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Barbosa-Leiker C, Brooks O, Smith CL, Burduli E, Gartstein MA. Healthcare professionals' and budtenders' perceptions of perinatal cannabis use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:186-194. [PMID: 34779673 PMCID: PMC9107527 DOI: 10.1080/00952990.2021.1988091] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: While national guidelines state that cannabis should not be consumed during pregnancy, cannabis use during pregnancy continues to increase. Pregnant individuals have reported using healthcare professionals and budtenders (i.e., cannabis store retailers) as resources for information on cannabis use during pregnancy and postpartum.Objectives: To determine healthcare professionals' and budtenders' perceptions of risks and benefits of perinatal cannabis use.Method: A qualitative study, using semi-structured, open-ended questions, was conducted with ten healthcare professionals (predominantly nurses; 100% women) and ten budtenders (70% women) in a state where cannabis use is legal for adults 21 years of age and older. Data were interpreted using a qualitative description methodology to identify themes. Themes were generated from participant responses (implicit and explicit). We analyzed data separately and sequentially and present linked themes across samples. Data saturation, rigor, and trustworthiness were discussed and agreed upon by the analytic team.Results: Six themes arose from the healthcare professional and budtender data: 1) Perinatal customers and patients perceive cannabis to be medicinal, 2) Supporting perinatal people who use cannabis, 3) Spectrum of perceived impacts of perinatal cannabis use, 4) Comparison to use of other substances during pregnancy, 5) Perceived limited knowledge and training about cannabis regulation and product safety, and 6) Current trends of purchase and use.Conclusion: Participants reported that perinatal patients/customers perceived cannabis to be medicinal, and highlighted non-judgmental/harm reduction strategies for engaging patients/customers. Training is needed for healthcare professionals and budtenders to assist with patient/customer discussions about perinatal cannabis use.
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Affiliation(s)
- Celestina Barbosa-Leiker
- College of Nursing, Washington State University, Spokane, WA, USA.,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Olivia Brooks
- College of Nursing, Washington State University, Spokane, WA, USA.,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Crystal Lederhos Smith
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, USA.,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Maria A Gartstein
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA.,Department of Psychology, Washington State University, Pullman, WA, USA
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2
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Smith BL. Improving translational relevance: The need for combined exposure models for studying prenatal adversity. Brain Behav Immun Health 2021; 16:100294. [PMID: 34589787 PMCID: PMC8474200 DOI: 10.1016/j.bbih.2021.100294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Prenatal environmental adversity is a risk factor for neurodevelopmental disorders (NDDs), with the neuroimmune environment proposed to play a role in this risk. Adverse maternal exposures are associated with cognitive consequences in the offspring that are characteristics of NDDs and simultaneous neuroimmune changes that may underlie NDD risk. In both animal models and human studies the association between prenatal environmental exposure and NDD risk has been shown to be complex. Maternal overnutrition/obesity and opioid use are two different examples of complex exposure epidemics, each with their own unique comorbidities. This review will examine maternal obesity and maternal opioid use separately, illustrating the pervasive comorbidities with each exposure to argue a need for animal models of compound prenatal exposures. Many of these comorbidities can impact neuroimmune function, warranting systematic investigation of combined exposures to begin to understand this complexity. While traditional approaches in animal models have focused on modeling a single prenatal exposure or second exposure later in life, a translational approach would begin to incorporate the most prevalent co-occurring prenatal exposures. Long term follow-up in humans is extremely challenging, so animal models can provide timely insight into neurodevelopmental consequences of complex prenatal exposures. Animal models that represent this translational context of comorbid exposures behind maternal obesity or comorbid exposures behind maternal opioid use may reveal potential synergistic neuroimmune interactions that contribute to cognitive consequences and NDD risk. Finally, translational co-exposure models can identify concerning exposure combinations to guide treatment in complex cases, and identify high risk children starting in the prenatal period where early interventions improve prognosis.
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Affiliation(s)
- Brittany L. Smith
- Department of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati, OH, USA
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Demiguel V, Laporal S, Quatremere G, Barry Y, Guseva Canu I, Goulet V, Germanaud D, Regnault N. The frequency of severe Fetal Alcohol Spectrum Disorders in the neonatal period using data from the French hospital discharge database between 2006 and 2013. Drug Alcohol Depend 2021; 225:108748. [PMID: 34058539 DOI: 10.1016/j.drugalcdep.2021.108748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUNDS At birth, only complete Fetal Alcohol Syndrome (FAS) can be properly diagnosed. However, other Consequences of prenatal Alcohol Exposure (CAE) can also be recorded. Our objective was to describe the frequency of diagnoses highly suggestive of "potential Fetal Alcohol Syndrome Disorder" (pFASD, i.e., FAS and CAE) among hospitalized neonates, during the neonatal period, in France, between 2006 and 2013. METHODS We used the French national hospital discharge database to identify the Q86.0 (FAS) and P04.3 (CAE) ICD-10 codes in hospital stays occurring in the first 28 days of life. FAS, CAE and pFASD rates were estimated per 1000 live births at the national level for the 2009-2013 period. We compared the 2006-2009 and 2010-2013 rates. The pFASD rates were also estimated at the regional level. RESULTS Overall, 3,207 cases of pFASD were diagnosed during the neonatal period (i.e., 0.48 cases per 1000 live births, including 0.07 cases of FAS per 1000). Between 2006-2009 and 2010-2013, pFASD remained stable, despite a moderate decrease in reported FAS (0.08 vs 0.06 cases per 1000, p < 0.001). At the regional level, pFASD rates varied between 0.13 and 1.22 cases per 1000. CONCLUSIONS This study provides the first national estimate of neonatal diagnosis of FAS, and more broadly pFASD, in France. Although our data certainly underestimate the real prevalence of FASD, they provide a minimal estimate of the burden of alcohol use during pregnancy. Observed variations deserve to be analyzed in the light of concomitant prevention and public information campaigns.
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Affiliation(s)
- Virginie Demiguel
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France.
| | - Stella Laporal
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Guillemette Quatremere
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Yaya Barry
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - Irina Guseva Canu
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Véronique Goulet
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
| | - David Germanaud
- Assistance Publique - Hôpitaux de Paris, Hôpital Robert-Debré, Centre d'Excellence InovAND, Service de Neurologie et des Maladies Métaboliques, Paris, France; Université de Paris, Inserm, CEA, UMR1141 NeuroDiderot, équipe InDev, Paris, France; CEA, Institut Juliot, NeuroSpin, UNIACT, Gif-sur-Yvette, France
| | - Nolwenn Regnault
- Santé publique France, French National Public Health Agency, F-94415 Saint-Maurice, France
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Austin AE, Berkoff MC, Shanahan ME. Incidence of Injury, Maltreatment, and Developmental Disorders Among Substance Exposed Infants. CHILD MALTREATMENT 2021; 26:282-290. [PMID: 32519558 DOI: 10.1177/1077559520930818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recent changes to federal legislation created a requirement for states to address the needs of infants with prenatal substance exposure. Understanding clinical outcomes among substance exposed infants prior to these changes is important for establishing a baseline of risk and informing systems-level responses. Using North Carolina, Georgia, and Texas Medicaid data, we examined the incidence of inpatient and outpatient diagnoses for injury, maltreatment, and developmental disorders prior to age 12 months and compared types of diagnoses among substance exposed and unexposed infants. The cumulative incidence of maltreatment (1.2% vs. 0.2%) and developmental disorder (10.7% vs. 1.5%) diagnoses prior to age 12 months was significantly higher among substance exposed compared to unexposed infants. The incidence of injury diagnoses was similar (3.7% vs. 3.4%). We observed differences in types of maltreatment and injury diagnoses. For example, diagnoses for neglect were more common among substance exposed infants while diagnoses for physical abuse were more common among unexposed infants. Results provide insight for informing monitoring and intervention by medical and public health professionals.
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Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health, 2331University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, 2331University of North Carolina at Chapel Hill, NC, USA
| | - Molly Curtin Berkoff
- Department of Pediatrics, 2331University of North Carolina at Chapel Hill, NC, USA
| | - Meghan E Shanahan
- Department of Maternal and Child Health, 2331University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, 2331University of North Carolina at Chapel Hill, NC, USA
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Abstract
Objective: To identify perceptions of risks and benefits of cannabis use during pregnancy and postpartum from the patient perspective. Methods: Pregnant and postpartum (up to 3 months) women residing in a state that legalized the sale of recreational cannabis in 2012 were interviewed to determine their perceptions of risks and benefits of cannabis use during pregnancy and postpartum. Qualitative description methodology was used to identify common themes in the data. Nineteen (n = 14 pregnant; n = 5 post-partum) women who used cannabis daily while pregnant were interviewed about perceptions of risks and benefits of cannabis use during pregnancy and postpartum. Results: Five themes, describing the participants’ cannabis use while pregnant and postpartum, emerged from the data. These themes include (1) continued use for health management, (2) ongoing evaluative process, (3) mixed messages, (4) wanting more information, and (5) legal considerations. All 5 of these themes contributed to the overarching theme of Taking Care of Mom and Baby, which encompasses the mother's need and struggle to care for her own health and wellness, as well as that of her unborn baby. Conclusions: In a state with legalized recreational cannabis, pregnant and postpartum women reported continuing daily cannabis use during pregnancy to take care of themselves and their baby. It is crucial for healthcare providers to follow national guidelines and explain risks of cannabis use during pregnancy and postpartum, while also managing expectations based on patient history. A harm reduction approach to decrease cannabis use is vital to help pregnant women who are using cannabis for health management to continuously evaluate their use during pregnancy and postpartum.
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Salameh TN, Hall LA, Crawford TN, Staten RR, Hall MT. Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014. J Psychosom Obstet Gynaecol 2020; 41:298-307. [PMID: 31718367 DOI: 10.1080/0167482x.2019.1689949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014. METHODS Using data from the 2008-2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared. RESULTS There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts. CONCLUSIONS There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.
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Affiliation(s)
| | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Timothy N Crawford
- Department of Population and Public Health Sciences, Wright State University, Dayton, OH, USA
| | - Ruth R Staten
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Martin T Hall
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
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Ward C, Christensen CW. Methadone for Opioid Use Treatment during Pregnancy: Trends in Postpartum Dose Adjustments. AJP Rep 2020; 10:e202-e209. [PMID: 33094005 PMCID: PMC7571562 DOI: 10.1055/s-0040-1713787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 12/05/2022] Open
Abstract
Objective This study examines methadone dose adjustment postpartum. Methods A retrospective study of women with methadone for opioid use treatment (OUT) during pregnancy was performed. Patient charts were reviewed and data were extracted. Methadone doses from five temporal data points for each patient were used: starting dose, day of delivery, and 1, 2, and 6 months postpartum. Results Over 26 months, 49 pregnancies to women using methadone for OUT were evaluated and 20 (41%) were included. The mean methadone starting dose was 47 mg, compared with 86 mg at the time of delivery. The mean dose postpartum remained unchanged from delivery and 75% of pregnancies required the same dose or higher 1 month postpartum. By 2 months postpartum, only 33% were able to decrease their methadone dose. Twelve pregnancies completed follow-up until 6 months postpartum; only 17% of patients were able to decrease their dose, with an overall mean dose decrease was 12%. There was no difference between the mean dose at delivery and the 6-month postpartum dose. Conclusion Patients using methadone for OUT during pregnancy achieved minimal dose decreases postpartum. Patients should be counseled that postpartum dose tapers may be challenging and about alternatives to methadone for OUT.
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Affiliation(s)
- Clara Ward
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center/McGovern Medical School, Houston, Texas
| | - Carl W Christensen
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
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Atkins DN, Durrance CP. State Policies That Treat Prenatal Substance Use As Child Abuse Or Neglect Fail To Achieve Their Intended Goals. Health Aff (Millwood) 2020; 39:756-763. [DOI: 10.1377/hlthaff.2019.00785] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Danielle N. Atkins
- Danielle N. Atkins is an assistant professor of health management and informatics at the University of Central Florida, in Orlando
| | - Christine Piette Durrance
- Christine Piette Durrance is an associate professor of public policy at the University of North Carolina at Chapel Hill
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9
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Gabrielson S, Carwile J, O'Connor A, Ahrens K. Maternal opioid use disorder at delivery hospitalization in a rural state: Maine, 2009–2018. Public Health 2020; 181:171-179. [DOI: 10.1016/j.puhe.2019.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/28/2022]
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Salameh TN, Hall LA. Depression, Anxiety, and Substance Use Disorders and Treatment Receipt Among Pregnant Women in the United States: A Systematic Review of Trend and Population-Based Studies. Issues Ment Health Nurs 2020; 41:7-23. [PMID: 31855501 DOI: 10.1080/01612840.2019.1667460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this systematic review was to synthesize findings of trend and population-based studies on depression, anxiety, and substance use disorders and treatment receipt among pregnant women in the United States. Twenty-eight articles (nine trend studies and 19 population-based studies) were included for review. Two trend studies showed that illicit drug use disorder increased in pregnant women over the past decade, particularly opioid and marijuana use disorders. Three studies reported an increase in treatment admissions for these disorders from 1992 to 2012; however, the overall treatment admission rate for pregnant women remained relatively stable at 4%. Three studies identified an increase in antidepressant use from 1995 to 2010 in pregnant women. Nine of 19 population-based studies revealed that White ethnicity, older reproductive age, college education, and health insurance coverage were associated with mental health and substance use treatment receipt among pregnant women. Further studies are warranted among a nationally representative sample of pregnant women.
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Affiliation(s)
| | - Lynne A Hall
- University of Louisville School of Nursing, Louisville, Kentucky, USA
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11
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Hasin DS, Shmulewitz D, Keyes K. Alcohol use and binge drinking among U.S. men, pregnant and non-pregnant women ages 18-44: 2002-2017. Drug Alcohol Depend 2019; 205:107590. [PMID: 31600616 PMCID: PMC6893082 DOI: 10.1016/j.drugalcdep.2019.107590] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Drinking during pregnancy dropped sharply in the U.S. in the 1980s. More recent time trends in adult drinking and binge drinking in men, non-pregnant and pregnant women have not been directly compared. METHODS Using logistic regression and National Surveys on Drug Use and Health (NSDUH) 2002-2017 data on any drinking and 2002-2014 data on binge drinking, trends in men, non-pregnant and pregnant women were compared. Analyses of any drinking included 470,309 participants (221,344 men; 236,197 non-pregnant women; 12,768 pregnant women); of binge drinking, 379,379 participants (178,869 men; 189,923 non-pregnant women; 10,587 pregnant women). RESULTS In all participants, drinking decreased (62.2%-60.3%). Among adults ages 18-20, drinking decreased in men, non-pregnant women, and pregnant women (-18.4%; -11.1%; -5.3%), as did binge drinking (-11.8%; -5.6%; -3.7%). Among adults ages 21-44, drinking increased in non-pregnant women (+2.3%), and decreased in men and pregnant women (-2.6% and -3.3%), while binge drinking increased in non-pregnant women (+2.7%), but not in pregnant women (-1.8%) or men (0.0%). CONCLUSIONS Drinking increased in U.S. women ages 21-44, but not those who were pregnant. Increases in women and continuing high rates in men indicate the need for better public health efforts. Divergent trends in men, non-pregnant, and pregnant women ages 21-44 suggest differential influences on drinking. Continued low rates in pregnant women are encouraging, but maintaining public health messages about drinking during pregnancy and innovative efforts to prevent such drinking are needed. Different results in ages 18-20 and 21-44 highlight the importance of developmental stages in drinking.
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Affiliation(s)
- Deborah S Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA.
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Katherine Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
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Shmulewitz D, Hasin DS. Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017. Prev Med 2019; 124:75-83. [PMID: 31054285 PMCID: PMC6561097 DOI: 10.1016/j.ypmed.2019.04.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 12/25/2022]
Abstract
Fetal alcohol exposure can lead to severe birth and developmental defects. Determining which pregnant women are most likely to drink is essential for targeting interventions. In National Survey on Drug Use and Health data on pregnant women from 2002 to 2017 (N = 13,488), logistic regression was used to produce adjusted odds ratios (aOR) indicating characteristics associated with two past-month outcomes: any alcohol use and binge drinking. Risk factors were sociodemographic (age, race/ethnicity, marital status, education level, income) and clinical (trimester, substance use, alcohol use disorder, major depression). Where associations differed by pregnancy stage (trimester 1 vs. trimesters 2 and 3), association was evaluated by stage. Overall, higher risk for any and binge drinking was observed among those with other substance use (aORs 2.9-25.9), alcohol use disorder (aORs 4.5-7.5), depression (aORs = 1.6), and unmarried women (aORs 1.6-3.2). For any drinking, overall, higher risk was observed in adolescents (aOR = 1.5) and those with higher education (aOR = 1.4), while lower risk was observed in those with lower income (aORs = 0.7). For binge drinking, associations differed by pregnancy stage. In trimester 1, lower risk was observed in middle ages (aOR = 0.4). In trimesters 2/3, higher risk was observed in Blacks (aOR = 3.3) and those with lower income (aORs 3.5-3.9), while lower risk was observed in those with higher education (aOR = 0.3). To prevent severe prenatal harm, health care providers should focus on women at higher risk for binge drinking during pregnancy: women with tobacco or drug use, alcohol use disorder, or depression, and women who are unmarried, Black, or of lower socioeconomic status.
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Affiliation(s)
- Dvora Shmulewitz
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
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Kozhimannil KB, Chantarat T, Ecklund AM, Henning-Smith C, Jones C. Maternal Opioid Use Disorder and Neonatal Abstinence Syndrome Among Rural US Residents, 2007-2014. J Rural Health 2018; 35:122-132. [PMID: 30370563 DOI: 10.1111/jrh.12329] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/30/2018] [Accepted: 09/17/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Opioid use disorder (OUD) during pregnancy is associated with poor maternal and infant outcomes, including neonatal abstinence syndrome (NAS), and both maternal OUD and NAS are increasing disproportionately among rural residents. This study describes the trajectory and characteristics associated with diagnosis of maternal OUD or NAS among rural residents who gave birth at different types of hospitals based on rural/urban location and teaching status. METHODS Hospital discharge data from the all-payer National Inpatient Sample were used to describe maternal OUD and infant NAS among rural residents from 2007-2014. Hospitals were categorized as rural, urban teaching, and urban nonteaching. We estimated incidence trends by hospital categories, followed by multivariable logistic regression analyses to identify correlates of OUD and NAS among rural residents, stratified by hospital category. FINDINGS Incidence of maternal OUD increased in all hospital categories, with higher rates (8.9/1,000 deliveries) among rural residents who gave birth at urban teaching hospitals compared with those who gave birth at rural hospitals (4.3/1,000 deliveries) or urban nonteaching hospitals (3.6/1,000 deliveries; P < .001). A similar pattern was observed for infant NAS. In multivariable models, the association between maternal OUD and infant NAS diagnoses and hospital category differed by rurality (micropolitan vs. noncore.) CONCLUSIONS: There has been a sustained increase in both maternal OUD and NAS diagnoses among rural residents. Measured sociodemographic and clinical correlates of maternal OUD and NAS differ by hospital category, indicating variability across hospital locations in patient populations and clinical needs for rural residents with these conditions.
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Affiliation(s)
- Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.,University of Minnesota Rural Health Research Center, Minneapolis, Minnesota
| | - Tongtan Chantarat
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.,University of Minnesota Rural Health Research Center, Minneapolis, Minnesota
| | - Alexandra M Ecklund
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.,University of Minnesota Rural Health Research Center, Minneapolis, Minnesota
| | - Carrie Henning-Smith
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.,University of Minnesota Rural Health Research Center, Minneapolis, Minnesota
| | - Cresta Jones
- Department of Obstetrics, Gynecology and Women's Health, Division of Maternal-Fetal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Comparison of Biological Screening and Diagnostic Indicators to Detect In Utero Opiate and Cocaine Exposure Among Mother-Infant Dyads. Ther Drug Monit 2018; 39:640-647. [PMID: 28937537 DOI: 10.1097/ftd.0000000000000447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Opioid and cocaine antenatal substance use can result in significant obstetric and pediatric health implications. Accurate detection of in utero-exposed neonates can improve patient care and health outcomes. Therefore, the effectiveness of mother-infant biological and diagnostic indicators collected at labor and delivery to provide accurate detection of in utero opiate and cocaine exposure was assessed. METHODS A retrospective medical chart review included 335 mother-infant dyads exposed to antenatal substances who were delivered between January 2009 and March 2014. Mother-infant dyads were a subset of a larger retrospective cohort of 560 substance-using mothers, who had a valid meconium drug screen (MDS) and anesthesia before delivery. Alternative biological and diagnostic indicators of maternal urine drug screens (UDS), maternal substance use International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and neonatal exposure diagnostic ICD-9-CM codes were compared against MDS. Data were analyzed using classification accuracy measures. RESULTS Compared with MDS, maternal UDS had the highest sensitivity [0.52, 95% confidence interval (CI), 0.39-0.65] and specificity (0.88, 95% CI, 0.79-0.97) to detect intrauterine opiate exposure. Maternal substance use diagnosis had the highest sensitivity (0.39, 95% CI, 0.16-0.61) and maternal UDS had the highest specificity (1.00, 95% CI, 0.99-1.00) to detect intrauterine cocaine exposure. Cocaine exposure had significantly higher accuracy scores across detection methods compared with opiate exposure. CONCLUSIONS Alternative indicators collected at delivery were ineffective at identifying in utero substance exposure, especially neonatal-exposed ICD-9-CM codes. Low sensitivity scores indicate that many exposed neonates could be misdiagnosed or left untreated. Accurate antenatal exposure identification at delivery is an important form of tertiary assessment that warrants the development of improved screening methodology and standardization of hospital biological drug testing.
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Kotelchuck M, Cheng ER, Belanoff C, Cabral HJ, Babakhanlou-Chase H, Derrington TM, Diop H, Evans SR, Bernstein J. The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts. Matern Child Health J 2018; 21:893-902. [PMID: 27832443 DOI: 10.1007/s10995-016-2190-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003-2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from 1-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women's perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Results 5.5% of Massachusetts's deliveries between 2003 and 2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28-1.41) and low birth weight (LBW) (AOR 1.73, 95% CI 1.64-1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95% CI 0.55-0.68) and LBW (AOR 0.54, 95% CI 0.49-0.61). Conclusions for Practice SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don't receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.
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Affiliation(s)
- Milton Kotelchuck
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, MA, USA.
| | - Erika R Cheng
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Candice Belanoff
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | | | - Taletha M Derrington
- Center on Education and Human Services, Education Division, SRI International, Menlo ParkCA, USA
| | - Hafsatou Diop
- Office of Data Translation, Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA
| | - Stephen R Evans
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Prindle JJ, Hammond I, Putnam-Hornstein E. Prenatal substance exposure diagnosed at birth and infant involvement with child protective services. CHILD ABUSE & NEGLECT 2018; 76:75-83. [PMID: 29078100 DOI: 10.1016/j.chiabu.2017.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 05/13/2023]
Abstract
Infants have the highest rates of maltreatment reporting and entries to foster care. Prenatal substance exposure is thought to contribute to early involvement with child protective services (CPS), yet there have been limited data with which to examine this relationship or variations by substance type. Using linked birth, hospital discharge, and CPS records from California, we estimated the population prevalence of medically diagnosed substance exposure and neonatal withdrawal disorders at birth. We then explored the corresponding rates of CPS involvement during the first year of life by substance type after adjusting for sociodemographic and health factors. Among 551,232 infants born alive in 2006, 1.45% (n=7994) were diagnosed with prenatal substance exposure at birth; 61.2% of those diagnosed were reported to CPS before age 1 and nearly one third (29.9%) were placed in foster care. Medically diagnosed prenatal substance exposure was strongly associated with an infant's likelihood of being reported to CPS, yet significant variation in the likelihood and level of CPS involvement was observed by substance type. Although these data undoubtedly understate the prevalence of prenatal illicit drug and alcohol use, this study provides a population-based characterization of a common pathway to CPS involvement during infancy. Future research is needed to explicate the longer-term trajectories of infants diagnosed with prenatal substance exposure, including the role of CPS.
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Affiliation(s)
- John J Prindle
- Children's Data Network, Suzanne Dworak-Peck School of Social Work, University of Southern California, United States.
| | - Ivy Hammond
- Children's Data Network, Suzanne Dworak-Peck School of Social Work, University of Southern California, United States
| | - Emily Putnam-Hornstein
- Children's Data Network, Suzanne Dworak-Peck School of Social Work, University of Southern California, United States
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18
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Kozhimannil KB, Graves AJ, Jarlenski M, Kennedy-Hendricks A, Gollust S, Barry CL. Non-medical opioid use and sources of opioids among pregnant and non-pregnant reproductive-aged women. Drug Alcohol Depend 2017; 174:201-208. [PMID: 28285727 PMCID: PMC5486870 DOI: 10.1016/j.drugalcdep.2017.01.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The morbidity and mortality burden of the US opioid epidemic falls heavily on reproductive-age women. Information on the patterns of and sources for non-medical use of prescription opioids among reproductive age women, including pregnant women, will inform public health and prevention efforts to mitigate the effects of the opioid epidemic. This study characterized non-medical use of prescription opioids among reproductive-age U.S. women, with a focus on pregnancy status. METHODS We used nationally-representative data from the National Survey of Drug Use and Health (2005-2014) to examine non-medical use (NMU) of prescription opioids in the past 30days among females ages 18-44 (N=154,179), distinguishing pregnant women (N=8069). We used multivariable logistic regression to describe reported sources of opioids, including opioids obtained from a doctor, friend or relative, dealer, or other source. RESULTS Nearly 1% of pregnant women and 2.3% of non-pregnant reproductive-age women reported opioid NMU in the past 30days. Forty-six percent of pregnant women identified a doctor as their source compared with 27.6% of non-pregnant women reporting NMU. Pregnant women reported a friend or relative as their source of opioids less frequently than non-pregnant women (53.8% versus 75.0%), and some pregnant and non-pregnant women acquired opioids from a dealer (14.6% and 10.6%). CONCLUSION Opioid NMU among reproductive-age women is a complex public health challenge affecting a vulnerable population. Pregnant women were more likely than non-pregnant women to list a doctor as their source of opioids for NMU, suggesting the need for targeted policies to address physician prescribing during pregnancy.
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Affiliation(s)
- Katy B Kozhimannil
- Division of Health Policy and Management,University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN 55455, United States.
| | - Amy J Graves
- Division of Health Policy and Management,University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN 55455, United States.
| | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, 130 DeSoto St., A619, Pittsburgh, PA 15261, United States.
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 311, Baltimore, MD 21205, United States.
| | - Sarah Gollust
- Division of Health Policy and Management,University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN 55455, United States.
| | - Colleen L Barry
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 311, Baltimore, MD 21205, United States.
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Kozhimannil KB, Graves AJ, Levy R, Patrick SW. Nonmedical Use of Prescription Opioids among Pregnant U.S. Women. Womens Health Issues 2017; 27:308-315. [PMID: 28408072 DOI: 10.1016/j.whi.2017.03.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Nonmedical use of opioids during pregnancy is associated with adverse outcomes for women and infants, making it a prominent target for prevention and identification. Using a nationally representative sample, we determined characteristics of U.S. pregnant women who reported prescription opioid misuse in the past year or during the past month. METHODS We used data from the National Survey on Drug Use and Health (2005-2014) in a retrospective analysis. The sample included 8,721 (weighted n = 23,855,041) noninstitutionalized women, ages 12 to 44, who reported being pregnant when surveyed. Outcomes were nonmedical use of prescription opioid medications during the past 12 months and during the past 30 days. Multivariable logistic regression models were created to determine correlates of nonmedical opioid use after accounting for potential confounding variables. RESULTS Among pregnant women in the United States, 5.1% reported nonmedical opioid use in the past year. In adjusted models, depression or anxiety in the past year was strongly associated with past year nonmedical use (adjusted odd ratio [AOR], 2.15; 95% CI, 1.52-3.04), as were past year use of alcohol (AOR, 1.56; 95% CI, 1.11-2.17), tobacco (AOR, 1.72; 95% CI, 1.17-2.53), and marijuana (AOR, 3.44; 95% CI, 2.47-4.81). Additionally, 0.9% of U.S. pregnant women reported nonmedical opioid use in the past month. Past year depression or anxiety and past month use of alcohol, tobacco, and marijuana each independently predicted past month nonmedical use. CONCLUSIONS Characteristics associated with nonmedical opioid use by pregnant women reveal populations with mental illness and co-occurring substance use. Policy and prevention efforts to improve screening and treatment could focus on the at-risk populations identified in this study.
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Affiliation(s)
- Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
| | - Amy J Graves
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Robert Levy
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Stephen W Patrick
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Health Policy, Vanderbilt Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee
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Palmer KL, Wood KE, Krasowski MD. Evaluating a switch from meconium to umbilical cord tissue for newborn drug testing: A retrospective study at an academic medical center. Clin Biochem 2017; 50:255-261. [DOI: 10.1016/j.clinbiochem.2016.11.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 11/27/2022]
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Delcher C, Livingston M, Wang Y, Mowitz M, Maldonado-Molina M, Goldberger BA. Supply-Side Disruption in Cocaine Production Associated With Cocaine-Related Maternal and Child Health Outcomes in the United States. Am J Public Health 2017; 107:812-814. [PMID: 28323460 DOI: 10.2105/ajph.2017.303708] [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
OBJECTIVES To investigate the effects of precursor chemical regulation aimed at reducing cocaine production on cocaine-related maternal and newborn hospital stays in the United States. METHODS We analyzed monthly counts of maternal and neonatal stays from January 2002 through December 2013 by using a quasi-experimental interrupted time series design. We estimated the preregulation linear trend, postregulation change in linear trend, and abrupt change in level. RESULTS The number of monthly cocaine-related maternal and neonatal stays decreased by 221 and 128 stays, respectively, following the cocaine precursor regulation change. We also observed a further decline in per-month maternal and neonatal stays of 18 and 8 stays, respectively. CONCLUSIONS A supply-side disruption in the United States cocaine market was associated with reduced hospital stays for 2 vulnerable populations: pregnant women and newborns. Results support findings that federal precursor regulation can positively reduce cocaine availability in the United States.
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Affiliation(s)
- Chris Delcher
- Chris Delcher, Yanning Wang, and Mildred Maldonado-Molina are with the Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville. Melvin Livingston is with the Department of Biostatistics and Epidemiology, University of North Texas, Fort Worth. Meredith Mowitz is with the Department of Pediatrics, College of Medicine, University of Florida. Bruce A. Goldberger is with the Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida
| | - Melvin Livingston
- Chris Delcher, Yanning Wang, and Mildred Maldonado-Molina are with the Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville. Melvin Livingston is with the Department of Biostatistics and Epidemiology, University of North Texas, Fort Worth. Meredith Mowitz is with the Department of Pediatrics, College of Medicine, University of Florida. Bruce A. Goldberger is with the Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida
| | - Yanning Wang
- Chris Delcher, Yanning Wang, and Mildred Maldonado-Molina are with the Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville. Melvin Livingston is with the Department of Biostatistics and Epidemiology, University of North Texas, Fort Worth. Meredith Mowitz is with the Department of Pediatrics, College of Medicine, University of Florida. Bruce A. Goldberger is with the Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida
| | - Meredith Mowitz
- Chris Delcher, Yanning Wang, and Mildred Maldonado-Molina are with the Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville. Melvin Livingston is with the Department of Biostatistics and Epidemiology, University of North Texas, Fort Worth. Meredith Mowitz is with the Department of Pediatrics, College of Medicine, University of Florida. Bruce A. Goldberger is with the Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida
| | - Mildred Maldonado-Molina
- Chris Delcher, Yanning Wang, and Mildred Maldonado-Molina are with the Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville. Melvin Livingston is with the Department of Biostatistics and Epidemiology, University of North Texas, Fort Worth. Meredith Mowitz is with the Department of Pediatrics, College of Medicine, University of Florida. Bruce A. Goldberger is with the Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida
| | - Bruce A Goldberger
- Chris Delcher, Yanning Wang, and Mildred Maldonado-Molina are with the Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville. Melvin Livingston is with the Department of Biostatistics and Epidemiology, University of North Texas, Fort Worth. Meredith Mowitz is with the Department of Pediatrics, College of Medicine, University of Florida. Bruce A. Goldberger is with the Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida
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22
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Van Scoyoc A, Harrison JA, Fisher PA. Beliefs and Behaviors of Pregnant Women with Addictions Awaiting Treatment Initiation. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2017; 34:65-79. [PMID: 31588163 PMCID: PMC6777720 DOI: 10.1007/s10560-016-0474-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Substance use during pregnancy poses clear risks to children's healthy development. However, women with addictions face unique barriers to accessing substance abuse treatment and often delay or avoid treatment seeking. The objective of this study was to examine women's beliefs about the impact of use on the developing baby and to examine the protective behaviors that women with addictions engage in during the period of time between when they first find out they are pregnant and when they begin substance abuse treatment. Semi-structured interviews were conducted with 15 women who were either pregnant or postpartum and who had used illicit substances during pregnancy. All participants were currently receiving inpatient substance abuse treatment services to address their addiction and were asked to retrospectively report on their experiences. Interviews were transcribed, imported into a qualitative data analysis software, and iteratively coded for themes. Women reported being concerned about the impact of substance use on the developing baby, in particular, about the physical and long-term developmental consequences of prenatal exposure. Given these concerns, women described trying to protect the baby from harm on their own, outside of accessing traditional treatment services. They sought information anonymously, increased their engagement in health-promoting behaviors, and decreased their use of alcohol and other drugs. The results suggest that women who use alcohol and other drugs during pregnancy are often motivated to protect their baby from harm and are engaging in harm reduction behaviors prior to accessing treatment services.
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Affiliation(s)
- Amanda Van Scoyoc
- University of Oregon, Eugene, OR
- Yale Child Study Center, New Haven, CT
- Doris Duke Fellow Alumni
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Dharmasena A, Keenan T, Goldacre R, Hall N, Goldacre MJ. Trends over time in the incidence of congenital anophthalmia, microphthalmia and orbital malformation in England: database study. Br J Ophthalmol 2016; 101:735-739. [PMID: 27601422 DOI: 10.1136/bjophthalmol-2016-308952] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/26/2016] [Accepted: 08/12/2016] [Indexed: 11/03/2022]
Abstract
AIMS To study trends over time in the incidence of congenital anophthalmia, microphthalmia and orbital malformations in England, along with changes in hospital admission rates for these conditions. METHODS Using English National Hospital Episode Statistics (1999-2011), the annual rate of hospital admissions related to anophthalmia, microphthalmia and congenital malformations of orbit/lacrimal apparatus was calculated per 100 000 infants. The records were person-linked, which enabled patients' 'first record' rates to be calculated as proxies for incidence. Similar analyses on pre-1999 datasets were also undertaken for microphthalmia. RESULTS There was no systematic increase or decrease over time in the incidence of these conditions, but there was some fluctuation from year to year. The incidence of congenital anophthalmia ranged from 2.4 (95% CI 1.3 to 4.0) per 100 000 infants in 1999 to 0.4 (0 to 1.3) in 2011. The annual incidence of congenital microphthalmia was 10.8 (8.2 to 13.5) in 1999 and 10.0 (7.6 to 12.4) in 2011. The annual incidence of congenital orbital/lacrimal malformations was 0.5 (0 to 1.1) in 1999 and 0.7 (0 to 1.4) in 2011. Including multiple admissions per person, admission rates for microphthalmia showed a linear increase over time from 1999. The earlier data for microphthalmia indicated an increase in admission rates, but no change in incidence, from 1971 to 2011. CONCLUSIONS The incidence of these conditions has remained stable in England in recent years. Although the incidence of microphthalmia was stable, hospital admission rates for it increased over time reflecting an increase in multiple admissions per affected person. These data may be useful for planning service provision.
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Affiliation(s)
- Aruna Dharmasena
- Department of Oculoplastics, Lacrimal and Orbital surgery, Manchester Royal Eye Hospital, Manchester, UK.,Department of Adnexal surgery, Moorfields Eye Hospital, London, UK
| | - Tiarnan Keenan
- Department of Oculoplastics, Lacrimal and Orbital surgery, Manchester Royal Eye Hospital, Manchester, UK
| | - Raph Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Hall
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Parolin M, Simonelli A. Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions. Front Psychiatry 2016; 7:152. [PMID: 27625612 PMCID: PMC5004230 DOI: 10.3389/fpsyt.2016.00152] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022] Open
Abstract
Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.
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Affiliation(s)
- Micol Parolin
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
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25
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Abstract
Opioid misuse during pregnancy is associated with negative outcomes for both mother and fetus due not only to the physiological effects of the drug but also to the associated social, medical and mental health problems that accompany illicit drug use. An interdisciplinary approach to the treatment of opioid use disorder during pregnancy is most effective. Ideally, obstetric and substance use treatment are co-located and ancillary support services are readily available. Medication-assisted treatment with methadone or buprenorphine is intrinsic to evidence-based care for the opioid-using pregnant woman. Women who are not stabilized on an opioid maintenance medication experience high rates of relapse and worse outcomes. Methadone has been the mainstay of maintenance treatment for nearly 50 years, but recent research has found that both methadone and buprenorphine maintenance treatments significantly improve maternal, fetal and neonatal outcomes. Although methadone remains the current standard of care, the field is beginning to move towards buprenorphine maintenance as a first-line treatment for pregnant women with opioid use disorder, because of its greater availability and evidence of better neonatal outcomes than methadone. However, there is some evidence that treatment dropout may be greater with buprenorphine relative to methadone.
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Affiliation(s)
- Christine M Wilder
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH, 45229, USA. .,Department of Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati, OH, 45220, USA.
| | - Theresa Winhusen
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH, 45229, USA
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27
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Bernstein J, Bernstein E, Belanoff C, Cabral HJ, Babakhanlou-Chase H, Derrington TM, Diop H, Douriez C, Evans SR, Jacobs H, Kotelchuck M. The association of injury with substance use disorder among women of reproductive age: an opportunity to address a major contributor to recurrent preventable emergency department visits? Acad Emerg Med 2014; 21:1459-68. [PMID: 25491709 PMCID: PMC4330107 DOI: 10.1111/acem.12548] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/20/2014] [Accepted: 05/31/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used. METHODS This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates. RESULTS Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost two-thirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (±SD) number of events also differed (2.27 ± 4.1 for SUD-positive women vs. 0.73 ± 1.3 for SUD-negative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (±SD) number of events was more than double (0.72 ± 0.9 vs. 0.26 ± 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean ± SD events = 0.19 ± 0.9 vs. 0.009 ± 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean ± SD events = 0.18 ± 0.1 vs. 0.02 ± 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean ± SD = 3.67 ± 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor. CONCLUSIONS The presence of SUD increases the likelihood that women in the 15- to 49-year age group will present to the ED with injury. Conversely, women with injury may be more likely to be involved in alcohol abuse or other substance use. The high rates of injury that we identified among women with SUD suggest the utility of including a brief, validated screen for substance use as part of an ED injury treatment protocol and referring injured women for assessment and/or treatment when scores indicate the likelihood of SUD.
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Martin CE, Longinaker N, Terplan M. Recent trends in treatment admissions for prescription opioid abuse during pregnancy. J Subst Abuse Treat 2014; 48:37-42. [PMID: 25151440 DOI: 10.1016/j.jsat.2014.07.007] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022]
Abstract
Prescription opioid abuse is a significant and costly public health problem among pregnant women in the United States. We investigated recent trends in substance abuse treatment admissions for prescription opioids during pregnancy using the Treatment Episodes Data Set. From 1992 to 2012 the overall proportion of pregnant admissions remained stable at 4%; however, admissions of pregnant women reporting prescription opioid abuse increased substantially from 2% to 28% especially in the south. Demographic characteristics of pregnant opioid admissions changed from 1992 to 2012 with younger, unmarried White non-Hispanic women, criminal justice referrals, and those with a psychiatric co-morbidity becoming more common (p<0.01). About a third received medication assisted therapy despite this being the standard of care for opioid abuse in pregnancy. While substance abuse treatment centers have increased treatment volume to address the increase in prescription opioid dependence among pregnant women, targeting certain risk groups and increasing utilization of medication assisted therapy should be emphasized.
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Affiliation(s)
- Caitlin E Martin
- Department of obstetrics and gynecology, University of North Carolina hospitals.
| | - Nyaradzo Longinaker
- Graduate Program in Life Sciences - Epidemiology and Human Genetics Program, University of Maryland, Baltimore.
| | - Mishka Terplan
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD.
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Abstract
Several clinical tools have been developed to quantify the severity of withdrawal signs and symptoms exhibited by infants born to substance-using mothers. Scores from the systematic assessments are used to guide treatment of infants with moderate to severe clinical signs. This article provides an overview of published assessment tools developed for infants with neonatal abstinence syndrome. Nurses caring for infants at risk for neonatal abstinence syndrome should be knowledgeable about the tools used to evaluate these infants and guide their treatment. The ideal assessment tool should be published and include item definitions and a protocol for administering the tool. Nurses need education and training to achieve competency and interobserver reliability in the use of a selected tool. Tool-specific materials should be used to standardize training and improve accuracy in assessments. Competent and knowledgeable nurses play a critical role in improving outcomes for infants with neonatal abstinence syndrome.
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Fridman M, Korst LM, Chow J, Lawton E, Mitchell C, Gregory KD. Trends in maternal morbidity before and during pregnancy in California. Am J Public Health 2013; 104 Suppl 1:S49-57. [PMID: 24354836 DOI: 10.2105/ajph.2013.301583] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined trends in maternal comorbidities in California. METHODS We conducted a retrospective cohort study of 1,551,017 California births using state-linked vital statistics and hospital discharge cohort data for 1999, 2002, and 2005. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify the following conditions, some of which were preexisting: maternal hypertension, diabetes, asthma, thyroid disorders, obesity, mental health conditions, substance abuse, and tobacco use. We estimated prevalence rates with hierarchical logistic regression models, adjusting for demographic shifts, and also examined racial/ethnic disparities. RESULTS The prevalence of these comorbidities increased over time for hospital admissions associated with childbirth, suggesting that pregnant women are getting sicker. Racial/ethnic disparities were also significant. In 2005, maternal hypertension affected more than 10% of all births to non-Hispanic Black mothers; maternal diabetes affected nearly 10% of births to Asian/Pacific Islander mothers (10% and 43% increases, respectively, since 1999). Chronic hypertension, diabetes, obesity, mental health conditions, and tobacco use among Native American women showed the largest increases. CONCLUSIONS The prevalence of maternal comorbidities before and during pregnancy has risen substantially in California and demonstrates racial/ethnic disparity independent of demographic shifts.
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Affiliation(s)
- Moshe Fridman
- Moshe Fridman is with AMF Consulting, Los Angeles, CA. Lisa M. Korst is with the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, and Childbirth Research Associates, LLC, Los Angeles. Jessica Chow is with the Departments of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles (UCLA). Kimberly D. Gregory is with the Departments of Obstetrics and Gynecology, Cedars Sinai Medical Center and David Geffen School of Medicine, UCLA. Elizabeth Lawton is with the Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, under contract with the University of California San Francisco. Connie Mitchell is with the California Department of Public Health, Maternal, Child and Adolescent Health Division, Sacramento
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Hekman KA, Grigorescu VI, Cameron LL, Miller CE, Smith RA. Neonatal withdrawal syndrome, Michigan, 2000-2009. Am J Prev Med 2013; 45:113-117. [PMID: 23790996 PMCID: PMC4690455 DOI: 10.1016/j.amepre.2013.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 12/14/2012] [Accepted: 02/25/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neonatal withdrawal syndrome, which is associated most frequently with opioid use in pregnancy, is an emerging public health concern, with recent studies documenting an increase in the rate of U.S. infants diagnosed. PURPOSE This study examined neonatal withdrawal syndrome diagnosis among Michigan infants from 2000 to 2009 and hospital length of stay (LOS) between infants with and without the syndrome for a subset of years (2006-2009). METHODS Michigan live birth records from 2000 to 2009 were linked with hospital discharge data to identify infants with neonatal withdrawal syndrome. Linked data were restricted to infants born between 2006 and 2009 to examine the difference in hospital LOS between infants with and without the syndrome. Multivariable regression models were constructed to examine the adjusted impact of syndrome diagnosis on infant LOS and fit using negative binomial distribution. Data were analyzed from July 2011 to February 2012. RESULTS From 2000 to 2009, the overall birth rate of infants with neonatal withdrawal syndrome increased from 41.2 to 289.0 per 100,000 live births (p<0.0001). Among infants born from 2006 to 2009, the average hospital LOS for those with the syndrome was between 1.36 (95% CI=1.24, 1.49) and 5.75 (95% CI=5.41, 6.10) times longer than for infants without it. CONCLUSIONS Diagnosis of neonatal withdrawal syndrome increased significantly in Michigan with infants who had the syndrome requiring a significantly longer LOS compared to those without it.
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Affiliation(s)
- Kimberly A Hekman
- Bureau of Disease Control, Prevention, and Epidemiology Michigan Department of Community Health, Lansing, Michigan.
| | - Violanda I Grigorescu
- Applied Sciences Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Lorraine L Cameron
- Bureau of Disease Control, Prevention, and Epidemiology Michigan Department of Community Health, Lansing, Michigan
| | - Corinne E Miller
- Bureau of Disease Control, Prevention, and Epidemiology Michigan Department of Community Health, Lansing, Michigan
| | - Ruben A Smith
- Applied Sciences Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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