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Wohrer F, Ngo H, DiDomenico J, Ma X, Roberts MH, Bakhireva LN. Potentially modifiable risk and protective factors affecting mental and emotional wellness in pregnancy. Front Hum Neurosci 2024; 18:1323297. [PMID: 38445095 PMCID: PMC10912531 DOI: 10.3389/fnhum.2024.1323297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Impaired mental and emotional wellness often co-occurs with prenatal substance use, and both affect infant socio-emotional, cognitive, language, motor, and adaptive behavioral outcomes. Guided by the modified biopsychosocial framework, this study examined the role of common substance exposures during pregnancy (i.e., alcohol and cannabis), socio-cultural factors (social support during pregnancy, adverse childhood experiences), and reproductive health factors on maternal mental health (MMH). Methods Data were obtained from a prospective cohort study-Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2), and included 202 pregnant persons. Alcohol and cannabis exposures were assessed through repeated prospective interviews and a comprehensive battery of drug and ethanol biomarkers. MMH outcomes were evaluated during the third trimester through the Perceived Stress Scale, Edinburgh Depression Scale, Generalized Anxiety Disorders-7, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders. Univariate and multivariable linear regression models evaluated significant predictors of MMH. Results Results of multivariable analysis indicate that both maternal adverse childhood experiences and alcohol exposure, even at low-to-moderate levels, during pregnancy were associated with poorer scores for most MMH measures, while higher level of social support and Spanish as the primary language at home (as a proxy of enculturation) had protective effects (all p's < 0.05). Conclusion These findings highlight the importance of assessing substance use, including periconceptional alcohol exposure, and mental health in pregnant persons as closely related risk factors which cannot be addressed in isolation. Our findings also emphasize a strong protective effect of socio-cultural factors on maternal mental and emotional wellbeing-a strong precursor to maternal-infant bonding and infant neurodevelopment.
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Affiliation(s)
- Fiona Wohrer
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Helen Ngo
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jared DiDomenico
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Xingya Ma
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Melissa H. Roberts
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Ludmila N. Bakhireva
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Lau E, Adams YJ. Predictors of Postpartum Depression Among Women with Low Incomes in the United States. MCN Am J Matern Child Nurs 2023; 48:326-333. [PMID: 37589952 DOI: 10.1097/nmc.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
PURPOSE To evaluate the predictors of postpartum depression and to examine the effects of maternal racial identity on postpartum depression among women with low incomes in the United States. STUDY DESIGN AND METHODS We conducted a secondary data analysis using baseline data from the Baby's First Years study, including postpartum women living below the federal poverty line who were recruited from four diverse communities in the United States. Postpartum depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regressions were performed to identify associations between pre-identified postpartum depression risk factors and postpartum depression among participants, followed by predictive margins analyses to elaborate on probability of postpartum depression across different racial identity groups in the sample. RESULTS The sample included 1,051 postpartum women. Almost one-half of participants identified as Black (45.9%), followed by White (20.7%), American Indian (1.8%), and Asian (1.3%). Prevalence of postpartum depression in the sample was 24%. Financial insecurity and alcohol use were positively associated with postpartum depression, whereas level of education and reported physical health were negatively associated with postpartum depression. Mothers who identified as Black had an 8.3% higher probability of postpartum depression than that of White mothers in the sample. CLINICAL IMPLICATIONS Nurses working with populations with low income should assess social determinants of health to provide holistic mental health care. Women with low incomes should be referred to resources which account for their financial burden. Racial disparities exist in perinatal care, and birth and postpartum mental health outcomes. It is crucial to address the systemic racism faced by Black mothers experiencing postpartum depression.
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Godleski S, Schuetze P, Eiden RD, Nickerson AB, Ostrov JM. Developmental Pathways from Prenatal Substance Exposure to Reactive Aggression. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2022; 83:101474. [PMID: 38827951 PMCID: PMC11142622 DOI: 10.1016/j.appdev.2022.101474] [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] [Indexed: 11/09/2022]
Abstract
Few studies have examined etiological pathways from prenatal substance exposure to adolescent reactive aggression. We tested a conceptual model that included hypothesized pathways from prenatal substance exposure to adolescent aggression via autonomic reactivity and violence exposure from infancy to early school age and maternal harshness across early childhood. The sample included 216 families (106 boys) who primarily self-identified as Black or Mixed Race. Results supported the hypothesized path from violence exposure across early childhood and early school age to school age autonomic reactivity and early adolescent reactive aggression. There was also a significant interaction effect of sympathetic and parasympathetic reactivity on adolescent reactive aggression, with sympathetic arousal and parasympathetic suppression at early school age associated with higher reactive relational and physical aggression in adolescence. Results emphasize the importance of early experiences and autonomic nervous system changes in contributing to the cascade of risk for reactive aggression in early adolescence.
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Affiliation(s)
- Stephanie Godleski
- Department of Psychology, College of Liberal Arts, Rochester Institute of Technology
| | - Pamela Schuetze
- Department of Psychology, State University of New York Buffalo State
| | - Rina D. Eiden
- Department of Psychology and The Social Science Research Institute, The Pennsylvania State University, University Park
| | - Amanda B. Nickerson
- Alberti Center for Bullying Abuse Prevention, University at Buffalo, The State University of New York
| | - Jamie M. Ostrov
- Department of Psychology, University at Buffalo, The State University of New York
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Washio Y, Hayashi YP, Atreyapurapu S, Chang K, Ma T, Howard BN, van der Drift I, Browne FA, Wechsberg WM. A Scoping Review of Computer-Based and Telecommunication Technology Interventions to Address Drug and Alcohol Misuse and Smoking in Women. Subst Use Misuse 2022; 57:1257-1272. [PMID: 35582861 PMCID: PMC10083725 DOI: 10.1080/10826084.2022.2076878] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND Computer-based and telecommunication technology has become increasingly common to address addiction among women. This review assessed the effect of technology-based interventions on substance misuse, alcohol use, and smoking outcomes among women. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guideline was used to conduct the scoping review. Four databases (PubMed, Web of Science, PsycINFO, and Scopus) were used to search for peer-reviewed articles published in English on computer-based and telecommunication technology use to address substance misuse, alcohol use, and smoking among women. RESULTS A total of 30 articles were selected after the final full-text review from the U.S., England, Japan, and the Netherlands. The types of technology used in the interventions included computer software (standalone or web-based), mobile applications, video calling, phone, and text messaging. Intervention outcomes included alcohol and other substance misuse reduction as polysubstance misuse (n = 5), smoking cessation (n = 10), substance misuse reduction only (n = 6), and alcohol use reduction only (n = 9). The populations reached included women who were pregnant (n = 13), postpartum (n = 4), or non-pregnant (n = 14) ranging from adolescent to adulthood. Interventions that targeted polysubstance misuse showed statistically significant reductions (p < .05). CONCLUSION Although effective in reducing alcohol and other substance misuse, mixed findings were identified for other outcomes targeting a single substance. Technology-based interventions might maximize their effects by targeting polysubstance misuse and addressing associated contextual issues in the form of a computer-delivered module(s).
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Affiliation(s)
- Yukiko Washio
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Lewis Katz School of Medicine, Philadelphia, PA, 19140 U.S.A
| | | | | | - Katie Chang
- Benten Technologies, Inc., Manassas, VA, U.S.A
| | - Tony Ma
- Benten Technologies, Inc., Manassas, VA, U.S.A
| | - Brittni N. Howard
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
| | - Isa van der Drift
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
| | - Felicia A. Browne
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, U.S.A
| | - Wendee M. Wechsberg
- Substance Use, Gender and Applied Research, RTI International, Research Triangle Park, NC, 27709 U.S.A
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, U.S.A
- Department of Psychology, North Carolina State University, Raleigh, NC, U.S.A
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, U.S.A
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Peak JM, Ingram V, Urbanoski K, Milligan K. Specifying the Relations among PTSD Symptom Clusters and Parenting Stress in Mothers Engaged in Substance Use Treatment. Subst Use Misuse 2022; 57:1552-1562. [PMID: 35819030 DOI: 10.1080/10826084.2022.2096236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Parenting stress is often heightened in mothers receiving treatment for substance use. Experiences of trauma are commonly seen in this population, which may give rise to Posttraumatic Stress Disorder (PTSD) symptoms, including intrusion, avoidance, negative cognition and mood, and affective arousal. While past research has demonstrated a significant relation between PTSD symptoms and parenting stress, no studies have examined the relative contributions of these symptoms to parenting stress in mothers engaged in substance use treatment. METHODS Seventy-four mothers attending outpatient substance use treatment who were parenting children aged 0-3 years completed measures of parenting stress, PTSD, substance use, and depression symptoms. RESULTS A canonical correlation analysis indicated two canonical variates accounting for significant variance between PTSD symptom clusters and parenting stress measures. The first canonical variate, primarily reflecting depressive and PTSD cognition and mood symptoms, was predominantly related to the parental distress aspect of parenting stress (40%). The second canonical variate, primarily reflecting intrusion and avoidance PTSD symptoms, was associated with increased parental perceptions of their child as difficult (10%). CONCLUSION Future research directions and clinical implications of these results are discussed for designing parenting interventions with mothers attending substance use treatment who present with PTSD symptoms.
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Affiliation(s)
- Julia Marie Peak
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Victoria Ingram
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Karen Urbanoski
- Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Karen Milligan
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Nidey N, Kair LR, Wilder C, Froelich TE, Weber S, Folger A, Marcotte M, Tabb K, Bowers K. Substance Use and Utilization of Prenatal and Postpartum Care. J Addict Med 2022; 16:84-92. [PMID: 33758116 PMCID: PMC8449796 DOI: 10.1097/adm.0000000000000843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Prenatal and postpartum care for women with substance use is important due to increased risk of poor health outcomes. The influence of substance use on perinatal care utilization is not well characterized, especially postpartum care. The objective of this study was to examine the effect of substance use during pregnancy on prenatal and postpartum care utilization in a nationally representative sample and to identify maternal characteristics associated with inadequate prenatal and postpartum care among women with substance use. METHODS Pregnancy Risk Assessment Monitoring System data (2016-2018) from 8 states were used for this study. Logistic regression models adjusted for complex survey weights and confounder variables were used to estimate the odds of not receiving adequate prenatal care and postpartum care. Weighted Rao-Scott chi-square tests were used to examine maternal characteristics associated with care utilization among women who reported substance use during pregnancy. RESULTS The study included 15,131 women, with 5.3% who reported illicit substance use during pregnancy. In multivariable models, substance use was associated with an increase in the odds of not receiving adequate prenatal care (OR 1.69, CI 1.32, 2.17) and not receiving postpartum care (OR: 1.47, CI 1.10, 1.95). Among women who reported substance use, depression and smoking status were associated with not receiving adequate prenatal or postpartum care. CONCLUSIONS Substance use during pregnancy is independently associated with disparities in prenatal and postpartum care access. Future studies are needed to identify how barriers lead to care inequalities and importantly, to identify strategies to improve care utilization.
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Affiliation(s)
- Nichole Nidey
- Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, Ohio, USA
- Cincinnati Children’s Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura R. Kair
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Christine Wilder
- Department of Psychiatry and Behavioral Neuroscience University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tanya E Froelich
- Cincinnati Children’s Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephanie Weber
- Cincinnati Children’s Hospital Medical Center, Division of Developmental and Behavioral Pediatrics, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alonzo Folger
- Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael Marcotte
- Tri-State Maternal-Fetal Medicine Associates, United States of America
| | - Karen Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Katherine Bowers
- Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Pentecost R, Latendresse G, Smid M. Scoping Review of the Associations Between Perinatal Substance Use and Perinatal Depression and Anxiety. J Obstet Gynecol Neonatal Nurs 2021; 50:382-391. [PMID: 33773955 PMCID: PMC8286297 DOI: 10.1016/j.jogn.2021.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate published literature on the associations between perinatal substance use (PSU), perinatal depression and anxiety (PDA), and known maternal-newborn outcomes. DATA SOURCES We conducted a systematic search of health-related databases, including PubMed, CINAHL, MEDLINE, and Embase. Search terms included maternal mental health, substance use, postpartum, opioid, alcohol, methamphetamine, addiction, dependence, pregnancy, depression, and anxiety. STUDY SELECTION We included English-language, peer-reviewed reports of primary research and systematic reviews that were published between 2010 and 2020 and focused on PSU and PDA. We excluded commentaries, nonsystematic reviews, and articles on maternal mental health other than PDA. Fourteen of 379 articles met the inclusion criteria. DATA EXTRACTION We used the Joanna Briggs Institute Review Guidelines to guide extraction of the following data: author(s), year of publication, type of study, country of origin, study sample, targeted substance(s), mental health, key findings, and recommendation(s). DATA SYNTHESIS In studies of PSU, researchers identified a strong association with PDA. Likewise, researchers investigating PDA found a strong association with PSU. Findings from these articles suggest an increasing risk for PSU with increasing severity of PDA, depending on the specific substances of use. Findings also indicated that women with polysubstance use have greater odds for comorbid perinatal mental health conditions. A relationship between PSU and PDA and adverse newborn outcomes, such as low birth weight, was found. CONCLUSION There is a paucity of published research on co-occurring PSU and PDA. However, polysubstance use appears to be associated with the greatest risk for PDA. It is essential to address PSU and PDA together to better understand the effects on maternal and infant outcomes.
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Paterno MT, Jablonski L, Klepacki A, Friedmann PD. Evaluation of a Nurse-Led Program for Rural Pregnant Women With Opioid Use Disorder to Improve Maternal–Neonatal Outcomes. J Obstet Gynecol Neonatal Nurs 2019; 48:495-506. [DOI: 10.1016/j.jogn.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 01/28/2023] Open
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Garcia-Guix A, Mestre-Pinto JI, Tirado-Muñoz J, Domingo-Salvany A, Torrens M. Psychiatric co-morbidity among women with substance use disorders. ADVANCES IN DUAL DIAGNOSIS 2018. [DOI: 10.1108/add-11-2017-0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mancini K. Body Image, Eating Attitudes and Breastfeeding Intention: Implications for Mental Health and Maternal Child Nurses. Issues Ment Health Nurs 2017; 38:750-755. [PMID: 28574762 DOI: 10.1080/01612840.2017.1324928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Body image dissatisfaction and disordered eating are often overlooked as personal factors that may affect pregnancy, postpartum, and infant feeding method. The current study compared body image, eating attitudes, and breastfeeding intention of first-time breastfeeding mothers to first-time non-breastfeeding mothers. A two-group, comparative design was used to analyze data for first-time mothers recruited through a large pediatric practice with multiple offices. Although there was no significant difference in body image scores between the groups, the literature suggests that body image dissatisfaction can affect the transition to motherhood and lead to more serious mental health issues. Prevention of psychiatric disorders such as eating disorders can be addressed early with information regarding body dissatisfaction and disordered eating. Findings from this study have implications for mental health and maternal child health providers.
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Affiliation(s)
- Karen Mancini
- a College of Nursing and Public Health , Adelphi University , Garden City , New York , USA
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Abstract
Mood and substance use disorders (SUDs) are mental conditions that are highly prevalent in the general population. Cooccurrence of major depression and SUD, also known as dual depression, is very common in the field of substance addiction. Sex differences are found in both major depression and SUD. This review, after presenting the state of the art of dual depression as regards prevalence, ethiopathologic mechanisms, and clinical aspects, is focused on dual depression in women. An overview of some potential factors associated with the sex gap in dual depression such as injecting, sexual risk behavior, intimate partner violence, and the reproductive cycle is presented.
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