolescent cannabinoid exposure. The most consistent findings point to long-term impairments in cognitive function that are associated with structural alterations and disturbed synaptic plasticity. In addition, several neurochemical modifications are also evident after prenatal or adolescent cannabinoid exposure, especially in the endocannabinoid, glutamatergic, dopaminergic and opioidergic systems. Important sexual dimorphisms are also evident in terms of the long-lasting effects of cannabinoid consumption during pregnancy and adolescence, and cannabinoids possibly have a protective effect in adolescents who have suffered traumatic life challenges, such as maternal separation or intense stress. Finally, we suggest some future research directions that may encourage further advances in this exciting field.
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Affiliation(s)
- Alejandro Higuera-Matas
- Department of Psychobiology, School of Psychology, National University of Distance Learning (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain.
| | - Marcos Ucha
- Department of Psychobiology, School of Psychology, National University of Distance Learning (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain
| | - Emilio Ambrosio
- Department of Psychobiology, School of Psychology, National University of Distance Learning (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain
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White TJ, Redner R, Skelly JM, Higgins ST. Examining educational attainment, prepregnancy smoking rate, and delay discounting as predictors of spontaneous quitting among pregnant smokers. Exp Clin Psychopharmacol 2014; 22:384-91. [PMID: 25069014 PMCID: PMC4180793 DOI: 10.1037/a0037492] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We investigated three potential predictors (educational attainment, prepregnancy smoking rate, and delay discounting [DD]) of spontaneous quitting among pregnant smokers. These predictors were examined alone and in combination with other potential predictors using study-intake assessments from controlled clinical trials examining the efficacy of financial incentives for smoking cessation and relapse prevention. Data from 349 pregnant women (231 continuing smokers and 118 spontaneous quitters) recruited from the greater Burlington, VT, area contributed to this secondary analysis, including psychiatric/sociodemographic characteristics, smoking characteristics, and performance on a computerized DD task. Educational attainment, smoking rate, and DD values were each significant predictors of spontaneous quitting in univariate analyses. A model examining those three predictors together retained educational attainment as a main effect and revealed a significant interaction of DD and smoking rate (i.e., DD was a significant predictor at lower but not higher smoking rates). A final model considering all potential predictors, included education, the interaction of DD and smoking rate, and five additional predictors (i.e., stress ratings, the belief that smoking during pregnancy will "greatly harm my baby," age of smoking initiation, marital status, and prior quit attempts during pregnancy). The study presented here contributes new knowledge on predictors of spontaneous quitting among pregnant smokers with substantive practical implications for reducing smoking during pregnancy.
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Affiliation(s)
- Thomas J. White
- Vermont Center on Behavior & Health, University of Vermont
- Department of Psychiatry, University of Vermont
| | - Ryan Redner
- Vermont Center on Behavior & Health, University of Vermont
- Department of Psychiatry, University of Vermont
| | - Joan M. Skelly
- Department of Medical Biostatistics, University of Vermont
| | - Stephen T. Higgins
- Vermont Center on Behavior & Health, University of Vermont
- Department of Psychiatry, University of Vermont
- Department of Psychology University of Vermont
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Wood KE, Sinclair LL, Rysgaard CD, Strathmann FG, McMillin GA, Krasowski MD. Retrospective analysis of the diagnostic yield of newborn drug testing. BMC Pregnancy Childbirth 2014; 14:250. [PMID: 25073780 PMCID: PMC4124162 DOI: 10.1186/1471-2393-14-250] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 07/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study was to identify high-yield screening risk factors for detecting maternal non-medical drug use during pregnancy. Methods A four year retrospective analysis was conducted at an academic medical center. Detailed chart review of both the newborn and mother’s medical record was performed on all cases for which one or more drug(s) or metabolite(s) were identified and confirmed in meconium or urine. Results 229 (9.2%) of 2,497 meconium samples out of 7,749 live births confirmed positive for one or more non-medical drugs. History of maternal non-medical drug and/or tobacco use in pregnancy was present in 90.8% of non-medical drug use cases. Addition of social risk factors and inadequate prenatal care increased the yield to 96.9%. Conclusions Use of focused screening criteria based on specific maternal and social risk factors may detect many prenatal non-medical drug exposures. Electronic supplementary material The online version of this article (doi:10.1186/1471-2393-14-250) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kelly E Wood
- Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA 52242, USA.
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