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Ansari AZ, Al Sayed A, Patibandla S, Kumar S, Patibandla L, Ali R. Emergency Hysterectomy Following Placental Abruption in a Patient With a History of Substance Abuse: A Case Report. Cureus 2024; 16:e57997. [PMID: 38738144 PMCID: PMC11087213 DOI: 10.7759/cureus.57997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Placental abruption is a serious medical condition that can occur during pregnancy, involving the premature separation of the placenta from the inner uterine wall before childbirth. This detachment often leads to severe bleeding, and if conventional methods prove ineffective in managing the bleeding, a hysterectomy may be deemed necessary to ensure the mother's safety. This case report details the management of a 22-year-old female, gravida IV, para III, who experienced placental abruption during her fourth pregnancy. An emergent cesarean section resulted in severe postpartum hemorrhage and disseminated intravascular coagulation (DIC). Positive drug tests for cocaine and methamphetamines added further complexity, leading to an unplanned hysterectomy for life-saving measures. This case underscores the critical importance of early recognition, multidisciplinary collaboration, and timely intervention in managing obstetric emergencies within the context of substance abuse.
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Affiliation(s)
- Ali Z Ansari
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Assem Al Sayed
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Srihita Patibandla
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Sarthak Kumar
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | | | - Rashad Ali
- Obstetrics and Gynecology, South Central Regional Medical Center, Laurel, USA
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McCurdy LY, Yip SW, Worhunsky PD, Zhai ZW, Kim S, Strathearn L, Potenza MN, Mayes LC, Rutherford HJV. Neural correlates of altered emotional responsivity to infant stimuli in mothers who use substances. J Psychiatr Res 2024; 171:126-133. [PMID: 38277872 PMCID: PMC10922955 DOI: 10.1016/j.jpsychires.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Mothers who use substances during pregnancy and postpartum may have altered maternal behavior towards their infants, which can have negative consequences on infant social-emotional development. Since maternal substance use has been associated with difficulties in recognizing and responding to infant emotional expressions, investigating mothers' subjective responses to emotional infant stimuli may provide insight into the neural and psychological processes underlying these differences in maternal behavior. In this study, 39 mothers who used substances during the perinatal period and 42 mothers who did not underwent functional magnetic resonance imaging while viewing infant faces and hearing infant cries. Afterwards, they rated the emotional intensity they thought each infant felt ('think'-rating), and how intensely they felt in response to each infant stimulus ('feel'-rating). Mothers who used substances had lower 'feel'-ratings of infant stimuli compared to mothers who did not. Brain regions implicated in affective processing (e.g., insula, inferior frontal gyrus) were less active in response to infant stimuli, and activity in these brain regions statistically predicted maternal substance-use status. Interestingly, 'think'-ratings and activation in brain regions related to cognitive processing (e.g., medial prefrontal cortex) were comparable between the two groups of mothers. Taken together, these results suggest specific neural and psychological processes related to emotional responsivity to infant stimuli may reflect differences in maternal affective processing and may contribute to differences in maternal behavior in mothers who use substances compared to mothers who do not. The findings suggest potential neural targets for increasing maternal emotional responsivity and improving child outcomes.
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Affiliation(s)
- Li Yan McCurdy
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, 06510, USA; Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA.
| | - Sarah W Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Patrick D Worhunsky
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Zu Wei Zhai
- Department of Neuroscience, Middlebury College, Middlebury, VT, 05753, USA
| | - Sohye Kim
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, 01655, USA; Departments of Psychiatry, Pediatrics, and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, 52242, USA; Hawkeye Intellectual and Developmental Disabilities Research Center, University of Iowa, Iowa City, IA, 52242, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, 06510, USA; The Connecticut Council on Problem Gambling, Wethersfield, CT, 06109, USA; The Connecticut Mental Health Center, New Haven, CT, 06519, USA
| | - Linda C Mayes
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
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Cooke LM, Moodley S, Paruk L. The profile of adolescent patients presenting to a tertiary maternal mental health clinic. S Afr J Psychiatr 2023; 29:2185. [PMID: 38223306 PMCID: PMC10784263 DOI: 10.4102/sajpsychiatry.v29i0.2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
Background Between March 2021 and April 2022, there were 90 037 documented adolescent pregnancies in South Africa. Statistics SA reports that this number is growing. Pregnancy places adolescents at greater risk of psychiatry-related morbidity and may have far-reaching consequences for their children. To date, there is no published data describing the patient profile of adolescent pregnancies in Gauteng Province, South Africa. Aim To describe the patient profile (demographics, schooling history and type of accommodation), pregnancy-related factors, substance use habits and contraceptive use in pregnant adolescents seen at a tertiary care maternal mental health clinic (MMHC). Setting The MMHC at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa. Methods A retrospective file review of all pregnant adolescents referred to the MMHC between January and June 2022. Results The mean age of the patients was 15.2 years; 72% attended school and 97.4% planned to return. Most pregnancies were unplanned (97.9%), wanted (84%) and presented in the second (41.24%) and third (51.55%) trimesters. Most did not report using substances (76.7%). Fifty percent of the participants met the criteria for a major depressive disorder. Repeating a grade was an identifiable risk factor for an increased Edinburgh depression score. An unplanned pregnancy was associated with a higher risk factor assessment. Conclusion Pregnant adolescents represent a vulnerable population group. A greater understanding of this patient profile may inform early psychiatric and psychosocial interventions, improved service delivery and help-seeking behaviour. Contribution This study gives significant insights into the challenges faced, as well as the health and social needs of pregnant adolescents. This contributes to wholistic care and opportunities for early intervention, including awareness of contraceptive use and the risks of substance use and adolescent pregnancy on mental health, benefiting all South African adolescents.
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Affiliation(s)
- Luzaan M Cooke
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanushka Moodley
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laila Paruk
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Seid J, Mohammed E, Muktar Y. Factors associated with perinatal substance use among Ethiopian women: an institutional-based cross-sectional study. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:11913. [PMID: 38389813 PMCID: PMC10880761 DOI: 10.3389/adar.2023.11913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/27/2023] [Indexed: 02/24/2024]
Abstract
Introduction: Substance use during the perinatal period is a significant public health concern, as it can have potential adverse effects on maternal and neonatal health outcomes. Unexpectedly, no previous studies have been conducted to assess the prevalence of substance use during the perinatal period among Ethiopian women. Therefore, this study aimed to determine the magnitude of substance use and its determinant factors during the perinatal period. Method: We conducted a hospital-based descriptive cross-sectional study among a systematically selected sample of 418 women who attended perinatal care between May and July 2022. Data were collected using an interviewer-administered structured questionnaire. Multivariate logistic regression analysis, with a 95% confidence interval and p-values less than 0.05, was employed to identify factors associated with substance use behavior. Result: The prevalence of perinatal substance use was found to be 38.3% (95% CI: 33.5-43.5). Of the women who used substances, 109 (26.1%) reported using chat, 46 (11.0%) reported alcohol consumption, and 5 (1.20%) reported using shisha. Factors significantly associated with substance use behavior during the perinatal period included a history of obstetric complications (AOR = 1.722, 95% CI: 1.022-2.902), the presence of chronic medical conditions (AOR = 3.784, 95% CI: 2.164-6.615), experiencing physical abuse (AOR = 5.323, 95% CI: 2.171-13.050), depression (AOR = 1.963, 95% CI: 1.028-3.749), and experiencing sleep disturbances (AOR = 2.016, 95% CI: 0.975-4.168). Conversely, giving birth to a live baby was found to be a protective factor against substance use behavior (AOR = 0.389, 95% CI: 0.187-0.810). Discussion: This study highlights a high prevalence of substance abuse among women during the perinatal period. In light of these findings, a comprehensive approach is recommended to address perinatal substance use among Ethiopian women. This should include the integration of preventive educational programs into perinatal care.
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Affiliation(s)
- Jemal Seid
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Emam Mohammed
- Department of Public Health, Kutaber Health Center, Kutaber, Ethiopia
| | - Yimer Muktar
- School of Veterinary Medicine, Woldia University, Woldia, Ethiopia
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Jones AA, Duncan MS, Perez-Brumer A, Connell CM, Burrows WB, Oser CB. Impacts of intergenerational substance use and trauma among black women involved in the criminal justice system: A longitudinal analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 153:208952. [PMID: 37654010 PMCID: PMC10474323 DOI: 10.1016/j.josat.2023.208952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Intergenerational substance use and trauma disproportionately impact racialized women. Yet, how these factors impact outcomes in women involved in the criminal justice system is understudied. METHODS Using data from 443 participants in the Black Women in a Study of Epidemics, we assessed the impact of intergenerational substance use and trauma on participant drug use and open Child Protective Services (CPS) cases over 18 months. In repeated-measures logistic regression, intergenerational substance and trauma were independent variables, while participants' drug use at each follow-up and any open CPS case (s) served as separate dependent variables. Models were adjusted for criminal justice involvement, age, marital status, education, childhood guardian, number of children, and prior year homelessness. RESULTS On average, participants were aged 35 years, 64 % had never married, and 44 % were raised by both parents. Two-thirds of women (67 %) reported intergenerational substance use (≥1 parent and/or grandparent with alcohol/drug problems), while only 13 % reported intergenerational trauma. Each increase in the number of parents/grandparents with drug/alcohol problems was associated with 30 % increased odds of participants' drug use (aOR 1.30, 95 % CI: 1.07,1.57) and 40 % increased odds of having an open CPS case (aOR 1.40, 95 % CI: 1.11, 1.78). The association of intergenerational trauma and CPS cases was attenuated with sociodemographic/contextualizing factors. CONCLUSIONS Intergenerational substance use and trauma are associated with negative outcomes. Our findings highlight the need for substance use treatment to address the pervasive generational effects of substance use and trauma faced by racialized women in the criminal justice system.
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Affiliation(s)
- Abenaa A Jones
- Department of Human Development and Family Studies, Pennsylvania State University, United States of America; Consortium for Substance Use and Addiction, The Pennsylvania State University, United States of America.
| | - Meredith S Duncan
- Department of Biostatistics, University of Kentucky, United States of America.
| | | | - Christian M Connell
- Department of Human Development and Family Studies, Pennsylvania State University, United States of America.
| | - William B Burrows
- Department of Biostatistics, University of Kentucky, United States of America.
| | - Carrie B Oser
- Department of Sociology, University of Kentucky, United States of America; Center on Drug & Alcohol Research, Center for Health Equity Transformation.
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Sundaram VL, Lamichhane R, Cecchetti A, Arthur S, Murughiyan U. Maternal and Neonatal Outcomes in Women with Metabolic Syndrome and Substance Use Disorder. Life (Basel) 2023; 13:1933. [PMID: 37763336 PMCID: PMC10533184 DOI: 10.3390/life13091933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Metabolic syndrome amplifies the risk of gestational diabetes, preeclampsia, and preterm labor in pregnant women. Similarly, women with substance use disorder have worsened obstetric and birth outcomes. Despite these two conditions being major healthcare disparities in Appalachia, the health outcomes of this cohort have not been studied thus far. This study looks at the health outcomes of this cohort. METHOD AND RESULTS In this retrospective cohort study, we analyzed 27,955 mothers who delivered at Cabell Huntington Hospital between January 2010 and November 2021. We implemented Chi-square tests to determine the associations and multiple logistic regression methods for comparison after controlling for other factors, and found that MetS, together with SUD, significantly increases the risk as well as the number of pregnancy complications such as gestational diabetes (p-value < 0.001), preeclampsia (p-value < 0.001), premature rupture (p-value < 0.001), preterm labor (p-value < 0.001), and newborn disorder (p-value < 0.001) compared to the women who had none or had either MetS or SUD alone. CONCLUSION Women with both metabolic syndrome and substance abuse had worsened pregnancy and neonatal outcomes compared to women with metabolic syndrome or SUD alone. In conclusion, analysis of all the variables is crucial to strategically planning and implementing health interventions that will positively influence the health outcome of the pregnant woman as well as the child.
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Affiliation(s)
- Vijaya Lakshmi Sundaram
- Department of Clinical and Translational Sciences, Marshall University School of Medicine, 1600 Medical Center Drive, Huntington, WV 25701, USA
| | - Rajan Lamichhane
- Department of Clinical and Translational Sciences, Marshall University School of Medicine, 1600 Medical Center Drive, Huntington, WV 25701, USA
| | - Alfred Cecchetti
- Department of Clinical and Translational Sciences, Marshall University School of Medicine, 1600 Medical Center Drive, Huntington, WV 25701, USA
| | - Subha Arthur
- Department of Clinical and Translational Sciences, Marshall University School of Medicine, 1600 Medical Center Drive, Huntington, WV 25701, USA
| | - Usha Murughiyan
- Department of Clinical and Translational Sciences, Marshall University School of Medicine, 1600 Medical Center Drive, Huntington, WV 25701, USA
- Department of Internal Medicine, Marshall University School of Medicine, 1600 Medical Center Drive, Huntington, WV 25701, USA
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Szlyk HS, Constantino-Pettit A, Li X, Kasson E, Maranets E, Worku Y, Montayne M, Banks DE, Kelly JC, Cavazos-Rehg PA. Self-Identified Stage in Recovery and Substance-Use Behaviors among Pregnant and Postpartum Women and People with Opioid Use Disorder. Healthcare (Basel) 2023; 11:2392. [PMID: 37685426 PMCID: PMC10486579 DOI: 10.3390/healthcare11172392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Opioid use among pregnant and postpartum women and people (PPWP) has significant health repercussions. This study explores how substance-use behaviors may vary by stage in recovery among PPWP with opioid use disorder (OUD). We recruited 29 PPWP with OUD. "High-risk" participants self-identified as "not being engaged in treatment" or "new or early in their recovery" (n = 11); "low-risk" participants self-identified as being "well-established" or "in long-term recovery" (n = 18). Participants were queried regarding sociodemographic, mental health, and drug-misuse factors; urine drug screens were collected at baseline. Univariate group comparisons between high-risk and low-risk PPWP were conducted. High-risk PPWP were more likely to self-identify as non-Hispanic African American and more likely to report current opioid use, other illicit drugs, and tobacco. High-risk PPWP had higher opioid cravings versus low-risk PPWP. High-risk PPWP were more likely to screen positive on urine tests for non-opioid drugs and on concurrent use of both non-opioid drugs and opioids versus low-risk participants. PPWP earlier in recovery are at higher-risk for opioid and other illicit drug misuse but are willing to disclose aspects of their recent use. PPWP early in recovery are an ideal population for interventions that can help facilitate recovery during the perinatal period and beyond.
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Affiliation(s)
- Hannah S. Szlyk
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Anna Constantino-Pettit
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
- Brown School, Washington University in St. Louis, 1 Brookings Dr., St. Louis, MO 63130, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Emily Maranets
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Yoseph Worku
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Mandy Montayne
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
| | - Devin E. Banks
- Department of Psychological Sciences, University of Missouri–St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO 63121, USA;
| | - Jeannie C. Kelly
- Department of Obstetrics & Gynecology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA;
| | - Patricia A. Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA; (A.C.-P.); (X.L.); (E.K.); (E.M.); (Y.W.); (M.M.); (P.A.C.-R.)
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Einat T, Shoshan OB. "Don't You Understand That We Are Punishing You for Your Own Good?": Attitudes of Women With Substance Use Disorder to Punitive and Therapeutic Methods in Closed Communities. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023:306624X231188227. [PMID: 37551861 DOI: 10.1177/0306624x231188227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The growing numbers of women with substance use disorder (SUD) and the resulting establishment of dedicated treatment and rehabilitation services have spawned a rich literature on the etiology of addiction among women, their therapy needs and the effectiveness of the treatments they receive. Nevertheless, very few studies have examined the punitive methods applied to women with SUD as part of their treatment. This study examines the positions of thirteen Israeli women with SUD regarding punishments meted out in closed therapeutic communities (TCs), and their experienced short- and long-term implications. The findings suggest ambivalence toward the harsh treatment and punishment in the communities, and to their negative repercussions for the clients' mental condition after their release. We conclude that the methods of treatment and punishment in these settings must be changed and based on the clients' strengths and empowerment. Punishments should be meted out in a proportional way, and as a last resource.
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Affiliation(s)
- Tomer Einat
- Bar-Ilan University Faculty of Social Sciences, Ramat-Gan, Israel
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Thomson KC, Greenwood CJ, Letcher P, Spry EA, Macdonald JA, McAnally HM, Hines LA, Youssef GJ, McIntosh JE, Hutchinson D, Hancox RJ, Patton GC, Olsson CA. Continuities in maternal substance use from early adolescence to parenthood: findings from the intergenerational cohort consortium. Psychol Med 2023; 53:2136-2145. [PMID: 37310325 DOI: 10.1017/s0033291721003925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study assessed the extent to which women's preconception binge drinking, tobacco use and cannabis use, reported prospectively in adolescence and young adulthood, predicted use of these substances during pregnancy and at 1 year postpartum. METHODS Data were pooled from two intergenerational cohort studies: the Australian Temperament Project Generation 3 Study (395 mothers, 691 pregnancies) and the Victorian Intergenerational Health Cohort Study (398 mothers, 609 pregnancies). Alcohol, tobacco and cannabis use were assessed in adolescence (13-18 years), young adulthood (19-29 years) and at ages 29-35 years for those transitioning to parenthood. Exposures were weekly or more frequent preconception binge drinking (5 + drinks in one session), tobacco use and cannabis use. Outcomes were any alcohol, tobacco and cannabis use prior to awareness of the pregnancy, after awareness of pregnancy (up to and including the third trimester pregnancy) and at 1 year postpartum. RESULTS Frequent preconception binge drinking, tobacco use and cannabis use across both adolescence and young adulthood were strong predictors of continued use post-conception, before and after awareness of the pregnancy and at 1 year postpartum. Substance use limited to young adulthood also predicted continued use post-conception. CONCLUSIONS Persistent alcohol, tobacco use and cannabis use that starts in adolescence has a strong continuity into parenthood. Reducing substance use in the perinatal period requires action well before pregnancy, commencing in adolescence and continuing into the years before conception and throughout the perinatal period.
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Affiliation(s)
- Kimberly C Thomson
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- University of British Columbia, Human Early Learning Partnership, School of Population and Public Health, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Christopher J Greenwood
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Primrose Letcher
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Elizabeth A Spry
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Jacqui A Macdonald
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Helena M McAnally
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Lindsey A Hines
- Centre for Academic Mental Health, Population Health Sciences Institute, University of Bristol, Bristol, UK
- Integrative Epidemiology Unit, Population Health Sciences Institute, University of Bristol, Bristol, UK
| | - George J Youssef
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Jennifer E McIntosh
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Department of Psychology, La Trobe University, The Bouverie Centre, Melbourne, Victoria, Australia
| | - Delyse Hutchinson
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Faculty of Medicine, University of New South Wales, National Drug and Alcohol Research Centre, Sydney, New South Wales, Australia
| | - Robert J Hancox
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - George C Patton
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
| | - Craig A Olsson
- Faculty of Health, Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital Campus, Parkville, Victoria, Australia
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Horan H, Mobley E, Lavender C, Thompson A, Bryant W, McDaniel J, Robertson E, McIntosh S, Albright DL. "I am busy enough…": Navigating challenges experienced by Medicaid providers serving pregnant people living with substance use disorders in Alabama. J Nurs Scholarsh 2023; 55:556-565. [PMID: 36642921 DOI: 10.1111/jnu.12867] [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: 08/01/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Perinatal substance use is a clinical and public health concern. The purpose of the study was to understand the perspectives and experiences of perinatal healthcare providers serving pregnant people who receive Medicaid and are living with a substance use disorder. DESIGN AND METHODS We conducted a secondary data analysis of the responses from perinatal healthcare providers who completed a survey to assess the state of Alabama's capability to effectively identify and treat individuals with substance use disorder. We analyzed short answer responses using consensus coding. FINDINGS Nine-hundred and ninety-five Medicaid providers completed the survey, 36 of the respondents identified that they were employed in an obstetric practice. Health insurance limitations, a lack of time and resources, and limited treatment options were the primary barriers indicated in the participants' responses. CONCLUSIONS Structural and health system barriers negatively impact the capacity of perinatal healthcare providers in Alabama to serve pregnant people who receive Medicaid and are living with a substance use disorder. CLINICAL RELEVANCE Perinatal healthcare providers need educational opportunities, training, and up-to-date resources to provide supportive, comprehensive care programming for perinatal populations with substance use disorders.
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Affiliation(s)
- Holly Horan
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Emmily Mobley
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Alyssa Thompson
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Wesley Bryant
- Department of Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
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11
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Chou JL, Noel JG, Williams C, Spruell S, Nixon K, Riedel E, Zaarur A. Residential substance use treatment outcomes for pregnant and postpartum women: Distinct patterns for women enrolled before versus during the COVID-19 pandemic. J Nurs Scholarsh 2022; 55:730-738. [PMID: 35920587 PMCID: PMC9539050 DOI: 10.1111/jnu.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/24/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
Introduction Substance use among pregnant and postpartum women (PPW) is a serious public health concern. The COVID‐19 pandemic has exacerbated substance use among the general population including pregnant women, and disrupted operations for substance use treatment centers. Little is known about the outcomes of substance use treatment for PPW before and during the COVID‐19 pandemic. Method Data from a longitudinal program evaluation were analyzed to examine outcomes among 136 PPW participating in a residential SUD treatment program, and to explore differences in treatment outcomes for women who enrolled in services before versus during the COVID‐19 pandemic. Analyses were used to test the significance of change from treatment intake to 6‐month post‐intake on assessments of substance use, mental health symptoms, and functioning collected to evaluate the Healthy Families Program (HFP), a comprehensive program for PPW located within a gender‐specific SUD treatment facility in the United States. Results Results indicated that from treatment intake to follow‐up assessment, clients self‐reported statistically significant improvements in family functioning and daily functioning as well as reduced days of substance use. Notably, the rate of treatment intakes declined during the COVID‐19 pandemic. In separate analyses by subgroup, mental health indicators showed improvements only for clients engaged in treatment before the COVID‐19 pandemic and not for clients served during the COVID‐19 pandemic, but substance use decreased significantly for both pre‐pandemic and pandemic enrollees. Conclusion Specialized treatment considerations and implications for PPW are discussed, including a need for added emphasis on co‐occurring mental health symptoms and family system stress during a pandemic, and the role of nurses in identifying and addressing these concerns. Additionally, potential relapse prevention efforts during COVID‐19 for PPW with substance use disorders are examined. Clinical Relevance The present research continues to highlight the importance of specialized treatment programming for PPW with SUDs as well as the potential need for additional recovery support mechanisms to be utilized during the COVID‐19 pandemic.
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Affiliation(s)
- Jessica L Chou
- Department of Counseling and Family Therapy, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jeffrey G Noel
- University of Missouri Saint Louis, Missouri Institute of Mental Health, Saint Louis, Missouri, USA
| | - Catherine Williams
- University of Missouri Saint Louis, Missouri Institute of Mental Health, Saint Louis, Missouri, USA
| | | | - Kevana Nixon
- Department of Counseling and Family Therapy, Drexel University, Philadelphia, Pennsylvania, USA
| | - Edward Riedel
- University of Missouri Saint Louis, Missouri Institute of Mental Health, Saint Louis, Missouri, USA
| | - Asif Zaarur
- Department of Counseling and Family Therapy, Drexel University, Philadelphia, Pennsylvania, USA
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12
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Choi S, Stein MD, Raifman J, Rosenbloom D, Clark JA. Motherhood, pregnancy and gateways to intervene in substance use disorder. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1268-e1277. [PMID: 34363426 PMCID: PMC8818808 DOI: 10.1111/hsc.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 06/06/2023]
Abstract
Motherhood increases women's use of health and social services, presenting opportunities to identify and refer women with substance use disorder (SUD) to treatment. We pooled 4 years (2015-2018) of cross-sectional data from National Survey on Drug Use and Health on women of child-bearing age (18-44) in the United States (n = 64,346). (1) We compared the use of services (health, social and criminal justice involvement) by SUD and 'motherhood' (pregnant or has one or more children under 18). We used multivariable logistic regression models to estimate the association between motherhood, SUD and their interaction with the use of services. (2) We estimated the association between the use of different services and SUD treatment use among women with SUD. Among women of child-bearing age, 9.7% had SUD. Mothers who had SUD were more likely to use social services (AOR = 1.48 [95% CI: 1.22, 1.79]) and mental health services compared with non-mothers who did not have SUD (AOR = 1.40 [95% CI: 1.19, 1.65]). The following factors were associated with increased odds of receiving SUD treatment among mothers: mental health treatment utilisation (AOR = 1.94 [95% CI: 1.29, 2.93]); Medicaid coverage (AOR = 2.48 [95% CI: 1.64, 3.76]); and criminal justice involvement (AOR = 3.38 [95% CI: 1.97, 5.80]). To increase treatment access, it is important to address women's different stages in life, including how to best engage women in SUD care across different settings.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Michael D. Stein
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Julia Raifman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - David Rosenbloom
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Jack A. Clark
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
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Ulrich SM, Löchner J, Walper S, Ghezih S, Lux U. Welche psychosozialen Belastungen weisen Familien mit einem Kind mit einer Entwicklungsauffälligkeit auf und welche Unterstützungsangebote nutzen sie? KINDHEIT UND ENTWICKLUNG 2022. [DOI: 10.1026/0942-5403/a000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Früherkennung bei Entwicklungsauffälligkeiten (EA) ist wichtig, insbesondere wenn diese mit psychosozialer Belastung einhergehen. Fragestellung: Bisher ist wenig darüber bekannt, wie sich die Belastungssituation bei Familien mit Kind mit EA im Alter von 0 – 3 Jahren verändert und welche Unterstützungsangebote sie nutzen. Methode: 779 Eltern schätzten EA für ihr Kind in den Bereichen Kommunikation, Fein- und Grobmotorik, Problemlösekompetenz und Soziale Entwicklung ein und 765 Eltern füllten einen Fragebogen zu psychosozialen Belastungen (T1 und T2) aus. Ergebnisse: 30,6 % der Kinder zeigen eine EA. Die kumulierte Belastung ist bei Familien mit Kind mit EA erhöht. Im Bereich der Kommunikation, Feinmotorik und Problemlösekompetenz zeigt sich ein stärkerer Anstieg der Belastungskumulation, wenn keine Frühförderung genutzt wurde. Diskussion und Schlussfolgerung: Die elterliche Einschätzung beim frühen Erkennen einer EA sollte stärker in Betracht genommen werden.
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Affiliation(s)
- Susanne M. Ulrich
- Nationales Zentrum Frühe Hilfen (NZFH), Deutsches Jugendinstitut e.V., München, Deutschland
| | - Johanna Löchner
- Nationales Zentrum Frühe Hilfen (NZFH), Deutsches Jugendinstitut e.V., München, Deutschland
| | - Sabine Walper
- Nationales Zentrum Frühe Hilfen (NZFH), Deutsches Jugendinstitut e.V., München, Deutschland
| | - Sarah Ghezih
- Nationales Zentrum Frühe Hilfen (NZFH), Deutsches Jugendinstitut e.V., München, Deutschland
| | - Ulrike Lux
- Nationales Zentrum Frühe Hilfen (NZFH), Deutsches Jugendinstitut e.V., München, Deutschland
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14
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Weerakoon SM, Chen B, Harrell MB, Vidot DC, Messiah SE. Effect of in-utero polysubstance exposure on adolescent cardiovascular disease risk: Results from the maternal lifestyle study. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Associations Between Adverse Childhood Experiences and Prenatal Mental Health and Substance Use Among Urban, Low-Income Women. Community Ment Health J 2022; 58:595-605. [PMID: 34184153 DOI: 10.1007/s10597-021-00862-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
This study examined associations between Adverse Childhood Experiences (ACEs) and perinatal mental health and substance use among 98 low-income women (mean age 25.4 years; 93% Black/African American) referred to a mental health care manager in an urban women's clinic. Self-report and retrospective chart review data were utilized. Chi-squared and Fisher's Exact tests were performed to assess bivariate relationships between ACEs and mental health and substance use outcomes. Multivariate logistic regressions were used to examine the impact of ACEs on mental health and substance use, adjusting for marital status, education, and age. Findings indicate high levels of childhood adversity, specifically childhood abuse, are associated with negative perinatal mental health and substance use outcomes, including suicidal thoughts, anxiety, mood dysregulation, and tobacco and marijuana use. Inquiring about ACEs during prenatal care and/or in community health clinics may help identify patients' overall risk and provide opportunities for intervention for mothers and their infants.
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16
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Flannigan K, Odell B, Rizvi I, Murphy L, Pei J. Complementary therapies in substance use recovery with pregnant women and girls. WOMEN'S HEALTH 2022; 18:17455057221126807. [PMID: 36173262 PMCID: PMC9528000 DOI: 10.1177/17455057221126807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Supporting women and girls who are pregnant and experiencing substance use challenges is a high priority for researchers, clinicians, and policymakers. Complementary therapies (CTs) can be effective forms of treatment in some contexts and populations; however, research on the use of CTs in substance use recovery with pregnant women and girls is scarce. To fill this gap, we conducted a mixed methods study using survey data collected at a women’s recovery center in Canada. Our objectives were to describe CTs provided at the program; identify what CTs are perceived by participants as most/least positive; and explore factors that may impact participant experiences with CTs. Methods: We analyzed feedback responses from 255 women and girls ( Mage = 27.5 years, range 15–64) using Pearson chi-square tests, logistic regression, and inductive content analysis. Results: The most frequently provided CTs were yoga, energy-related activities (e.g. reiki, reflexology), and meditation. Among the most common CTs, participants provided the highest endorsements for massage and physical activity, and the lowest endorsements for yoga and drumming. Across CTs, whether participants looked forward to an activity contributed significantly to whether they found it helpful, would like to do it again, and planned to continue engaging in the activity after leaving the program. Four broad contextual factors were identified that may impact experiences and perspectives about CTs: (1) goodness of fit, (2) self-awareness, (3) growth, and (4) healing and holistic wellbeing. Conclusions: This study provides novel evidence on the potential impacts of CTs in substance use treatment for pregnant women and girls, and important contextual factors to consider when implementing these approaches.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
| | - Bryce Odell
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Imad Rizvi
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Murphy
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
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17
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Harris MTH, Laks J, Stahl N, Bagley SM, Saia K, Wechsberg WM. Gender Dynamics in Substance Use and Treatment: A Women's Focused Approach. Med Clin North Am 2022; 106:219-234. [PMID: 34823732 PMCID: PMC8881090 DOI: 10.1016/j.mcna.2021.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Gender impacts substance use initiation, substance use disorder development, engagement with treatment, and harms related to drug and alcohol use. Using the biopsychosocial model of addiction, this review provides a broad summary of barriers and facilitators to addiction services among women. It also reviews substance use among pregnant and parenting women and approaches to care. Given the increasing rates of substance use among women, there is a need to implement and scale-up gender-responsive addiction programming and pursue advocacy at the policy level that addresses the root drivers of substance use inequities among women.
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Affiliation(s)
- Miriam T H Harris
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
| | - Jordana Laks
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Natalie Stahl
- Yale Program in Addiction Medicine, Yale University School of Medicine, E.S. Harkness Memorial Building A, 367 Cedar Street, Suite 417A, New Haven, CT 06520-8023, USA
| | - Sarah M Bagley
- Grayken Center for Addiction, Boston Medical Center, 801 Massachusetts Avenue, 1st Floor, Boston, MA 02118, USA; Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Division of General Pediatrics, Department of Pediatrics, 801 Albany Street, Boston, MA 02118, USA
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, 850 Harrison Avenue 5th Floor, Boston, MA 02118, USA
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC 27709-2194, USA; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Department of Psychology, North Carolina State University, Raleigh, NC 27599-7400, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27701, USA
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18
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Anandan A, Athirah Daud NA, Vicknasingam B, Narayanan S, Azman A, Singh D. Factors associated with drug use during pregnancy and breastfeeding among females who use drugs (FWUDs) in Malaysia. J Ethn Subst Abuse 2021; 22:766-781. [PMID: 34965841 DOI: 10.1080/15332640.2021.2019162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Females who use drugs (FWUDs) are at risk of continuing illicit substance use during pregnancy and breastfeeding. We investigated the prevalence rates and factors associated with these practices in a sample of 200 FWUDs recruited from a publicly-run drug rehabilitation center. A semi-structured questionnaire was used to collect the data. The majority (86%) was Malay (n = 171/200), currently single (71%, n = 141/200), and 51% had nine years of education. The mean age of respondents was 32.2 years (SD = 8.61). Thirty-eight percent (n = 75/200) reported ever using illicit substances during pregnancy, while 15% (n = 30/200) had used them during breastfeeding. Higher odds of using drugs during pregnancy were associated with having an intimate male drug-using partner and with persons who reported abandoning an infant in the past. Lower odds were linked with women who used heroin with ATS (relative to those who used only ATS), and shorter-term ATS (≤3 years) relative to long term ATS users. At a lower level of significance (p = 0.054), being married also lowered the odds. Higher odds of drug use during breastfeeding were associated with having an intimate male drug-using partner, and previous methadone use history, while lower odds were associated with short-term ATS use and being employed. The findings highlight the need for timely and targeted interventions to inform, engage and promote the participation of FWUDs in pre- and post-natal care services.
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Affiliation(s)
- Asnina Anandan
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia
| | | | | | - Suresh Narayanan
- School of Social Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Azlinda Azman
- School of Social Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Penang, Malaysia
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19
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Goldstein E, Nervik K, Hagen S, Hilliard F, Turnquist A, Bakhireva LN, McDonald R, Ossorio PN, Lo J, Zgierska AE. A socioecological framework for engaging substance-using pregnant persons in longitudinal research: Multi-stakeholder perspectives. Neurotoxicol Teratol 2021; 87:106997. [PMID: 34023390 PMCID: PMC8440364 DOI: 10.1016/j.ntt.2021.106997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Understanding the impact of substance use during pregnancy on fetal development and child health is essential for designing effective approaches for reducing prenatal substance exposures and improving child outcomes. Research on the developmental impacts of prenatal substance exposure has been limited by legal, ethical, and practical challenges. This study examined approaches to engage substance-using (with an emphasis on opioids) pregnant persons in longitudinal research, from multi-stakeholder perspectives. METHODS The present study solicited the expertise of 1) an advisory group of community stakeholders, including people with lived experienced of opioid/substance use; and 2) an online survey with content experts. Qualitative analysis examined facilitators and barriers to recruiting and retaining substance-using pregnant persons through a socioecological lens at the individual, interpersonal, organizational, community, and policy levels. RESULTS Stakeholders (N = 19) prioritized stigma, loss of confidentiality, legal consequences, and instability (e.g., homelessness and poverty) as important barriers that prevent substance-using persons from enrolling in research studies. Of 70 survey respondents, most self-identified as researchers (n = 37), followed by clinicians (n = 19), and 'others' (n = 14). Survey respondents focused on retention strategies that build trusting relationships with participants, including incentives (e.g., transportation and childcare support), participant-friendly study design, and team-related factors, (e.g., attitudes and practices). CONCLUSION The stakeholder input and survey data offer key insights strengthening our understanding of facilitators and barriers to research participation, and ways to overcome barriers among substance-using pregnant persons. A socioecological framework can be used to identify and address these factors to increase recruitment and long-term retention of high-risk populations.
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Affiliation(s)
- Ellen Goldstein
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Kendra Nervik
- Department of Sociology, University of Wisconsin, 8128 William H. Sewell Social Sciences Building, 1180 Observatory Drive, Madison, WI 53706-1393, United States of America.
| | - Shelbey Hagen
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Florence Hilliard
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Alyssa Turnquist
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Ludmila N Bakhireva
- College of Pharmacy Substance Use Research and Education (SURE) Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America; Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America; Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America.
| | - Ryan McDonald
- Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, McConnell Hall, 1010 Mound Street, Madison, WI 53715, United States of America.
| | - Pilar N Ossorio
- University of Wisconsin Law School, 975 Bascom Mall, Rm. 9103, Madison, WI 53706-1399, United States of America; University of Wisconsin, Morgridge Institute for Research, 330 N. Orchard St, Madison, WI 53715, United States of America.
| | - Jamie Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L466, Portland, OR 97239, United States of America.
| | - Aleksandra E Zgierska
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States of America.
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20
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Rutherford HJ, Kim S, Yip SW, Potenza MN, Mayes LC, Strathearn L. Parenting and addictions: Current insights from human neuroscience. CURRENT ADDICTION REPORTS 2021; 8:380-388. [PMID: 36185758 PMCID: PMC9523670 DOI: 10.1007/s40429-021-00384-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
Purpose A growing body of human research has documented associations between the maternal brain and maternal substance use and addictions. This neuroscience-informed approach affords the opportunity to unpack potential neurobiological mechanisms that may underscore challenges in maternal caregiving behavior among mothers with addictions and provide new directions for parenting interventions. Findings Consistent with theoretical models of parenting and addictions, five studies evidence both hypo- and hyper-reactivity to infant affective cues across neuroimaging methods and tasks that incorporate both infant face and cry stimuli. Three structural and resting-state brain studies as a function of maternal substance use are also reported. Conclusions While human neuroimaging research converges in showing that maternal substance use is associated with differential reactivity to infant affective cues, further multi-level/multi-modal, longitudinal, and dimensional research is critically needed to advance this area of investigation.
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Affiliation(s)
- Helena Jv Rutherford
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Sohye Kim
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA 01655
- Departments of Psychiatry, Pediatrics, and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA 01655
| | - Sarah W Yip
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Marc N Potenza
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520, United States
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT 06510, United States
- The Connecticut Council on Problem Gambling, Wethersfield, CT 06109, United States
- The Connecticut Mental Health Center, New Haven, CT 06519, United States
| | - Linda C Mayes
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, United States
- Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA 52242, United States
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21
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Wouldes TA, Crawford A, Stevens S, Stasiak K. Evidence for the Effectiveness and Acceptability of e-SBI or e-SBIRT in the Management of Alcohol and Illicit Substance Use in Pregnant and Post-partum Women. Front Psychiatry 2021; 12:634805. [PMID: 34025470 PMCID: PMC8131659 DOI: 10.3389/fpsyt.2021.634805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Alcohol and illicit psychoactive drug use during pregnancy have increased worldwide, putting women and their children's health and development at risk. Multiple drug use, comorbid psychiatric disorders, sexual and physical abuse are common in women who use alcohol and drugs during pregnancy. The effects on the mother include poor reproductive and life-long health, legal, family, and social problems. Additionally, the exposed child is at increased risk of long-term physical health, mental health, and developmental problems. The stigma associated with substance use during pregnancy and some clinicians' reticence to inquire about substance use means many women are not receiving adequate prenatal, substance abuse, and mental health care. Evidence for mHealth apps to provide health care for pregnant and post-partum women reveal the usability and effectiveness of these apps to reduce gestational weight gain, improve nutrition, promote smoking cessation and manage gestational diabetes mellitus, and treat depression and anxiety. Emerging evidence suggests mHealth technology using a public health approach of electronic screening, brief intervention, or referral to treatment (e-SBIRT) for substance use or abuse can overcome the typical barriers preventing women from receiving treatment for alcohol and drug use during pregnancy. This brief intervention delivered through a mobile device may be equally effective as SBIRT delivered by a health care professional in preventing maternal drug use, minimizing the effects to the exposed child, and providing a pathway to therapeutic options for a substance use disorder. However, larger studies in more diverse settings with women who have co-morbid mental illness and a constellation of social risk factors that are frequently associated with substance use disorders are needed.
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Affiliation(s)
- Trecia A Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Andi Crawford
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Te Ara Manapou, Parenting and Pregnancy Service, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Suzanne Stevens
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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Yazdanfar N, Farnam A, Sadigh-Eteghad S, Mahmoudi J, Sarkaki A. Enriched environment and social isolation differentially modulate addiction-related behaviors in male offspring of morphine-addicted dams: The possible role of μ-opioid receptors and ΔFosB in the brain reward pathway. Brain Res Bull 2021; 170:98-105. [PMID: 33592274 DOI: 10.1016/j.brainresbull.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 12/20/2022]
Abstract
Prenatal opioids exposure negatively affects the neurobehavioral abilities of children born from dependence dams. Adolescent housing conditions can buffer the detrimental impacts of early life experiences or contradictory can worsen individual psychosocial functions. The present study investigated the effects of maternal morphine dependence and different rearing conditions on behaviors and protein expression in brain reward circuits of male pups. Female Wistar rats a week before conception, during pregnancy and lactation were injected twice daily with escalating doses of morphine or saline. On a postnatal day 21, male pups were weaned and subjected to three different environments for two months: standard (STD), isolated (ISO), or enriched environment (EE). The anxiety and drug-related reward were measured using elevated plus maze, open field test, and conditioned place preference. Western blotting was used to determine the protein level of ΔFosB and μ-opioid receptor proteins in the striatum and the midbrain of male offspring, respectively. Results showed that maternal morphine administration dramatically increased anxiety-like and morphine place preference behaviors in offspring. Also, ISO condition aggravated these behavioral outcomes. While, rearing in EE could attenuate anxiety and morphine conditioning in pups. At molecular levels, maternal morphine exposure and social isolation markedly increased both of ΔFosB and μ-opioid receptor proteins expression. However, rearing in the EE declined ΔFosB protein expression. Together, these findings help to elucidate long lasting impacts of early life morphine exposure and rearing environment on the behavioral and molecular profile of addicted individuals.
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Affiliation(s)
- Neda Yazdanfar
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Neuroscience, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Farnam
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Sadigh-Eteghad
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Mahmoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Alireza Sarkaki
- The Persian Gulf Physiology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Association of adverse prenatal exposure burden with child psychopathology in the Adolescent Brain Cognitive Development (ABCD) Study. PLoS One 2021; 16:e0250235. [PMID: 33909652 PMCID: PMC8081164 DOI: 10.1371/journal.pone.0250235] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 04/03/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Numerous adverse prenatal exposures have been individually associated with risk for psychiatric illness in the offspring. However, such exposures frequently co-occur, raising questions about their cumulative impact. We evaluated effects of cumulative adverse prenatal exposure burden on psychopathology risk in school-aged children. METHODS Using baseline surveys from the U.S.-based Adolescent Brain and Cognitive Development (ABCD) Study (7,898 non-adopted, unrelated children from 21 sites, age 9-10, and their primary caregivers), we examined 8 retrospectively-reported adverse prenatal exposures in relation to caregiver-reported total and subscale Child Behavior Checklist (CBCL) scores. We also assessed cumulative effects of these factors on CBCL total as a continuous measure, as well as on odds of clinically significant psychopathology (CBCL total ≥60), in both the initial set and a separate ABCD sample comprising an additional 696 sibling pairs. Analyses were conducted before and after adjustment for 14 demographic and environmental covariates. RESULTS In minimally and fully adjusted models, 6 exposures (unplanned pregnancy; maternal alcohol, marijuana, and tobacco use early in pregnancy; pregnancy complications; and birth complications) independently associated with significant but small increases in CBCL total score. Among these 6, none increased the odds of crossing the threshold for clinically significant symptoms by itself. However, odds of exceeding this threshold became significant with 2 exposures (OR = 1.86, 95% CI 1.47-2.36), and increased linearly with each level of exposure (OR = 1.39, 95% CI 1.31-1.47), up to 3.53-fold for ≥4 exposures versus none. Similar effects were observed in confirmatory analysis among siblings. Within sibling pairs, greater discordance for exposure load associated with greater CBCL total differences, suggesting that results were not confounded by unmeasured family-level effects. CONCLUSION Children exposed to multiple common, adverse prenatal events showed dose-dependent increases in broad, clinically significant psychopathology at age 9-10. Fully prospective studies are needed to confirm and elaborate upon this pattern.
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Kumar N, Rocha FG, Moustafa ASZ, Masten M, Bruder A, Parmar K, Adekola H, Sampath V, Monga R. Impact of opioid maintenance treatment during pregnancy on neonatal birth weight and head circumference. J Neonatal Perinatal Med 2021; 14:475-484. [PMID: 33843703 DOI: 10.3233/npm-200645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pregnant mothers with opioid dependency commonly receive maintenance treatment of opioid (OMT), either as buprenorphine (BMT) or methadone maintenance treatment (MMT). We investigated, whether OMT adversely affects standardized neonatal anthropometric outcomes and whether BMT is potentially safer than MMT in this regard. METHODS Retrospective chart review of mother infant dyad, with and without OMT. Infant's absolute and standardized (z-score) anthropometric outcomes at birth were first compared, between OMT and control group (negative meconium drug screen), and then between BMT and MMT group. These outcomes were also compared between infants who did or did not require treatment after birth for neonatal abstinence syndrome (NAS). RESULT A total of 1479 participants with MDS were included [Control = 1251; OMT = 228 (MMT = 181; BMT = 47)]. Both the z-scores of birth weight (BW) and head circumference (HC) was lower in OMT group (p < 0.001). Among the OMT group, GA at delivery was slightly higher in the BMT group (p = 0.05). There was an inverse correlation between maternal dose at the time of delivery and anthropometric z-scores in the BMT group, mainly in female infants (BW: p = 0.006; HC: p = 0.003). Furthermore, In BMT group, infants with lower HC were more likely to require treatment for NAS (p = 0.01). CONCLUSION HC and BW when comparing Z-scores were not different between MMT and BMT. High maternal dosing of buprenorphine is associated with lower BW and HC Z-scores but dose effect is not seen with methadone. In addition, there seems to be an association between NAS severity and HC, especially in the BMT group.
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Affiliation(s)
- N Kumar
- Division of Neonatology, Hurley Medical Center, Flint, MI, USA
| | - F G Rocha
- Division of Maternal-Fetal Medicine, University of California, San Francisco, CA, USA
| | - A S Z Moustafa
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI, USA
| | - M Masten
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI, USA
| | - A Bruder
- Department of Pediatrics, Hurley Medical Center, Flint, MI, USA
| | - K Parmar
- Department of Pediatrics, Hurley Medical Center, Flint, MI, USA
| | - H Adekola
- Division of Maternal-Fetal Medicine, Southern Illinois University, Springfield, IL, USA
| | - V Sampath
- Division of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - R Monga
- Division of Neonatology, Hurley Medical Center, Flint, MI, USA
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Villarreal YR, Spellman ML, Prudon J, Northrup TF, Berens PD, Blackwell S, Velasquez MM, Stotts AL. A Brief, Hospital-Initiated Motivational Interviewing and Acceptance and Commitment Therapy Intervention to Link Postpartum Mothers Who Use Illicit Drugs With Treatment and Reproductive Care: A Case Report. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gilmartin CE, Milman O, Leung L. Postpartum contraceptive planning of women with substance abuse disorders. Int J Clin Pharm 2020; 43:1006-1014. [PMID: 33236276 DOI: 10.1007/s11096-020-01209-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women with substance abuse disorders have lower use of contraception. Unplanned pregnancies increase risk of fetal exposure to addictive and teratogenic substances. Postpartum inpatient periods for these women can be challenging times to facilitate contraception planning. OBJECTIVE To explore postnatal contraceptive planning practices, patient preferences for contraception, and supply challenges, and to identify how clinical pharmacists may best provide care in this context. SETTING A tertiary maternity referral hospital in metropolitan Victoria, Australia (January 2015-December 2018). METHOD A retrospective cohort study was conducted on postnatal women with substance abuse disorders. Patients were excluded if they had delivered at another health service, had inadequate documented evidence of a substance abuse disorder, or had incomplete or unavailable medical records. Records were reviewed for demographic data, admission details, and documented contraceptive planning. MAIN OUTCOME MEASURES Documented contraceptive planning, patient contraception preferences and identified supply challenges. RESULTS Ninety-three women were included. Seventy-one (76.3%) had psychiatric disorders or impairments, and 92 (98.9%) had identifiable follow-up challenges (eg. Homelessness). Nine (9.7%) self-discharged/absconded. Eighty-seven (93.5%) had documented postnatal contraception discussions. Sixty-two of 87 (71.3%) considered a medicine/device, three (3.4%) preferred condoms, 10 (11.5%) considered sterilisation, 2 (2.3%) preferred no contraception, and 16 (18.4%) undecided. Etonogestral 68 mg implants were most commonly prescribed (28 of 42; 66.7%). CONCLUSION Inpatient postpartum periods for this cohort were characterised by psycho-social complexities, inconsistent contraceptive planning documentation, and patients seemingly unprepared to consider contraception. This study highlights a need for an earlier decision-making process and pragmatic counselling with antenatal pharmacists.
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Affiliation(s)
- Christine E Gilmartin
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Oran Milman
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia.,Hawke's Bay Hospital, Hastings, New Zealand
| | - Laura Leung
- The Royal Women's Hospital Pharmacy Department, The Royal Women's Hospital, Parkville, Victoria, Australia
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Odom GC, Cottler LB, Striley CW, Lopez-Quintero C. Perceived Risk of Weekly Cannabis Use, Past 30-Day Cannabis Use, and Frequency of Cannabis Use Among Pregnant Women in the United States. Int J Womens Health 2020; 12:1075-1088. [PMID: 33235517 PMCID: PMC7678496 DOI: 10.2147/ijwh.s266540] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND While accumulated evidence has shown that the prevalence of cannabis use among pregnant women in the US has increased in recent years, little is known about the specific subpopulations affected. The aim of this study was to estimate the prevalence and correlates of the perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of past 30-day cannabis use among US pregnant women. METHODS We analyzed data from 2,247 pregnant women 14 to 44 years of age surveyed in the 2015 to 2017 cross-sectional National Survey on Drug Use and Health. Analyses account for the sampling design. Primary outcomes included perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of cannabis use. We conducted multivariable logistic and negative binomial regression models to assess the associations between the primary outcomes and multiple correlates. RESULTS Among US pregnant women, 21.6% (95% CI=19.4, 23.8) did not perceive any risk associated with weekly cannabis use, 5.3% (95% CI=4.2, 6.5) used cannabis in the past 30 days, and among past-month users, the average number of days of use was 15.6 (95% CI=13.5, 17.7). Pregnant women living below the poverty line were both more likely to perceive no risk of weekly cannabis use (aOR=1.8; 95% CI=1.3, 2.5) and use cannabis more often in the past 30 days (aOR=2.9; 95% CI=1.5, 5.7) than pregnant women within an income bracket of more than two times the federal poverty threshold. Age, race, trimester of pregnancy, co-use of tobacco and/or alcohol were also associated with these outcomes. CONCLUSION Younger age, living in poverty, early trimester of pregnancy, and co-use of tobacco and/or alcohol increased the odds of cannabis use among pregnant women. As cannabis legalization spreads and cannabis use is increasingly perceived as safe, there is a growing need for research to determine the reasons why women in the identified at-risk subgroups are using cannabis during pregnancy.
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Affiliation(s)
- Gage C Odom
- Department of Epidemiology, University of Florida, Gainesville, FL32611, USA
| | - Linda B Cottler
- Department of Epidemiology, University of Florida, Gainesville, FL32611, USA
| | - Catherine W Striley
- Department of Epidemiology, University of Florida, Gainesville, FL32611, USA
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Charron E, Mayo RM, Heavner-Sullivan SF, Eichelberger KY, Dickes L, Truong KD, Rennert L. “It’s a very nuanced discussion with every woman”: Health care providers’ communication practices during contraceptive counseling for patients with substance use disorders. Contraception 2020; 102:349-355. [DOI: 10.1016/j.contraception.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
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Mravčík V, Nechanská B, Gabrhelík R, Handal M, Mahic M, Skurtveit S. Socioeconomic characteristics of women with substance use disorder during pregnancy and neonatal outcomes in their newborns: A national registry study from the Czech Republic. Drug Alcohol Depend 2020; 209:107933. [PMID: 32109712 DOI: 10.1016/j.drugalcdep.2020.107933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal substance use can pose a risk to the fetal health. We studied the background characteristics of women with substance use disorders (SUDs) and selected neonatal outcomes in their children. MATERIAL AND METHODS A database-linkage study was performed. The sample consisted of pregnant women with a SUD during pregnancy (ICD-10 diagnosis F10-F19 except F17, n = 1710), women not diagnosed with a SUD (n = 1,511,310) in Czechia in 2000-2014, and their children. The monitored neonatal outcomes were gestational age, birth weight, preterm birth, and small-for-gestational age (SGA). Binary logistic regression adjusted for age, marital status, education, concurrent substance use, and prenatal care was performed. RESULTS Women with illicit SUDs were younger, more often unmarried, with a lower level of education, a higher abortion rate, a higher smoking rate, and lower compliance to prenatal care than women with a SUD related to alcohol, or sedatives and hypnotics (SH). Women with a SUD had worse socioeconomic situations, poorer pregnancy care, and worse neonatal outcomes than women without a SUD. After adjustment, we found no difference in SGA between the illicit SUD groups and the alcohol and the SH groups. The newborns from all SUD groups had a higher risk of SGA when compared to women without a SUD. However after adjustment, the difference remained significant just in the alcohol group (OR = 1.9, 95 % CI = 1.4-2.6). CONCLUSION Mother's SUD during pregnancy increased risk of fetal growth restriction as measured by SGA. The role of maternal socioeconomic and lifestyle factors for the risk of SGA was substantial.
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Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic.
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Marte Handal
- Norwegian Institute of Public Health, Oslo, Norway
| | - Milada Mahic
- Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway; Norwegian Centre for Addiction Research at the University of Oslo, Norway
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Ahmad N, Robert CA, Jampa A, Ashraf S, Patel RS. Antepartum Drug Dependence and Pregnancy- or Birth-related Complications: A Cross-sectional Study of 19 Million Inpatients. Cureus 2019; 11:e6117. [PMID: 31886056 PMCID: PMC6903893 DOI: 10.7759/cureus.6117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate the demographic characteristics, hospitalization outcomes [severity, length of stay (LOS), and total expense], and comorbidities in pregnant patients with antepartum drug dependence (ADD). Methods We used the national inpatient sample (NIS) and included 19,170,561 female patients (age: 12-40 years) hospitalized for pregnancy- or birth-related complications and grouped by co-diagnosis of ADD. We used descriptive statistics and Pearson’s chi-square test for categorical data and independent sample T-test for the continuous data to measure the differences in demographic and hospital outcomes. A logistic regression model was used to evaluate the odds ratio (OR) for medical and psychiatric comorbidities. Results The hospitalizations with ADD declined initially, from 2010 to 2011, followed by an increase of 50% from 2011 to 2014. White pregnant females (77.5%), and those from low-income families (<25th percentile, 37.1 %) had comorbid ADD. Among medical comorbidities, iron-deficiency anemia was the most prevalent condition in pregnant inpatients (12.0% in ADD vs. 9.2% in non-ADD) followed by obesity and hypertension. Depression (12.9%) was the most prevalent psychiatric comorbidity in ADD inpatients followed by comorbid psychosis (three-fold higher odds). Among patients with substance use disorder (SUD), opioid abuse was the most prevalent one (67.3%) followed by cannabis (11.2%), cocaine (5.7%), amphetamine (4.0%), and alcohol (2.4%). Half of the pregnant inpatients with ADD had moderate severity of illness due to pregnancy or birth-related complications with four-fold higher odds [95% confidence interval (CI): 3.67-8.88]. They also had a higher LOS with a mean difference of 0.88 days (95% CI: 0.904-0.865) and had incurred higher total charges, by USD 3,797 (95% CI: 3,927-3,666), per inpatient admission for pregnancy- or birth-related complications compared to non-ADD inpatients Conclusion ADD is associated with the worsening of severity of illness in pregnancy- or birth-related complications and requires acute inpatient care that leads to increased healthcare-related economic burden. The integration of SUD services with primary or maternal care is required to improve outcomes in at-risk women in the reproductive age group.
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Affiliation(s)
| | | | - Alekhya Jampa
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Belgaum, IND
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Affiliation(s)
- Stephanie C Cox
- Department of Obstetric Medicine, Auckland City Hospital, Auckland, New Zealand
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