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Backer KD, Rayment-Jones H, Lever Taylor B, Bicknell-Morel T, Montgomery E, Sandall J, Easter A. Healthcare experiences of pregnant and postnatal women and healthcare professionals when facing child protection in the perinatal period: A systematic review and Critical Interpretative Synthesis. PLoS One 2024; 19:e0305738. [PMID: 38959192 PMCID: PMC11221698 DOI: 10.1371/journal.pone.0305738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers. AIM To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement. METHODS A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline. RESULTS A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play. CONCLUSIONS Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.
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Affiliation(s)
- Kaat De Backer
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Hannah Rayment-Jones
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Billie Lever Taylor
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | | | - Elsa Montgomery
- Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Jane Sandall
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
| | - Abigail Easter
- Department of Women and Children’s Health, School of Medicine and Life Course Sciences, King’s College London, London, United Kingdom
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McCurdy LY, Yip SW, Worhunsky PD, Zhai ZW, Kim S, Strathearn L, Potenza MN, Mayes LC, Rutherford HJV. Neural correlates of altered emotional responsivity to infant stimuli in mothers who use substances. J Psychiatr Res 2024; 171:126-133. [PMID: 38277872 PMCID: PMC10922955 DOI: 10.1016/j.jpsychires.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Mothers who use substances during pregnancy and postpartum may have altered maternal behavior towards their infants, which can have negative consequences on infant social-emotional development. Since maternal substance use has been associated with difficulties in recognizing and responding to infant emotional expressions, investigating mothers' subjective responses to emotional infant stimuli may provide insight into the neural and psychological processes underlying these differences in maternal behavior. In this study, 39 mothers who used substances during the perinatal period and 42 mothers who did not underwent functional magnetic resonance imaging while viewing infant faces and hearing infant cries. Afterwards, they rated the emotional intensity they thought each infant felt ('think'-rating), and how intensely they felt in response to each infant stimulus ('feel'-rating). Mothers who used substances had lower 'feel'-ratings of infant stimuli compared to mothers who did not. Brain regions implicated in affective processing (e.g., insula, inferior frontal gyrus) were less active in response to infant stimuli, and activity in these brain regions statistically predicted maternal substance-use status. Interestingly, 'think'-ratings and activation in brain regions related to cognitive processing (e.g., medial prefrontal cortex) were comparable between the two groups of mothers. Taken together, these results suggest specific neural and psychological processes related to emotional responsivity to infant stimuli may reflect differences in maternal affective processing and may contribute to differences in maternal behavior in mothers who use substances compared to mothers who do not. The findings suggest potential neural targets for increasing maternal emotional responsivity and improving child outcomes.
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Affiliation(s)
- Li Yan McCurdy
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, 06510, USA; Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA.
| | - Sarah W Yip
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Patrick D Worhunsky
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Zu Wei Zhai
- Department of Neuroscience, Middlebury College, Middlebury, VT, 05753, USA
| | - Sohye Kim
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA, 01655, USA; Departments of Psychiatry, Pediatrics, and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, 52242, USA; Hawkeye Intellectual and Developmental Disabilities Research Center, University of Iowa, Iowa City, IA, 52242, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA; Department of Neuroscience, Yale School of Medicine, New Haven, CT, 06510, USA; The Connecticut Council on Problem Gambling, Wethersfield, CT, 06109, USA; The Connecticut Mental Health Center, New Haven, CT, 06519, USA
| | - Linda C Mayes
- Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA
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Fadaei-Kenarsary M, Esmaeilpour K, Shabani M, Sheibani V. Maternal Substance Use and Early-Life Adversity: Inducing Drug Dependence in Offspring, Interactions, Mechanisms, and Treatments. ADDICTION & HEALTH 2024; 16:51-66. [PMID: 38651025 PMCID: PMC11032613 DOI: 10.34172/ahj.2024.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/11/2023] [Indexed: 04/25/2024]
Abstract
The likelihood of substance dependency in offspring is increased in cases when there is a family history of drug or alcohol use. Mothering is limited by maternal addiction because of the separation. Maternal separation (MS) leads to the development of behavioural and neuropsychiatric issues in the future. Despite the importance of this issue, empirical investigations of the influences of maternal substance use and separation on substance use problems in offspring are limited, and studies that consider both effects are rare. This study aims to review a few studies on the mechanisms, treatments, genetics, epigenetics, molecular and psychological alterations, and neuroanatomical regions involved in the dependence of offspring who underwent maternal addiction and separation. The PubMed database was used. A total of 95 articles were found, including the most related ones in the review. The brain's lateral paragigantocellularis (LPGi), nucleus accumbens (NAc), caudate-putamen (CPu), prefrontal cortex (PFC), and hippocampus, can be affected by MS. Dopamine receptor subtype genes, alcohol biomarker minor allele, and preproenkephalin mRNA may be affected by alcohol or substance use disorders. After early-life adversity, histone acetylation in the hippocampus may be linked to brain-derived neurotrophic factor (BDNF) gene epigenetics and glucocorticoid receptors (GRs). The adverse early-life experiences differ in offspring›s genders and rewire the brain›s dopamine and endocannabinoid circuits, making offspring more susceptible to dependence. Related psychological factors rooted in early-life stress (ELS) and parental substance use disorder (SUD). Treatments include antidepressants, histone deacetylase inhibitors, lamotrigine, ketamine, choline, modafinil, methadone, dopamine, cannabinoid 1 receptor agonists/antagonists, vitamins, oxytocin, tetrahydrocannabinol, SR141716A, and dronabinol. Finally, the study emphasizes the need for multifaceted strategies to prevent these outcomes.
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Affiliation(s)
- Maysam Fadaei-Kenarsary
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Khadijeh Esmaeilpour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Mohammad Shabani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Sheibani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Flykt M, Belt R, Salo S, Pajulo M, Punamäki RL. Prenatal Reflective Functioning as a Predictor of Substance-Using Mothers' Treatment Outcome: Comparing Results From Two Different RF Measures. Front Psychol 2022; 13:909414. [PMID: 35959038 PMCID: PMC9359121 DOI: 10.3389/fpsyg.2022.909414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Mothers with prenatal substance use disorder (SUD) often show broad deficits in their reflective functioning (RF), implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF (AAI-RF), regarding parent's own childhood experiences, and parenting-focused RF (PRF) regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview (during pregnancy/pre-intervention), and with Parent Development Interview at 4 months (during intervention). Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months (post-intervention), and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions.
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Affiliation(s)
- Marjo Flykt
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, Department of Psychology, Tampere University, Tampere, Finland
- *Correspondence: Marjo Flykt
| | - Ritva Belt
- Department of Social Services, Tampere, Finland
| | - Saara Salo
- Faculty of Education, University of Helsinki, Helsinki, Finland
| | - Marjukka Pajulo
- Faculty of Medicine, Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Raija-Leena Punamäki
- Faculty of Social Sciences, Department of Psychology, Tampere University, Tampere, Finland
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