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Horan H, Thompson A, Willard K, Mobley E, McDaniel J, Robertson E, McIntosh S, Albright DL. Social Determinants Associated with Substance Use and Treatment Seeking in Females of Reproductive Age in the United States. J Womens Health (Larchmt) 2024; 33:584-593. [PMID: 38533906 DOI: 10.1089/jwh.2023.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Introduction: Females of reproductive age (FoRA; 15-49 years) are the demographic most likely to be diagnosed with a substance use disorder. Preventative treatment prior to or during pregnancy is critical. Stigma and social inequities can delay access to care. There is limited research examining social determinants of health (SDoH) and how they are related to substance use and treatment seeking in this demographic. Methods: We analyzed the 2016-2019 data from the United States National Survey on Drug Use and Health using multivariable logistic regression models. Statistically significant variables were conceptually linked to the Office of Disease Prevention and Health Promotion's (ODPHP's) SDoH framework's five domains. Results: From a total sample of 1,477,336 (weighted) pregnant people and 39,600,523 (weighted) FoRA, substance use was reported by 879,209 (2.14% [95% confidence interval = 2.13-2.15]). Pregnancy status was not associated with substance use or treatment seeking. Past-month substance use was associated with high educational attainment, an annual income <$20,000, a history of criminality, low religiosity, and having health insurance. Past-month treatment-seeking behavior was associated with older age, an annual income >$20,000, a history of criminality, and greater religiosity. Behavioral health support seeking in the past month was associated with some college education. Higher depression severity was associated with all the three models. Conclusions: Using the ODPHP's SDoH framework, we begin to elicit critical connections that can describe substance use and treatment-seeking practices in FoRA. We encourage additional research to inform public health, health care, behavioral health, and other support service programming.
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Affiliation(s)
- Holly Horan
- The University of Alabama at Birmingham, Heersink School of Medicine, Department of Obstetrics and Gynecology, Birmingham, Alabama, USA
| | - Alyssa Thompson
- The University of Alabama, College of Liberal Arts and Sciences, Department of Anthropology, Tuscaloosa, Alabama, USA
| | - Kendall Willard
- The University of Alabama, College of Human and Environmental Sciences, Public Health - Health Professions Concentration, Tuscaloosa, Alabama, USA
| | - Emmily Mobley
- The University of Alabama, College of Liberal Arts and Sciences, Department of Anthropology, Tuscaloosa, Alabama, USA
| | - Justin McDaniel
- Southern Illinois University, School of Human Sciences, Public Health Program, Carbondale, Illinois, USA
| | - Ellen Robertson
- The University of Alabama, VitAL Program, Tuscaloosa, Alabama, USA
| | - Shanna McIntosh
- The University of Alabama, VitAL Program, Tuscaloosa, Alabama, USA
| | - David L Albright
- The University of Alabama, VitAL Program, Tuscaloosa, Alabama, USA
- The University of Alabama, College of Arts and Sciences, Department of Political Science, Tuscaloosa, Alabama, USA
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Seid J, Mohammed E, Muktar Y. Factors associated with perinatal substance use among Ethiopian women: an institutional-based cross-sectional study. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:11913. [PMID: 38389813 PMCID: PMC10880761 DOI: 10.3389/adar.2023.11913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/27/2023] [Indexed: 02/24/2024]
Abstract
Introduction: Substance use during the perinatal period is a significant public health concern, as it can have potential adverse effects on maternal and neonatal health outcomes. Unexpectedly, no previous studies have been conducted to assess the prevalence of substance use during the perinatal period among Ethiopian women. Therefore, this study aimed to determine the magnitude of substance use and its determinant factors during the perinatal period. Method: We conducted a hospital-based descriptive cross-sectional study among a systematically selected sample of 418 women who attended perinatal care between May and July 2022. Data were collected using an interviewer-administered structured questionnaire. Multivariate logistic regression analysis, with a 95% confidence interval and p-values less than 0.05, was employed to identify factors associated with substance use behavior. Result: The prevalence of perinatal substance use was found to be 38.3% (95% CI: 33.5-43.5). Of the women who used substances, 109 (26.1%) reported using chat, 46 (11.0%) reported alcohol consumption, and 5 (1.20%) reported using shisha. Factors significantly associated with substance use behavior during the perinatal period included a history of obstetric complications (AOR = 1.722, 95% CI: 1.022-2.902), the presence of chronic medical conditions (AOR = 3.784, 95% CI: 2.164-6.615), experiencing physical abuse (AOR = 5.323, 95% CI: 2.171-13.050), depression (AOR = 1.963, 95% CI: 1.028-3.749), and experiencing sleep disturbances (AOR = 2.016, 95% CI: 0.975-4.168). Conversely, giving birth to a live baby was found to be a protective factor against substance use behavior (AOR = 0.389, 95% CI: 0.187-0.810). Discussion: This study highlights a high prevalence of substance abuse among women during the perinatal period. In light of these findings, a comprehensive approach is recommended to address perinatal substance use among Ethiopian women. This should include the integration of preventive educational programs into perinatal care.
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Affiliation(s)
- Jemal Seid
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Emam Mohammed
- Department of Public Health, Kutaber Health Center, Kutaber, Ethiopia
| | - Yimer Muktar
- School of Veterinary Medicine, Woldia University, Woldia, Ethiopia
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Flannigan K, Murphy L, Pei J. Integrated Supports for Women and Girls Experiencing Substance Use and Complex Needs. Subst Abuse 2023; 17:11782218231208980. [PMID: 37954218 PMCID: PMC10637139 DOI: 10.1177/11782218231208980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
There is strong research to support integrated and gender-sensitive harm reduction approaches for supporting women, girls, and gender diverse people. For individuals who are pregnant, flexible and integrated treatment approaches may be especially important. In this study, we report on an integrated program in rural Canada designed to support pregnant women, girls, and gender diverse people experiencing substance use and other complex needs. Program data (N = 393) from the 2nd Floor Women's Recovery Centre (2nd Floor) at the Lakeland Centre for Fetal Alcohol Spectrum Disorder (LCFASD) was analyzed with several aims. Study goals were to (1) describe characteristics and needs of clients, (2) identify factors associated with program completion, and (3) for a subset of clients, examine resources, wellbeing, and social and behavioral outcomes after treatment. Clients (Mage = 27.4 years, range 15-64) presented at the 2nd Floor with complex medical and mental health needs, and experiences of significant socioenvironmental adversity. However, almost two-thirds (63.4%) successfully completed the program, which was more likely for clients who had stable housing at intake and a possible or confirmed diagnosis of FASD. After treatment, clients reported high levels of wellbeing, and most were connected to health care and community resources. In the year after program completion, clients who were contacted for follow-up maintained strong connection to resources and reported notable improvements in social and behavioral functioning. Many were working or volunteering, most were in stable home environments, rates of substance use and legal involvement were substantially reduced, and many clients were actively caring for their children. This study offers important findings to inform future research, practice, and policy for supporting health and wellbeing for women, children, families, and communities.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Lisa Murphy
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
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Wogayehu B, Demissie T, Wolka E, Alemayehu M, Daka K. The epidemiology of khat (catha edulis) chewing and alcohol consumption among pregnant women in Ethiopia: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002248. [PMID: 37713384 PMCID: PMC10503716 DOI: 10.1371/journal.pgph.0002248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/16/2023] [Indexed: 09/17/2023]
Abstract
The use of khat (Catha edulis) and alcohol during pregnancy is a serious public health problem that has been associated with a number of harmful outcomes for both the fetus and the mother's health. There has been no systematic review with meta-analysis to determine risk factors associated with khat and alcohol use among pregnant women in Ethiopia. Therefore, we aimed to determine the pooled prevalence and risk factors of khat and alcohol use during pregnancy in Ethiopia. This review has been registered in PROSPERO with protocol ID: CRD42023395115. Studies identified from PubMed, Google Scholar, the WHO African Index Medicus, the Cochrane Library, African Journal Online, and Science Direct. Articles published from January 1, 2000 to February 10, 2023 were included. We searched for articles that included any combination of the following key terms: "khat", "qat", "alcohol", "ethanol", "prevalence", "factors", "pregnant" and "Ethiopia". Two reviewers worked independently to screen studies and extract data. A funnel plot and Egger's regression test were used to test publication bias. A forest plot was used to present the pooled prevalence and odds ratio with a 95% confidence interval (CI) using the random effect model. I2 metrics were used to assess heterogeneity. The meta-analysis was carried out with Stata 14.0 software. Nine hundred sixty-two records were retrieved from different sources, and 23 studies were included in the final analysis. The pooled prevalence of khat use and alcohol drinking during pregnancy was 26.6% (95% CI 17.8, 35.5) and 31.65% (95% CI: 21.8, 41.5), respectively. Partner khat use (OR 5.9 [95% CI (2.4, 14.5)]) was associated factor for khat use during pregnancy. Low educational level (OR 2.54 [95% CI (1.8, 3.5)]), pre-pregnancy alcohol use (OR 3.5 [95% CI (2.6, 4.7)]), unplanned pregnancy (OR 2.7 [95% CI (1.8, 4.0)]), history of abortion (OR 2.3 [95% CI (1.4, 3.7)]), poor social support (OR 3.3 [95% CI (2.0, 5.3)]), and mental distress (OR 2.6 [95% CI (2.0, 3.3)]) were associated factors for alcohol drinking during pregnancy. This review indicated that the magnitude of khat and alcohol use during pregnancy in Ethiopia was high. Targeted interventions for groups of pregnant women at high risk of khat and alcohol use are urgently needed. Community-based health education interventions and point-of-sale warnings are essential to reduce the burden. Future studies should consider the influence of community-level factors on khat and alcohol use during pregnancy.
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Affiliation(s)
- Biruk Wogayehu
- Department of Public Health, Arbaminch College of Health Sciences, Arbaminch Town, Ethiopia
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo Town, Ethiopia
| | - Tsegaye Demissie
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo Town, Ethiopia
| | - Eskinder Wolka
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo Town, Ethiopia
| | - Mekuriaw Alemayehu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar Town, Ethiopia
| | - Kassa Daka
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Sodo Town, Ethiopia
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Karvonen KL, Anunwah E, Chambers Butcher BD, Kwarteng L, Mathis-Perry T, McLemore MR, Oh S, Pantell MS, Smith O, Rogers E. Structural Racism Operationalized via Adverse Social Events in a Single-Center Neonatal Intensive Care Unit. J Pediatr 2023; 260:113499. [PMID: 37211208 DOI: 10.1016/j.jpeds.2023.113499] [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: 09/20/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate structural racism in the neonatal intensive care unit (NICU) by determining if differences in adverse social events occur by racialized groups. STUDY DESIGN Retrospective cohort study of 3290 infants hospitalized in a single center NICU between 2017 and 2019 in the Racial and Ethnic Justice in Outcomes in Neonatal Intensive Care (REJOICE) study. Demographics and adverse social events including infant urine toxicology screening, child protective services (CPS) referrals, behavioral contracts, and security emergency response calls were collected from electronic medical records. Logistic regression models were fit to test the association of race/ethnicity and adverse social events, adjusting for length of stay. Racial/ethnic groups were compared with a White referent group. RESULTS There were 205 families (6.2%) that experienced an adverse social event. Black families were more likely to have experienced a CPS referral and a urine toxicology screen (OR, 3.6; 95% CI, 2.2-6.1 and OR, 2.2; 95% CI, 1.4-3.5). American Indian and Alaskan Native families were also more likely to experience CPS referrals and urine toxicology screens (OR, 15.8; 95% CI, 6.9-36.0 an OR, 7.6; 95% CI, 3.4-17.2). Black families were more likely to experience behavioral contracts and security emergency response calls. Latinx families had a similar risk of adverse events, and Asian families were less likely to experience adverse events. CONCLUSIONS We found racial inequities in adverse social events in a single-center NICU. Investigation of generalizability is necessary to develop widespread strategies to address institutional and societal structural racism and to prevent adverse social events.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA.
| | - Erica Anunwah
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Brittany D Chambers Butcher
- California Preterm Birth Initiative, San Francisco, CA; Department of Human Ecology, University of California Davis, Sacramento, CA
| | - Lydia Kwarteng
- University of California San Francisco School of Medicine, San Francisco, CA
| | | | - Monica R McLemore
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
| | - Sally Oh
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Matthew S Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA
| | - Olga Smith
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Elizabeth Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA
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Kinsella M, Capel Y, Nelson SM, Kearns RJ. Opioid substitution in pregnancy a narrative review: contemporary evidence for use of methadone and buprenorphine in pregnancy. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2106600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- M. Kinsella
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Y. Capel
- Foundation Programme, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - R. J. Kearns
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Weerakoon SM, Chen B, Harrell MB, Vidot DC, Messiah SE. Longitudinal effect of prenatal polydrug use and birthweight status on pediatric growth. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2078826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sitara M. Weerakoon
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Children’s Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Baojiang Chen
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, TX, USA
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, TX, USA
| | - Denise C. Vidot
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Children’s Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
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Demeke GB, Bayu EK. Assessment of alcohol utilization during pregnancy and its associated factors among reproductive women in Mecha Woreda of North Western Ethiopia. BMC Womens Health 2022; 22:189. [PMID: 35614455 PMCID: PMC9131653 DOI: 10.1186/s12905-022-01776-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pregnancy is a time when women are making many changes, including the patterns of alcohol consumption. Alcohol consumption during pregnancy encourages the risks of mothers and unborn child. Alcohol use during pregnancy can result in prematurity, brain damage, growth restriction, developmental delay and social, emotional and behavioral deficits, particularly in developing countries.
Methods A community based cross-sectional study was employed. Structured questionnaires were used to assess the prevalence of alcohol utilization, and socio-demographic as well as economic characteristics of women who have pregnancy experience. Both bivariate and multivariate logistic regression models were employed. Descriptive and inferential statistical analyses were used.
Results The study results showed that the prevalence of alcohol use and response rate was high. Factors like age group of women from 35–49 years (AOR = 0.221; 95%CI = 0.057–0.856), illiterate women(AOR = 2.697;95% CI = 1.207–6.026), currently pregnant (AOR = 0.139;95%CI = 0.057 0.343), women currently use alcohol (AOR = 0.021; 95% CI = 0.009 0.049), alcohol use pre-pregnancy (AOR = 0.016; 95% CI = 0.006–0.042), women drinking alcohol with husband during pregnancy (AOR = 0.228; 95% CI = 0.085–0.614), the risk of alcohol consumption during pregnancy is low(AOR = 0.262;95%CI = 0.074–0.925), risk alcohol consumption during pregnancy is medium (AOR = 0.296;95% CI = 0.103–0.849),utilization of alcohol during pregnancy is valuable (AOR = 0.104; 95%CI = .0.013–0.833) were statistically associated with alcohol use during pregnancy. Conclusion The result inferred that there is a high level of alcohol use throughout pregnancy. Due to the differences in the culture and communal means of drinking alcohol, the frequency of alcohol consumption during pregnancy varies among different regional studies and countries.
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Affiliation(s)
- Getaneh Bizuayehu Demeke
- Department of Population Studies, College of Social Sciences and Humanities, University of Gondar, Gondar, Ethiopia.
| | - Eyayu Kasseye Bayu
- Department of Gender and Development Studies, College of Social Sciences and Humanities, University of Gondar, Gondar, Ethiopia
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Austin AE, Gest C, Atkeson A, Berkoff MC, Puls HT, Shanahan ME. Prenatal Substance Exposure and Child Maltreatment: A Systematic Review. CHILD MALTREATMENT 2022; 27:290-315. [PMID: 33550839 DOI: 10.1177/1077559521990116] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
State and federal policies regarding substance use in pregnancy, specifically whether a notification to child protective services is required, continue to evolve. To inform practice, policy, and future research, we sought to synthesize and critically evaluate the existing literature regarding the association of prenatal substance exposure with child maltreatment. We conducted a comprehensive electronic search of PubMed, Web of Science, PsycInfo, CHINAL, Social Work Abstracts, Sociological Abstracts, and Social Services Abstracts. We identified 30 studies that examined the association of exposure to any/multiple substances, cocaine, alcohol, opioids, marijuana, and amphetamine/methamphetamine with child maltreatment. Overall, results indicated that substance exposed infants have an increased likelihood of child protective services involvement, maternal self-reported risk of maltreatment behaviors, hospitalizations and clinic visits for suspected maltreatment, and adolescent retrospective self-report of maltreatment compared to unexposed infants. While study results suggest an association of prenatal substance exposure with child maltreatment, there are several methodological considerations that have implications for results and interpretation, including definitions of prenatal substance exposure and maltreatment, study populations used, and potential unmeasured confounding. As each may bias study results, careful interpretation and further research are warranted to appropriately inform programs and policy.
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Affiliation(s)
- Anna E Austin
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, NC, USA
| | - Caitlin Gest
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Alexandra Atkeson
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Molly C Berkoff
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, NC, USA
| | - Meghan E Shanahan
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, NC, USA
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Weerakoon SM, Chen B, Harrell MB, Vidot DC, Messiah SE. Effect of in-utero polysubstance exposure on adolescent cardiovascular disease risk: Results from the maternal lifestyle study. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Impact of Plans of Safe Care on Prenatally Substance Exposed Infants. J Pediatr 2022; 241:54-61.e7. [PMID: 34699908 PMCID: PMC8792271 DOI: 10.1016/j.jpeds.2021.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of recent federal statute changes mandating child welfare-based Plan of Safe Care (POSC) supportive programming and community-based linkages to treatment providers, resources, and services for families of infants affected by prenatal substance exposure (IPSE). STUDY DESIGN Retrospective review of Delaware's statewide child welfare case registry data for IPSE birth notifications and subsequent hotline reports for serious physical injury/fatality concerns from November 1, 2018-October 31, 2020. Abstracted variables included IPSE sex, substance exposure type, family characteristics (maternal personal child welfare history or mental health diagnosis, treatment engagement), and POSC referrals. RESULTS Of 1436 IPSE, 1347 (93.8%) had POSC support. Most IPSE (67.2%) had exposure to single substance types prenatally. Nearly 90% avoided out-of-home placement. Nearly one-fourth of mothers delivered a prior IPSE; 40% of mothers had personal histories of childhood protective services involvement. Also, 43.5% of mothers and 9.1% of fathers were referred to community-based resources, including substance use, mental health treatment, parenting classes, and home visiting nursing. Nearly 58% of IPSE were referred for pediatric/developmental assessment. Notably, 0.82% (11 out of 1347) of IPSE with POSC sustained serious physical or fatal injury. CONCLUSIONS POSC promote supportive, potentially protective linkages to community-based programming for IPSE and their families.
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Winchester ML, Shahiri P, Boevers-Solverson E, Hartmann A, Ross M, Fitzgerald S, Parrish M. Racial and Ethnic Differences in Urine Drug Screening on Labor and Delivery. Matern Child Health J 2022; 26:124-130. [PMID: 34988865 DOI: 10.1007/s10995-021-03258-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study evaluates racial and ethnic differences in urine drug screening and patient consent to urine drug screening at a single tertiary care center. METHODS We conducted a retrospective cohort study of all deliveries at a single tertiary care center from January 1, 2015 to December 31, 2019. Medical records were queried for demographic data, performance of urine drug screening, commonly used diagnoses that prompted screening, documentation of patient consent, and result of screen. Associations between these outcomes were then assessed using Chi-square analysis and logistic regression. RESULTS During the study period, 685 of 9953 (6.9%) of patients had a urine drug screen performed. Non-Hispanic Black patients comprised 33.6% of patients receiving screening, but only 16.6% of the total population. Of examined indications for urine drug screening, only insufficient prenatal care and trauma differed significantly between groups. After adjusting for commonly used diagnoses prompting screening, non-Hispanic black patients were significantly more likely to have urine drug screening performed (OR 2.0, 95% CI 1.6-2.4). Non-Hispanic Black and Hispanic patients were not significantly more likely to have a positive screen result when compared to Non-Hispanic White patients. Consent to urine drug screening was poorly documented (only 11.7% of patients had documented consent). This did not differ significantly between the major racial or ethnic groups. CONCLUSION Non-Hispanic Black and Hispanic patients experience differences in urine drug screening during admission for delivery that cannot be solely explained by differences in incidence of diagnoses that typically trigger screening. Documentation of patient consent to urine drug screening is poor.
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Affiliation(s)
- Mae-Lan Winchester
- Department of Obstetrics & Gynecology, Medical Center, University of Kansas, Kansas City, KS, USA.
| | - Parmida Shahiri
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Emily Boevers-Solverson
- Department of Obstetrics & Gynecology, Medical Center, University of Kansas, Kansas City, KS, USA
| | | | - Meghan Ross
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Sharon Fitzgerald
- Department of Population Health, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Marc Parrish
- Department of Obstetrics & Gynecology, Medical Center, University of Kansas, Kansas City, KS, USA
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Lisboa CS, Santana JDM, Servo MLS, Silva AVR, Santos DBD. Socioeconomic and nutritional aspects of pregnant women assisted by Programa Bolsa Família: cohort NISAMI. CIENCIA & SAUDE COLETIVA 2022; 27:315-324. [DOI: 10.1590/1413-81232022271.37782020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/21/2020] [Indexed: 11/21/2022] Open
Abstract
Abstract The objective of this study was to evaluate the socioeconomic and nutritional assistance factors of pregnant women who are beneficiaries of the Bolsa Família Program and were attended at a prenatal service in the city of Recôncavo da Bahia. A cohort study was conducted with 250 pregnant women from the prenatal service in 16 Family Health Units from August 2013 to December 2014. A structured and previously tested questionnaire was used to collect data. Socioeconomic and nutritional variables were used. It was identified that the average age was 28.3 years, of these, 85.2% studied until high school, 72.4% of pregnant women reported having income less than or equal to two minimum wages, with a mean of 1,036.3 and 26.8% reported receiving the benefit. It was observed that 40% had a pre-gestational Body Mass Index of overweight, 38% presented adequate weight gain for Gestational Age; 90.57% performed more than 7 consultations and 75.6% reported that they made use of alcoholic beverages or stopped in the gestation. The Bolsa Família Program as an integrated strategy for social inclusion and economic development seems to have a protective effect on the nutritional health of pregnant women in the municipality.
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Park S, Ji Y, Hong X, Zuckerman B, Wang X, Surkan PJ. Effects of Stress and Nativity on Maternal Antenatal Substance Use and Postnatal Mental Disorders. J Womens Health (Larchmt) 2021; 31:878-886. [PMID: 34935494 DOI: 10.1089/jwh.2021.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Maternal substance use and common mental disorders (CMDs) during or after pregnancy can lead to negative health outcomes among mothers and infants. We examined whether nativity (US-born versus foreign-born) and stress levels during pregnancy were associated with antenatal substance use and postnatal CMDs. Methods: We analyzed the Boston Birth Cohort, a racially diverse cohort recruited at birth with rolling enrollment since 1998. Information on antenatal substance use (tobacco and/or alcohol use) was obtained using an in-person postpartum questionnaire (n = 6,514). Information on postnatal CMDs (depression and/or anxiety) was obtained from medical records (n = 2,052). Nativity and stress during pregnancy were self-reported. We performed multivariate logistic regression to examine how nativity and stress levels were jointly associated with antenatal substance use and postnatal CMDs. We further investigated if blacks, Hispanics, and whites were differentially at risk. Results: We found that US-born mothers were at higher risk of substance use and CMDs than their foreign-born counterparts. In analyses combining nativity and stress, being US-born with high stress was associated with increased odds of antenatal substance use (adjusted odds ratio [aOR] = 14.91, 95% confidence interval [CI]: 12.09-18.39) and postnatal CMDs (aOR = 4.09, 95% CI: 2.72-6.15) compared with foreign-born mothers with low stress. The results of the subanalyses limited to black and Hispanic women separately were similar; high stress alone was associated with fourfold increased odds of CMDs among foreign-born Hispanic mothers (aOR = 4.27, 95% CI: 1.96-9.33). Conclusions: Findings suggest that identifying and alleviating high stress among pregnant women may reduce their risk of antenatal substance use and postnatal CMDs.
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Affiliation(s)
- Soim Park
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Yuelong Ji
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Barry Zuckerman
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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Effects of maternal psychological stress during pregnancy on offspring brain development: Considering the role of inflammation and potential for preventive intervention. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:461-470. [PMID: 34718150 PMCID: PMC9043032 DOI: 10.1016/j.bpsc.2021.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
Heightened psychological stress during pregnancy has repeatedly been associated with increased risk for offspring development of behavior problems and psychiatric disorders. This review covers a rapidly growing body of research with the potential to advance a mechanistic understanding of these associations grounded in knowledge about maternal-placental-fetal stress biology and fetal brain development. Specifically, we highlight research employing magnetic resonance imaging to examine the infant brain soon after birth in relation to maternal psychological stress during pregnancy to increase capacity to identify specific alterations in brain structure and function and to differentiate between effects of pre- versus postnatal exposures. We then focus on heightened maternal inflammation during pregnancy as a mechanism through which maternal stress influences the developing fetal brain based on extensive preclinical literature and emerging research in humans. We place these findings in the context of recent work identifying psychotherapeutic interventions found to be effective for reducing psychological stress among pregnant individuals, which also show promise for reducing inflammation. We argue that a focus on inflammation, among other mechanistic pathways, has the potential to lead to a productive and necessary integration of research focused on the effects of maternal psychological stress on offspring brain development and prevention and intervention studies aimed at reducing maternal psychological stress during pregnancy. In addition to increasing capacity for common measurements and understanding potential mechanisms of action relevant to maternal mental health and fetal neurodevelopment, this focus can inform and broaden thinking about prevention and intervention strategies.
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Silang K, Sanguino H, Sohal PR, Rioux C, Kim HS, Tomfohr-Madsen LM. eHealth Interventions to Treat Substance Use in Pregnancy: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9952. [PMID: 34639252 PMCID: PMC8507611 DOI: 10.3390/ijerph18199952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023]
Abstract
Substance use during pregnancy is associated with adverse pregnancy and neonatal outcomes; eHealth interventions offer a potential accessible treatment option. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of eHealth interventions for the treatment of substance use during pregnancy. A comprehensive search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from May 2020 to April 2021. The protocol for this study was registered with Prospero (CRD42020205186) through the University of York Centre for Reviews and Dissemination. Two independent reviewers completed screening, data extraction, and quality assessment. RCTs were included if they reported: (a) administration of an eHealth intervention for (b) substance use outcomes, among (c) pregnant individuals. Comprehensive Meta-Analysis Software (CMA) was used to calculate pooled effect sizes (Odds Ratio) to determine the effect of eHealth interventions on substance use outcomes. Six studies were identified with substance use outcomes that included: smoking (n = 3), alcohol (n = 2), and other (n = 1). eHealth interventions were delivered through the internet (n = 1), computer (n = 3), telephone (n = 1), and text (n = 1). Results suggested that eHealth interventions significantly reduced substance use in pregnant individuals compared to controls (OR = 1.33, 95% CI = 1.06 to 1.65, p = 0.013). eHealth interventions offer a promising and accessible treatment option to reduce substance use during pregnancy. This work was supported by the generous donors of the Alberta Children's Hospital Foundation, the Canadian Child Health Clinician Scientist Program (CCHCSP), the Canadian Institute of Health Research and the Fonds de Recherche du Québec-Santé.
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Affiliation(s)
- Katherine Silang
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (H.S.); (P.R.S.)
| | - Hangsel Sanguino
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (H.S.); (P.R.S.)
| | - Pooja R. Sohal
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (H.S.); (P.R.S.)
| | - Charlie Rioux
- Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, TX 79409, USA;
| | - Hyoun S. Kim
- Department of Psychology, Ryerson University, Toronto, ON M5B 2K3, Canada;
| | - Lianne M. Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (H.S.); (P.R.S.)
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB T3B 6A8, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB T2N 1N4, Canada
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Goldstein E, Nervik K, Hagen S, Hilliard F, Turnquist A, Bakhireva LN, McDonald R, Ossorio PN, Lo J, Zgierska AE. A socioecological framework for engaging substance-using pregnant persons in longitudinal research: Multi-stakeholder perspectives. Neurotoxicol Teratol 2021; 87:106997. [PMID: 34023390 PMCID: PMC8440364 DOI: 10.1016/j.ntt.2021.106997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Understanding the impact of substance use during pregnancy on fetal development and child health is essential for designing effective approaches for reducing prenatal substance exposures and improving child outcomes. Research on the developmental impacts of prenatal substance exposure has been limited by legal, ethical, and practical challenges. This study examined approaches to engage substance-using (with an emphasis on opioids) pregnant persons in longitudinal research, from multi-stakeholder perspectives. METHODS The present study solicited the expertise of 1) an advisory group of community stakeholders, including people with lived experienced of opioid/substance use; and 2) an online survey with content experts. Qualitative analysis examined facilitators and barriers to recruiting and retaining substance-using pregnant persons through a socioecological lens at the individual, interpersonal, organizational, community, and policy levels. RESULTS Stakeholders (N = 19) prioritized stigma, loss of confidentiality, legal consequences, and instability (e.g., homelessness and poverty) as important barriers that prevent substance-using persons from enrolling in research studies. Of 70 survey respondents, most self-identified as researchers (n = 37), followed by clinicians (n = 19), and 'others' (n = 14). Survey respondents focused on retention strategies that build trusting relationships with participants, including incentives (e.g., transportation and childcare support), participant-friendly study design, and team-related factors, (e.g., attitudes and practices). CONCLUSION The stakeholder input and survey data offer key insights strengthening our understanding of facilitators and barriers to research participation, and ways to overcome barriers among substance-using pregnant persons. A socioecological framework can be used to identify and address these factors to increase recruitment and long-term retention of high-risk populations.
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Affiliation(s)
- Ellen Goldstein
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Kendra Nervik
- Department of Sociology, University of Wisconsin, 8128 William H. Sewell Social Sciences Building, 1180 Observatory Drive, Madison, WI 53706-1393, United States of America.
| | - Shelbey Hagen
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Florence Hilliard
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Alyssa Turnquist
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Ludmila N Bakhireva
- College of Pharmacy Substance Use Research and Education (SURE) Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America; Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America; Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America.
| | - Ryan McDonald
- Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, McConnell Hall, 1010 Mound Street, Madison, WI 53715, United States of America.
| | - Pilar N Ossorio
- University of Wisconsin Law School, 975 Bascom Mall, Rm. 9103, Madison, WI 53706-1399, United States of America; University of Wisconsin, Morgridge Institute for Research, 330 N. Orchard St, Madison, WI 53715, United States of America.
| | - Jamie Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L466, Portland, OR 97239, United States of America.
| | - Aleksandra E Zgierska
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States of America.
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Patel E, Bandara S, Saloner B, Stuart EA, Goodman D, Terplan M, McCourt A, White S, McGinty EE. Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016-2018. Am J Obstet Gynecol MFM 2021; 3:100419. [PMID: 34116233 DOI: 10.1016/j.ajogmf.2021.100419] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists recommends universal screening for tobacco, alcohol, and drug use as a part of routine prenatal care. However, little is known about the prevalence of prenatal substance use screening or factors that may contribute to differential rates of screening during prenatal care. OBJECTIVE This study aimed to describe the prevalence of prenatal substance use screening by substance, year, state, and state-level prenatal substance use policies and to examine individual-level factors associated with receipt of screening. STUDY DESIGN We analyzed 2016 to 2018 data from 103,608 women participating in the Pregnancy Risk Assessment Monitoring System, a population-based survey among women with recent live births. The Pregnancy Risk Assessment Monitoring System survey sampling weights were applied to all analyses. We described the percentage of individuals asked by a healthcare worker about substance use during a prenatal care appointment by substance, year, and state. Using chi-squared tests, we examined differences in the prevalence of screening by state-level prenatal substance use policies, including policies regarding classification of prenatal substance use as child abuse or neglect, mandatory testing or reporting of prenatal substance use, and targeted treatment funding and access for pregnant individuals with substance use disorders. Finally, we estimated the association between individual-level characteristics and receipt of prenatal substance use screening using logistic regression, controlling for year and state fixed effects and accounting for missingness using multiple imputation. RESULTS In 2018, approximately 95% individuals reported being asked about cigarette or alcohol use during a prenatal care appointment, whereas only 80% reported being asked about drug use. The percentage of individuals who were asked about substance use during a prenatal care appointment increased overall between 2016 and 2018, with variability across states. For all substances, states with laws designating prenatal drug use as child abuse or neglect had lower prevalence of screening, whereas states with laws mandating providers to test for substance use in pregnancy had higher prevalence of screening. Several individual-level characteristics were associated with increased odds of reported prenatal substance use screening for one or more substances, including being younger, less educated, unmarried, Black (vs White), non-Hispanic, or publicly insured (vs privately insured), receiving adequate prenatal care, and having a history of prepregnancy cigarette use. CONCLUSION Our study finds that despite recommendations for universal prenatal substance use screening, there are differences in who is actually asked about substance use during prenatal care appointments. This may be influenced by state-level prenatal substance use policies and selective screening approaches in which certain individuals are more likely to be asked about substance use during their prenatal care appointment. A better understanding of the repercussions of selective screening approaches on outcomes and the roles that policies, systems, and provider biases play in perpetuating these approaches is needed to advance guideline implementation efforts in prenatal care settings.
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Affiliation(s)
- Esita Patel
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute.
| | - Sachini Bandara
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Elizabeth A Stuart
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Daisy Goodman
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Mishka Terplan
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Alexander McCourt
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Sarah White
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
| | - Emma E McGinty
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (Drs Patel, Bandara, Saloner, Stuart, and McCourt, White, and McGinty); Geisel School of Medicine at Dartmouth, Lebanon, NH (Dr Goodman); Friends Research Institute, Baltimore, MD (Dr Terplan)Patel, McCourt, White - Department of Health Policy and Management.Bandara - Department of Mental Health.Saloner, Stuart, McGinty - Department of Health Policy and Managment; Department of Mental Health.Goodman - Department of Obstetrics and Gynecology; Department of Community and Family Medicine; The Dartmouth Institute
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Kroll-Desrosiers A, Holzhauer CG, Russo L, DeRycke EC, Kinney RL, Bastian LA, Mattocks KM. Factors Associated With Quitting Smoking During Pregnancy Among Women Veterans. Womens Health Issues 2021; 31:408-413. [PMID: 34049763 DOI: 10.1016/j.whi.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Little is known about the rates of smoking among pregnant veterans. Our objective was to examine rates of smoking during pregnancy and factors associated with quitting smoking during pregnancy. METHODS We used data from a cohort study of pregnant veterans from 15 Veterans Health Administration facilities nationwide. Veterans who reported smoking during pregnancy were included in this analysis. Poisson regression models were used to estimate the relative risk (RR) of quitting smoking during pregnancy. RESULTS Overall, 133 veterans reported smoking during pregnancy. Among this group of women who smoked, the average age was 31.6 years, 20% were Black, and 14% were Hispanic/Latino. More than one-half of women (65%) who reported smoking at the start of pregnancy quit smoking during pregnancy. Multivariable models, adjusted for history of deployment and age, indicated that prenatal care initiation at 12 or fewer weeks compared with more than 13 weeks (relative risk [RR], 2.06; 95% confidence interval [CI], 1.18-3.58), living without household smokers compared with any household smokers (RR, 1.58; 95% CI, 1.14-2.17), and first pregnancy (RR, 1.51; 95% CI, 1.17-1.95) were significant predictors of quitting versus persistent smoking during pregnancy. CONCLUSIONS Women veterans who quit smoking may be different than those who continue to smoke during pregnancy. Establishing prenatal care early in pregnancy, which likely includes counseling about smoking cessation, seems to be an important factor in quitting. Those for whom it is not a first pregnancy and who live with other smokers may especially benefit from such counseling.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- Research and Development, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Cathryn Glanton Holzhauer
- Research and Development, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lindsey Russo
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Eric C DeRycke
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Rebecca L Kinney
- Research and Development, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- Research and Development, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Jorda M, Conant BJ, Sandstrom A, Klug MG, Angal J, Burd L. Protective factors against tobacco and alcohol use among pregnant women from a tribal nation in the Central United States. PLoS One 2021; 16:e0243924. [PMID: 33571225 PMCID: PMC7877617 DOI: 10.1371/journal.pone.0243924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
Identifying social determinants of tobacco and alcohol use during pregnancy is critical to improving health outcomes for the next generation. This is especially important on a rural Tribal Nation where influences such as isolation, cultural barriers, and historical trauma have made it uniquely challenging to prevent substance use during pregnancy. The purpose of this study is to identify population-specific factors that are protective against smoking and drinking during pregnancy. We used data from 421 pregnancies collected as a part of the Safe Passages study from a rural Tribal Nation in the central United States. Pregnant women were classified as women who did not smoke (n = 84), women who quit during pregnancy (n = 23), women who smoked during pregnancy (n = 314), and women who both smoked and drank alcohol during pregnancy (n = 149). Demographic data revealed that 28.8% of the mothers were currently employed, and 91.8% of mothers reported a household income of less than $3,000 per year. Substance use rates were higher than national averages: 74.6% smoked during pregnancy and 35.4% of the women both smoked and drank alcohol during pregnancy. Five factors were identified as being protective against substance use during pregnancy: 1) living with someone (81% less likely to smoke and 92% less likely to smoke and drink), 2) having at least 12 years of education (128% less likely to smoke, and 126% less likely to smoke and drink), 3) having over 12 years of education (235% less likely to smoke, and 206% less likely to smoke and drink), 4) being employed (158% less likely to smoke, and 111% less likely to smoke and drink), and 5) not being depressed (214% less likely to smoke, and 229% less likely to smoke and drink). These social determinants should be considered for intervention research to decrease rates of substance use during pregnancy.
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Affiliation(s)
- Mariah Jorda
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
| | - Bradley J. Conant
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
| | - Anne Sandstrom
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
| | - Marilyn G. Klug
- Department of Population Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
| | - Jyoti Angal
- Department of Clinical Research, Alvera Research Institute, Sioux Falls, SD, United States of America
| | - Larry Burd
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
- * E-mail:
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Goin DE, Izano MA, Eick SM, Padula AM, DeMicco E, Woodruff TJ, Morello-Frosch R. Maternal Experience of Multiple Hardships and Fetal Growth: Extending Environmental Mixtures Methodology to Social Exposures. Epidemiology 2021; 32:18-26. [PMID: 33031217 PMCID: PMC7708528 DOI: 10.1097/ede.0000000000001272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women can be exposed to a multitude of hardships before and during pregnancy that may affect fetal growth, but previous approaches have not analyzed them jointly as social exposure mixtures. METHODS We evaluated the independent, mutually adjusted, and pairwise joint associations between self-reported hardships and birthweight for gestational age z-scores in the Chemicals in Our Bodies-2 prospective birth cohort (N = 510) using G-computation. We examined financial hardship, food insecurity, job strain, poor neighborhood environment, low community standing, caregiving, high burden of stressful life events, and unplanned pregnancy collected via questionnaire administered in the second trimester of pregnancy. We used propensity scores to ensure our analyses had sufficient data support and estimated absolute differences in outcomes. RESULTS Food insecurity was most strongly associated with reduced birthweight for gestational age z-scores individually, with an absolute difference of -0.16, 95% confidence interval (CI) -0.45, 0.14. We observed an unexpected increase in z-scores associated with poor perceived neighborhood environment (0.18, 95% CI -0.04, 0.41). Accounting for coexposures resulted in similar findings. The pairwise joint effects were strongest for food insecurity in combination with unplanned pregnancy (-0.45, 95% CI -0.93, 0.02) and stressful life events (-0.42, 95% CI -0.90, 0.05). Poor neighborhood environment in combination with caregiving was associated with an increase in z-scores (0.47, 95% CI -0.01, 0.95). CONCLUSIONS Our results are consistent with the hypothesis that experiencing food insecurity during pregnancy, alone and in combination with stressful life events and unplanned pregnancy, may affect fetal growth.
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Affiliation(s)
- Dana E. Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | | | - Stephanie M. Eick
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | - Erin DeMicco
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | - Tracey J. Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Science, School of Medicine, University of California, San Francisco
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy, and Management & School of Public Health, University of California, Berkeley
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22
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Wallin HP, Gissler M, Korhonen PE, Ekblad MO. Maternal Smoking and Hospital Treatment During Pregnancy. Nicotine Tob Res 2020; 22:1162-1169. [PMID: 31418024 DOI: 10.1093/ntr/ntz137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/02/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Previous research suggests that young maternal age, smoking, hospitalization during a previous pregnancy, and poor self-rated health could be risk factors for prenatal hospitalization. METHODS The objective of this retrospective observational register study was to investigate if maternal smoking during pregnancy is associated with mother's need for hospital treatment during pregnancy. The study population consists of all singleton pregnancies (n = 961 127) in 1999-2015 in Finland. Information on maternal smoking was received from the Medical Birth Register in three classes: nonsmoker, quit smoking in the first trimester, and continued smoking throughout the pregnancy. These data were linked with the Hospital Discharge Register data and analyzed according to ICD-10 chapters. RESULTS 10.7% of women continued to smoke after the first trimester. After adjusting for confounding factors women in both smoking groups had more hospital treatment compared with nonsmokers. Especially outpatient treatment was more common among mothers who continued to smoke compared to those who quit smoking in the first trimester in several ICD-10 chapters. Compared to non-smokers, aOR for mental and behavioral disorders (F00-F99) was 2.14 (95% confidence interval 2.00-2.30) in the quit smoking group and 3.88 (3.71-4.06) in the continued smoking group. Similarly, aOR for respiratory diseases (J00-J99) was 1.26 (1.15-1.39) and 1.61 (1.52-1.71), respectively and aOR for genitourinary diseases (N00-N99) was 1.10 (1.03-1.17) and 1.29 (1.23-1.35), respectively. Some similar findings were made also in inpatient care. Some similar findings were made also in inpatient care. CONCLUSIONS Women who smoke during pregnancy seem to require more hospital care for various reasons. These findings emphasize the importance of actions for smoking cessation during pregnancy and women should be encouraged to quit as early as possible. IMPLICATIONS Maternal smoking during pregnancy is associated with greater rates of both outpatient and inpatient hospital care during pregnancy. Women who quit smoking had a similar risk for hospital care during pregnancy with nonsmokers in certain diagnosis chapters, which is very motivational and could be used as an informational tool in prenatal clinics to encourage smoking cessation as it is never too late to quit smoking during pregnancy.
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Affiliation(s)
- Hanna P Wallin
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Mikael O Ekblad
- Department of Clinical Medicine; General Practice, University of Turku and Turku University Hospital, Turku, Finland.,Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.,Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
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23
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Beasley LO, Ciciolla L, Jespersen JE, Chiaf AL, Schmidt M, Shreffler KM, Breslin FJ, Bakhireva LN, Sanjuan PM, Stephen JM, Coles CD, Chambers CD, Kable JA, Leeman L, Singer LT, Zellner J, Morris AS, Croff JM. Best Practices for Engaging Pregnant and Postpartum Women at Risk of Substance Use in Longitudinal Research Studies: a Qualitative Examination of Participant Preferences. ACTA ACUST UNITED AC 2020; 1:235-246. [PMID: 33134976 PMCID: PMC7592139 DOI: 10.1007/s42844-020-00019-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
There are significant barriers in engaging pregnant and postpartum women that are considered high-risk (e.g., those experiencing substance use and/or substance use disorders (SUD)) into longitudinal research studies. To improve recruitment and retention of this population in studies spanning from the prenatal period to middle childhood, it is imperative to determine ways to improve key research engagement factors. The current manuscript uses a qualitative approach to determine important factors related to recruiting, enrolling, and retaining high-risk pregnant and postpartum women. The current sample included 41 high-risk women who participated in focus groups or individual interviews. All interviews were analyzed to identify broad themes related to engaging high-risk pregnant and parenting women in a 10-year longitudinal research project. Themes were organized into key engagement factors related to the following: (1) recruitment strategies, (2) enrollment, and (3) retention of high-risk pregnant and parenting women in longitudinal research studies. Results indicated recruitment strategies related to ideal recruitment locations, material, and who should share research study information with high-risk participants. Related to enrollment, key areas disclosed focused on enrollment decision-making, factors that create interest in joining a research project, and barriers to joining a longitudinal research study. With regard to retention, themes focused on supports needed to stay in research, barriers to staying in research, and best ways to stay in contact with high-risk participants. Overall, the current qualitative data provide preliminary data that enhance the understanding of a continuum of factors that impact engagement of high-risk pregnant and postpartum women in longitudinal research with current results indicating the need to prioritize recruitment, enrollment, and retention strategies in order to effectively engage vulnerable populations in research.
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Affiliation(s)
- Lana O Beasley
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | - Lucia Ciciolla
- Department of Psychology, Oklahoma State University, Stillwater, OK USA
| | - Jens E Jespersen
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | - Ashleigh L Chiaf
- National Center for Wellness and Recovery, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
| | - Mallory Schmidt
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | - Karina M Shreffler
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | | | - Ludmila N Bakhireva
- Department of Pharmacy Practice, University of New Mexico School of Pharmacy, Albuquerque, NM USA.,Department of Family and Community Medicine, and Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM USA
| | - Pilar M Sanjuan
- Department of Psychology, University of New Mexico School of Medicine, Albuquerque, NM USA
| | - Julia M Stephen
- Department of Neurosciences, University of New Mexico School of Medicine, & The Mind Research Network, Albuquerque, NM USA
| | - Claire D Coles
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA USA
| | - Julie A Kable
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Lawrence Leeman
- Department of Family & Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM USA
| | - Lynn T Singer
- Departments of Pediatrics, Psychiatry and Psychology, School of Medicine at Case Western Reserve University, Cleveland, OH USA
| | - Jennifer Zellner
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA USA
| | - Amanda S Morris
- Department of Human Development and Family Science, Oklahoma State University, 338 Human Sciences, Stillwater, OK 74078 USA
| | - Julie M Croff
- National Center for Wellness and Recovery, Oklahoma State University Center for Health Sciences, Tulsa, OK USA.,Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK USA
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24
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Coleman JN, DeRycke EC, Bastian LA, Calhoun PS, Beckham JC, Kroll-Desrosiers AR, Haskell SG, Mattocks K, Brandt CA, Wilson SM. Predictors of prenatal smoking among US women veterans. J Health Psychol 2020; 26:2648-2655. [PMID: 32255376 DOI: 10.1177/1359105320913100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated prevalence and factors associated with prenatal smoking among US women veterans using cross-sectional data from a cohort study of veterans from recent wars utilizing Veterans Health Administration primary care (N = 6190). Among the participants, 747 (12.0%) were current smokers and 1039 (16.8%) were former smokers. Multivariable logistic regression indicated that White race, substance use disorder, and posttraumatic stress disorder were associated with increased likelihood of smoking during pregnancy. Conversely, being married and officer rank were associated with decreased likelihood of prenatal smoking. Findings suggest a need for empirical testing of interventions to address perinatal smoking, substance use, and mental health.
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Affiliation(s)
| | | | - Lori A Bastian
- VA Connecticut Healthcare System, USA.,Yale University School of Medicine, USA
| | - Patrick S Calhoun
- Duke University School of Medicine, USA.,Durham VA Health Care System, USA.,VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, USA
| | - Jean C Beckham
- Duke University School of Medicine, USA.,VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, USA
| | | | | | - Kristin Mattocks
- University of Massachusetts Medical School, USA.,VA Central Western Massachusetts Healthcare System, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, USA.,Yale University School of Medicine, USA
| | - Sarah M Wilson
- Duke University School of Medicine, USA.,Durham VA Health Care System, USA
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25
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Abstract
PURPOSE OF REVIEW Perinatal opioid use is a major public health problem and is associated with a number of deleterious maternal and fetal effects. We review recent evidence of perinatal outcomes and treatment of opioid use disorder (OUD) during pregnancy. RECENT FINDINGS Opioid exposure in pregnancy is associated with multiple obstetric and neonatal adverse outcomes, with the most common being neonatal opioid withdrawal syndrome (NOWS). Treatment with buprenorphine or methadone is associated with NOWS, but neither medication appears to have significant adverse effects on early childhood development. Buprenorphine appears to be superior to methadone in terms of incidence and severity of NOWS in exposed infants. The long-term effects of opioid exposure in utero have been inconclusive, but recent longitudinal studies point to potential differences in brain morphology that may increase vulnerability to future stressors. Maintenance therapy with methadone or buprenorphine remains the standard of care for pregnant women with OUD given its consistent superiority to placebo in terms of rates of illicit drug use and pregnancy outcomes. New non-pharmacologic management options for NOWS appear promising. Future research is needed to further evaluate the effects of opioid exposure in utero and determine the optimal delivery model for maintenance therapy.
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Affiliation(s)
- Amalia Londono Tobon
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA
| | - Erin Habecker
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA.
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26
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Cohodes EM, Gee DG, Lieberman AF. Associations between prenatal substance exposure, prenatal violence victimization, unintended pregnancy, and trauma exposure in childhood in a clinical setting. Infant Ment Health J 2019; 40:786-798. [DOI: 10.1002/imhj.21815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Alicia F. Lieberman
- Child Trauma Research ProgramDepartment of PsychiatryUniversity of California San Francisco California
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27
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Wubetu AD, Habte S, Dagne K. Prevalence of risky alcohol use behavior and associated factors in pregnant antenatal care attendees in Debre Berhan, Ethiopia, 2018. BMC Psychiatry 2019; 19:250. [PMID: 31409311 PMCID: PMC6693166 DOI: 10.1186/s12888-019-2225-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 07/29/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND National Institute of alcohol and alcoholism define Problem/risky use of alcohol as drinking in a way that can negatively impact our health and life, but the body is not physically dependent on the substance. Risky alcohol use behavior is harmful to both the fetus and the mother such as maternal alcohol intoxication and alcohol use disorder, abortion, stillbirth, low birth weight, and prematurity. This study is aimed to assess the prevalence of risky alcohol use for both the mother and the fetus during pregnancy among mothers who have used alcohol at least once in the current pregnancy. METHODS Institution based cross-sectional study was conducted among a total of 380 mothers who have used alcohol at least once during the current pregnancy. The participants were selected using a systematic random sampling technique. Both Bivariable and Multivariable Binary Logistic Regression models were done to identify associated factors. Odds Ratios with their 95% Confidence Interval was computed and variables with a p-value < 0.05 during multivariable analysis were considered significantly associated factors. RESULTS A total of 380 mothers who used alcohol at least once (any amount) in the current pregnancy were included in the study and further interviewed for risky alcohol use behavior with a response rate of 100%. The overall prevalence of risky alcohol use behavior was 16.1% (95% CI = 12.1, 19.7). Having poor social support, having moderate to severe depression and anxiety, having diagnosed family history of mental illness, having a history of abortion were important factors which significantly associated with risky alcohol use behavior. CONCLUSION Significant proportions of pregnant mothers were risky alcohol drinkers. It will be better if screening of any amount of alcohol use during pregnancy and providing health education (about the risk of alcohol use) for all pregnant women who attend antenatal care follow up.
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Affiliation(s)
- Abate Dargie Wubetu
- Department of Psychiatry, College of Health Science and Medicine, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia.
| | - Surafel Habte
- Debre Berhan Public Health Institution, Debre Birhan, Ethiopia
| | - Kefyalew Dagne
- 0000 0004 0455 7818grid.464565.0Department of Psychiatry, College of Health Science and Medicine, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia
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28
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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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29
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Oga EA, Peters EN, Mark K, Trocin K, Coleman-Cowger VH. Prenatal Substance Use and Perceptions of Parent and Partner Use Using the 4P's Plus Screener. Matern Child Health J 2019; 23:250-257. [PMID: 30523484 DOI: 10.1007/s10995-018-2647-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Prenatal substance use screening is recommended. The 4 P's Plus screener includes questions on perceived problematic substance use in parents and partner that are not considered in risk stratification. Objectives This research examined the: (1) prevalence of self-reported problematic parental and partner substance use and associations with biochemically-verified prenatal substance use; (2) utility of self-reported perceptions of parent/partner substance use as proxies for prenatal substance use; and (3) degree to which the sensitivity of the 4P's Plus can be augmented with consideration of parent/partner questions in risk stratification. Methods A convenience sample of 500 pregnant women was recruited between January 2017 and January 2018. Participants completed the 4P's Plus and provided urine for drug testing. Diagnostic utility of problematic parent/partner substance use questions was assessed, then compared to the 4P's Plus used as designed, and to the 4P's Plus used with these 2 questions included in risk stratification. Results Half (51%) of respondents reported either partner or parental problematic substance use. When partner or parent problematic substance use were considered as proxies for prenatal substance use, sensitivity was 65% and specificity was 55%. When used as intended, sensitivity was 94% and specificity was 29%. Including partner/parent questions increased sensitivity to 96% but lowered specificity (19%). Partner substance use and combined partner/parent use were associated with prenatal substance use [adjusted odds ratio (aOR): 2.0 (1.2, 2.4; p = 0.006); aOR = 1.6 (1.1, 2.5, p = 0.04)]. Conclusions for Practice Sensitivity of the 4P's Plus may improve with inclusion of self-reported problematic partner/parent substance use items in risk stratification.
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Affiliation(s)
- Emmanuel A Oga
- Research Triangle Institute, 6110 Executive Boulevard, Suite 900, Rockville, MD, 20852, USA. .,Battelle Memorial Institute, Baltimore, MD, USA.
| | | | - Katrina Mark
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen Trocin
- Battelle Memorial Institute, Baltimore, MD, USA.,CommunicateHealth, Rockville, MD, USA
| | - Victoria H Coleman-Cowger
- Battelle Memorial Institute, Baltimore, MD, USA.,University of Maryland School of Medicine, Baltimore, MD, USA.,The Emmes Corporation, Rockville, MD, USA
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30
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Denny CH, Acero CS, Naimi TS, Kim SY. Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18-44 Years - United States, 2015-2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:365-368. [PMID: 31022164 PMCID: PMC6483284 DOI: 10.15585/mmwr.mm6816a1] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Objectives Substance use during pregnancy is a significant public health issue. Prenatal substance use increased in the past decade while prenatal cigarette smoking has remained stable. Co-use of tobacco and other drugs is a concern because of potential additive risks. This study aims to describe the prevalence rates of substance use among pregnant women and examine the association between smoking status (nonsmoker, recent quitter and current smoker) and other drug use. Methods In this cross-sectional study, pregnant women (n = 500) were recruited from two obstetric practices to complete three substance use screeners and have their urine tested for 12 different drug classes, including cannabis, opioids and cocaine. Participants were divided into three groups based on survey responses: nonsmokers, recent quitters (smoked in the month prior to pregnancy but not past month) and current smokers (past-month). Results Approximately 29% of participants reported smoking in the month before pregnancy. During pregnancy, 17, 12 and 71% were current smokers, recent quitters and nonsmokers respectively. Overall prevalence of illicit or prescription drug use in pregnancy was 27%. Cannabis was the most common drug used in pregnancy with prevalence of 22%, followed by opioids (4%), cocaine (1%), tricyclic antidepressants (TCAs) (1%), amphetamines (1%), and benzodiazepines (1%). On multivariable logistic regression, smoking in pregnancy was associated with a positive urine drug screen; with adjusted odds ratio (aOR) 4.7 (95% CI 2.6-8.3) for current smokers and 1.6 (95% CI 0.8-3.3) for recent quitters. Factors negatively associated with positive drug screen were second and third trimester pregnancies, 0.5 (0.3-0.9) and 0.3 (0.2-0.6) respectively; and employment, 0.5 (0.3-0.8). Conclusions for Practice Co-use of tobacco and illicit drugs, particularly cannabis, is relatively high during pregnancy. Additional research is needed to understand the health implications of co-use versus use of tobacco only. Given the strong association between smoking and other drug use, clinicians should routinely assess for illicit drug use in women who smoke during pregnancy.
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32
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Hua XG, Jiang W, Hu R, Hu CY, Huang K, Li FL, Zhang XJ. Large for gestational age and macrosomia in pregnancies without gestational diabetes mellitus. J Matern Fetal Neonatal Med 2019; 33:3549-3558. [PMID: 30714441 DOI: 10.1080/14767058.2019.1578746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective: This study aims to estimate the prevalence and risk factors of macrosomia and LGA (large for gestational age) in non-GDM (gestational diabetes mellitus) pregnant women in Fuyang, Anhui Province of China.Methods: A large population-based cohort study was conducted among non-GDM pregnant women aged 18-45 years. Maternal sociodemographic data prior to pregnancy were collected using interviewer-administered standardized questionnaire. Maternal obstetrical delivery records and newborn hospital records were extracted from antenatal care booklets and hospital discharge abstracts. Logistic regression analysis was used to identify the predictors of macrosomia and LGA.Results: The incidence of macrosomia and LGA was 9.2 and 15.9%, respectively. Mothers ≥35 years of age (aOR 2.75, 95% CI 1.98, 3.80), male neonates (aOR 1.68, 95% CI 1.51, 1.89), overweight and obese (aOR 1.61, 95% CI 1.34, 1.92 and aOR 3.05, 95% CI 2.05, 4.56, respectively) were associated with increased risk of macrosomia. Compared with the less educated mothers, the educated mothers were more likely to have increased risk of macrosomia. IFA (iron and folic acid) supplements intake during pregnancy was more likely to deliver macrosomia or LGA (aOR1.32, 95% CI 1.08, 1.49 and aOR1.42, 95% CI 1.24, 1.61, respectively) as compared with no IFA supplements intake. SCr (serum creatinine concentration) >80 µmol/L was related to decreased risk of macrosomia (aOR 0.73, 95% CI 0.61, 0.86) and LGA (aOR 0.67, 95% CI 0.59, 0.77) as compared with normal range (44-80 µmol/L).Conclusions: There was a high prevalence of macrosomia and LGA in non-GDM pregnant women in China. Healthcare educations and reasonable body weight are necessary for pregnant women to prevent macrosomia and LGA. Pregnant women should be checked regularly and have the first prenatal visit as soon as possible.
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Affiliation(s)
- Xiao-Guo Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wen Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Rui Hu
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Kai Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Feng-Li Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
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33
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Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study. Women Birth 2019; 32:e57-e64. [DOI: 10.1016/j.wombi.2018.04.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/20/2018] [Accepted: 04/02/2018] [Indexed: 01/09/2023]
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34
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Shenai N, Gopalan P, Glance J. Integrated Brief Intervention for PTSD and Substance Use in an Antepartum Unit. Matern Child Health J 2018; 23:592-596. [DOI: 10.1007/s10995-018-2686-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Latuskie KA, Leibson T, Andrews NCZ, Motz M, Pepler DJ, Ito S. Substance Use in Pregnancy Among Vulnerable Women Seeking Addiction and Parenting Support. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-0005-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Effects of mitochondrial disease/dysfunction on pregnancy: A retrospective study. Mitochondrion 2018; 46:214-220. [PMID: 29990538 DOI: 10.1016/j.mito.2018.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/11/2018] [Accepted: 06/28/2018] [Indexed: 12/29/2022]
Abstract
A retrospective survey assessed the gynecologic, obstetric and fertility history of 103 women with mitochondrial disease (MD)/dysfunction (Md) aged 16 to 75 who had previously been pregnant. Most participants (34%) had a mitochondrial myopathy and there were 248 combined pregnancies with live deliveries (average 3.6 pregnancies/woman). In general, pregnancy in those with MD/Md appears to exacerbate some constitutional and neurological symptoms and may be more frequently associated with common obstetric complications, but this did not appear to result in worse pregnancy outcomes. Most women carried their pregnancy to term, but their neonates tended to have more congenital anomalies than expected.
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Coleman-Cowger VH, Oga EA, Peters EN, Mark K. Prevalence and associated birth outcomes of co-use of Cannabis and tobacco cigarettes during pregnancy. Neurotoxicol Teratol 2018; 68:84-90. [PMID: 29883744 PMCID: PMC6054553 DOI: 10.1016/j.ntt.2018.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 01/21/2023]
Abstract
Use of Cannabis and use of tobacco overlap, and co-use of Cannabis and tobacco has increased over the past decade among adults. The current study aims to document the prevalence and correlates of co-use of Cannabis and tobacco cigarettes among adult pregnant women utilizing secondary data from a larger study that compared and validated screeners for illicit and prescription drug use during pregnancy. Pregnant women (N = 500; 71% African American; 65% never married, average age of 28 years) were recruited from two urban University obstetric clinics between January and December 2017. Participants self-reported demographic, Cannabis, and tobacco cigarette use characteristics, and provided urine and hair samples for drug testing. Within two weeks after due date, research staff reviewed participants' electronic medical records to collect birth outcome data. Results showed that 9.0% reported co-use of Cannabis and tobacco, 12.1% reported Cannabis only use, 7.8% reported tobacco cigarette only use, and 71.1% reported no Cannabis or tobacco cigarette use in the past month. The birth outcomes to emerge as significant correlates of co-use of Cannabis and tobacco cigarettes were small head circumference, and the occurrence of birth defects, with the co-use group having the highest odds of a small head circumference [aOR: 5.7 (1.1-28.9)] and birth defects [aOR: 3.1 (1.2-8.3)] compared with other use groups. The Cannabis only group had 12 times higher odds of a stillbirth or miscarriage (aOR = 12.1). Screening and interventions to address concurrent Cannabis and tobacco use during pregnancy are needed, particularly among subpopulations with higher co-use rates. It is imperative to further explore and highlight the possible health implications of maternal co-use given the high prevalence rates found in this study sample.
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Affiliation(s)
| | | | | | - Katrina Mark
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, United States
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Louw KA. Substance use in pregnancy: The medical challenge. Obstet Med 2018; 11:54-66. [PMID: 29997687 PMCID: PMC6038015 DOI: 10.1177/1753495x17750299] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023] Open
Abstract
Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.
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Affiliation(s)
- Kerry-Ann Louw
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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The Impact of Early Substance Use Disorder Treatment Response on Treatment Outcomes Among Pregnant Women With Primary Opioid Use. J Addict Med 2018. [PMID: 29538089 DOI: 10.1097/adm.0000000000000397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study examined the impact of early patient response on treatment utilization and substance use among pregnant participants enrolled in substance use disorder (SUD) treatment. METHODS Treatment responders (TRs) and treatment nonresponders (TNRs) were compared on pretreatment and treatment measures. Regression models predicted treatment utilization and substance use. RESULTS TR participants attended more treatment and had lower rates of substance use relative to TNR participants. Regression models for treatment utilization and substance use were significant. Maternal estimated gestational age (EGA) and baseline cocaine use were negatively associated with treatment attendance. Medication-assisted treatment, early treatment response, and baseline SUD treatment were positively associated with treatment attendance. Maternal EGA was negatively associated with counseling attendance; early treatment response was positively associated with counseling attendance. Predictors of any substance use at 1 month were maternal education, EGA, early treatment nonresponse, and baseline cocaine use. The single predictor of any substance use at 2 months was early treatment nonresponse. Predictors of opioid use at 1 month were maternal education, EGA, early treatment nonresponse, and baseline SUD treatment. Predictors of opioid use at 2 months were early treatment nonresponse, and baseline cocaine and marijuana use. Predictors of cocaine use at 1 month were early treatment nonresponse, baseline cocaine use, and baseline SUD treatment. Predictors of cocaine use at 2 months were early treatment nonresponse and baseline cocaine use. CONCLUSIONS Early treatment response predicts more favorable maternal treatment utilization and substance use outcomes. Treatment providers should implement interventions to maximize patient early response to treatment.
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Santos LAV, Lara MO, Lima RCR, Rocha AF, Rocha EM, Glória JCR, Ribeiro GDC. História gestacional e características da assistência pré-natal de puérperas adolescentes e adultas em uma maternidade do interior de Minas Gerais, Brasil. CIENCIA & SAUDE COLETIVA 2018; 23:617-625. [DOI: 10.1590/1413-81232018232.10962016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/20/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo desta pesquisa foi analisar a história gestacional e as características da assistência pré-natal de puérperas adolescentes e adultas em uma maternidade localizada em uma cidade de Minas Gerais, referência para a macrorregião de saúde do Jequitinhonha. Trata-se de um estudo transversal descritivo. Entrevistou-se 327 puérperas, entre maio de 2013 a março de 2014, utilizando um instrumento semiestruturado. Predominou o número de puérperas adultas com uma amostra de 255. Com relação ao pré-natal, 324 puérperas realizaram as consultas. Quanto ao local de realização do pré-natal, 79,2% das adolescentes, realizaram no serviço público de saúde, enquanto entre as adultas essa porcentagem foi de 60,4%. Quanto ao tipo de parto, 54,7% das puérperas o tiveram normal e 45% cesárea. Entre as adolescentes, houve uma maior porcentagem de parto normal comparado às adultas, e esse dado teve relação estatisticamente significativa com a idade da puérpera. Com relação à idade gestacional no momento do parto, 85,9% tiveram seus partos a termo; 13,5% pré-termo e 0,6% pós-termo. Evidenciou-se que as puérperas adolescentes estiveram em desvantagem em relação às demais mães no que diz respeito tanto às características socioeconômicas quanto na assistência recebida no pré-natal.
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Pochard L, Dupouy J, Frauger E, Giocanti A, Micallef J, Lapeyre-Mestre M. Impact of pregnancy on psychoactive substance use among women with substance use disorders recruited in addiction specialized care centers in France. Fundam Clin Pharmacol 2018; 32:188-197. [PMID: 29337399 DOI: 10.1111/fcp.12346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/04/2017] [Accepted: 12/22/2017] [Indexed: 01/23/2023]
Abstract
Pregnancy can be a motivation for decrease in drug abusing but may also represent a period of high vulnerability for relapse. We aimed to assess psychoactive substance use among women with substance use disorders followed in addiction care centers in France. We analyzed data from women aged 15-44 years included in the 'Observation of illegal drugs and misuse of psychotropic medication (OPPIDUM) survey', an annual cross-sectional survey collecting details on psychoactive substances used. Characteristics of women included in 2005-2012 yearly surveys were compared depending on their pregnant or not pregnant status. Factors, including pregnancy, associated with illicit substance use and medication misuse were investigated through logistic regression. The study included 518 pregnant and 6345 nonpregnant women; 85.3% pregnant women were on opioid maintenance therapy (OMT) (vs. 77.1% of nonpregnant). Pregnancy was associated with lower illicit substance use (adjusted OR 0.71 [0.58-0.88]) and with lower medication misuse (0.66 [0.49-0.89]), whereas financial insecurity and living as a couple were associated with increased risk. Raising children was significantly associated with less risk of substance use. Each substance taken separately, the part of women using illicit substance or misusing medication did not differ depending on whether they were pregnant or not, except for heroin (24.5% in pregnant vs. 17.9% nonpregnant; <0.001). This nationwide study provides new insights into psychoactive substance use in a large mixed population of women with drug use disorders. Results outline the challenge of preventing drug use and initiating care strategies with a specific approach on socio-economic environment.
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Affiliation(s)
- Liselotte Pochard
- Service de Pharmacologie Clinique, Faculté de Médecine, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance de Toulouse, CHU de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Hôpital de la Timone, 13005, Marseille, France
| | - Julie Dupouy
- Faculté de Médecine, UMR Inserm 1027, Université Toulouse 3, 37 Allées Jules Guesde, 31073, Toulouse Cedex, France
| | - Elisabeth Frauger
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Hôpital de la Timone, 13005, Marseille, France.,Institut de Neurosciences de la Timone, UMR 7289 CNRS, Aix-Marseille Université, Campus Timone, 13005, Marseille, France
| | - Adeline Giocanti
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Hôpital de la Timone, 13005, Marseille, France
| | - Joëlle Micallef
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodépendance Paca Corse, Hôpital de la Timone, 13005, Marseille, France.,Institut de Neurosciences de la Timone, UMR 7289 CNRS, Aix-Marseille Université, Campus Timone, 13005, Marseille, France
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Clinique, Faculté de Médecine, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance de Toulouse, CHU de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.,Faculté de Médecine, UMR Inserm 1027, Université Toulouse 3, 37 Allées Jules Guesde, 31073, Toulouse Cedex, France
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Zhao L, McCauley K, Sheeran L. The interaction of pregnancy, substance use and mental illness on birthing outcomes in Australia. Midwifery 2017; 54:81-88. [DOI: 10.1016/j.midw.2017.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/09/2017] [Accepted: 08/27/2017] [Indexed: 01/09/2023]
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Avilla RM, Surjan J, de Fátima Ratto Padin M, Canfield M, Laranjeira RR, Mitsuhiro S. Factors associated with attrition rate in a supportive care service for substance using pregnant women in Brazil. Am J Addict 2017; 26:676-679. [DOI: 10.1111/ajad.12579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 06/25/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Rosa Marina Avilla
- Department of Psychiatry; Federal University São Paulo; São Paulo Brazil
| | - Juliana Surjan
- Department of Psychiatry; Federal University São Paulo; São Paulo Brazil
| | - Maria de Fátima Ratto Padin
- Department of Psychiatry; Federal University São Paulo; São Paulo Brazil
- National Institute of Public Policy for Alcohol and Other Drugs; São Paulo Brazil
| | - Martha Canfield
- Health Psychology Section; Psychology Department, Institute of Psychiatry; Psychology and Neuroscience; King's College London; London United Kingdom
| | - Ronaldo Ramos Laranjeira
- Department of Psychiatry; Federal University São Paulo; São Paulo Brazil
- National Institute of Public Policy for Alcohol and Other Drugs; São Paulo Brazil
| | - SandroSendin Mitsuhiro
- Department of Psychiatry; Federal University São Paulo; São Paulo Brazil
- National Institute of Public Policy for Alcohol and Other Drugs; São Paulo Brazil
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44
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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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Childhood sexual abuse, intimate partner violence during pregnancy, and posttraumatic stress symptoms following childbirth: a path analysis. Arch Womens Ment Health 2017; 20:297-309. [PMID: 28032212 DOI: 10.1007/s00737-016-0705-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6-8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSD symptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.
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Brameld KJ, Jablensky A, Griffith J, Dean J, Morgan VA. Psychotropic Medication and Substance Use during Pregnancy by Women with Severe Mental Illness. Front Psychiatry 2017; 8:28. [PMID: 28261117 PMCID: PMC5313501 DOI: 10.3389/fpsyt.2017.00028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/01/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sociodemographic factors, alcohol and drug intake, and maternal health are known to be associated with adverse outcomes in pregnancy for women with severe mental illness in addition to their use of psychotropic medication. In this study, we describe the demographic characteristics of women hospitalized for severe mental illness along with their use of medication and other drugs during the pregnancy period. METHODS A clinical case note review of women with psychosis who were hospitalized at the State Psychiatric Hospital in Western Australia during 1966-1996, gave birth between 1980 and 1992, and received psychiatric treatment during the pregnancy period. The mother's clinical information was available from the case notes and the midwives record. The demographic characteristics of the mothers were described together with their hospitalization pattern and their medication and substance use during the pregnancy period. RESULTS A total of 428 mothers with a history of severe mental illness were identified who gave birth during 1980-1992. Of these, 164 mothers received psychiatric care during the pregnancy period. One hundred thirty-two had taken psychotropic medication during this period. Mothers who were married, of aboriginal status or living in regional and remote areas appeared less likely to be hospitalized during the pregnancy period, while older mothers and those with a diagnosis of schizophrenia were more likely to be hospitalized. The number of mothers taking psychotropic medication in the first trimester of pregnancy was reduced compared to the previous 6 months. The decline in the number taking substances over the same period was not significant. In all, 16% of the women attempted suicide during the pregnancy period and 10% non-suicidal self-injury. CONCLUSION The women demonstrate a pattern of decreased use of psychotropic medication use from the period before pregnancy to the first trimester of pregnancy. Our data highlight the importance of women with severe mental illness receiving regular ongoing monitoring and support from their psychiatrist during pregnancy regarding the level of medication required as well as counseling with regard to substance use, non-suicidal self-injury, and attempted suicide.
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Affiliation(s)
- Kate J. Brameld
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Assen Jablensky
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - Jenny Griffith
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - John Dean
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - Vera A. Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
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Popova S, Lange S, Probst C, Parunashvili N, Rehm J. Prevalence of alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorders among the general and Aboriginal populations in Canada and the United States. Eur J Med Genet 2017; 60:32-48. [DOI: 10.1016/j.ejmg.2016.09.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 11/26/2022]
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Chang JC, Holland CL, Tarr JA, Rubio D, Rodriguez KL, Kraemer KL, Day N, Arnold RM. Perinatal Illicit Drug and Marijuana Use. Am J Health Promot 2016; 31:35-42. [PMID: 26559718 DOI: 10.4278/ajhp.141215-qual-625] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits. DESIGN Observational study that qualitatively assesses provider screening and patient disclosure of substance use. SETTING Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania. PARTICIPANTS Pregnant patients and obstetric providers were recruited as participants. METHODS We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure. RESULTS Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use. CONCLUSION Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers.
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Affiliation(s)
- Judy C Chang
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences and General Internal Medicine, Magee-Womens Research Institute, and the Center for Research in Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Cynthia L Holland
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Jill A Tarr
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Doris Rubio
- 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Keri L Rodriguez
- 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,5 Center for Health Equity Research & Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Kevin L Kraemer
- 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nancy Day
- 4 Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M Arnold
- 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,6 Institute to Enhance Palliative Care, and Director, Pittsburgh, Pennsylvania
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Brown QL, Hasin DS, Keyes KM, Fink DS, Ravenell O, Martins SS. Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age. Drug Alcohol Depend 2016; 166:116-24. [PMID: 27422762 PMCID: PMC4983465 DOI: 10.1016/j.drugalcdep.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/22/2016] [Accepted: 07/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women can provide important insight into the role of access to care in preventing tobacco and alcohol use among pregnant women and women planning to become pregnant. METHODS We examined the association between health insurance coverage and both past month alcohol use and past month tobacco use in a nationally representative sample of women age 12-44 years old, by pregnancy status. The women (n=97,788) were participants in the National Survey of Drug Use and Health (NSDUH) in 2010-2013. Logistic regression models assessed the association between health insurance (insured versus uninsured), past month tobacco and alcohol use, and whether this was modified by pregnancy status. RESULTS Pregnancy status significantly moderated the relationship between health insurance and tobacco use (p-value≤0.01) and alcohol use (p-value≤0.01). Among pregnant women, being insured was associated with lower odds of alcohol use (adjusted odds ratio [AOR]=0.47; 95% confidence interval [CI]=0.27-0.82), but not associated with tobacco use (AOR=1.14; 95% CI=0.73-1.76). Among non-pregnant women, being insured was associated with lower odds of tobacco use (AOR=0.67; 95% CI=0.63-0.72), but higher odds of alcohol use (AOR=1.23; 95% CI=1.15-1.32). CONCLUSION Access to health care, via health insurance coverage is a promising method to help reduce alcohol use during pregnancy. However, despite health insurance coverage, tobacco use persists during pregnancy, suggesting missed opportunities for prevention during prenatal visits.
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Affiliation(s)
- Qiana L. Brown
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY,New York State Psychiatric Institute, New York, NY,Corresponding author at: Deborah S. Hasin, Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive #123, New York, NY 10032, US. Phone: 1 (646) 774-7909, Fax: 1 (646) 774-7920.
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - David S. Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Silvia S. Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Holland CL, Nkumsah MA, Morrison P, Tarr JA, Rubio D, Rodriguez KL, Kraemer KL, Day N, Arnold RM, Chang JC. "Anything above marijuana takes priority": Obstetric providers' attitudes and counseling strategies regarding perinatal marijuana use. PATIENT EDUCATION AND COUNSELING 2016; 99:1446-51. [PMID: 27316326 PMCID: PMC5007170 DOI: 10.1016/j.pec.2016.06.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/19/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe obstetric provider attitudes, beliefs, approaches, concerns, and needs about addressing perinatal marijuana use with their pregnant patients. METHODS We conducted individual semi-structured interviews with obstetric providers and asked them to describe their thoughts and experiences about addressing perinatal marijuana use. Interviews were transcribed verbatim, coded and reviewed to identify themes. RESULTS Fifty-one providers participated in semi-structured interviews. Providers admitted they were not familiar with identified risks of marijuana use during pregnancy, they perceived marijuana was not as dangerous as other illicit drugs, and they believed patients did not view marijuana as a drug. Most provider counseling strategies focused on marijuana's status as an illegal drug and the risk of child protective services being contacted if patients tested positive at time of delivery. CONCLUSIONS When counseling about perinatal marijuana use, obstetric providers focus more on legal issues than on health risks. They describe needing more information regarding medical consequences of marijuana use during pregnancy. PRACTICE IMPLICATIONS Provider training should include information about potential consequences of perinatal marijuana use and address ways to improve obstetric providers' counseling. Future studies should assess changes in providers' attitudes as more states consider the legalization of marijuana.
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Affiliation(s)
- Cynthia L Holland
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Michelle Abena Nkumsah
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA; University of Pittsburgh Dietrich School of Arts and Sciences, 139 University Pl, Pittsburgh PA 15260, USA
| | - Penelope Morrison
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Jill A Tarr
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Doris Rubio
- Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Research in Health Care University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh PA 15213, USA; Clinical and Translational Science Institute University of Pittsburgh, 200 Meyran Ave, Pittsburgh PA 15213, USA
| | - Keri L Rodriguez
- Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Health Equity Research & Promotion (CHERP) Veterans Affairs Pittsburgh Healthcare System University Drive 151C, Pittsburgh PA 15240, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Research in Health Care University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh PA 15213, USA; Clinical and Translational Science Institute University of Pittsburgh, 200 Meyran Ave, Pittsburgh PA 15213, USA
| | - Nancy Day
- Department of Psychiatry, University of Pittsburgh, 3800 O'Hara Street, Pittsburgh PA 15213, USA
| | - Robert M Arnold
- Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Research in Health Care University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh PA 15213, USA; Section of Palliative Care and Medical Ethics, Institute to Enhance Palliative Care; Institute for Doctor-Patient Communication UPMC Montefiore 932W, 200 Lothrop St. Pittsburgh PA, 15213, USA
| | - Judy C Chang
- Magee Womens Research Institute Department of Obstetrics, Gynecology and Reproductive Sciences, 300 Halket Street, Pittsburgh, PA 15213, USA; Division of General Internal Medicine, Department of Medicine, UPMC Presbyterian Hospital Suite W933, Pittsburgh PA 15213, USA; Center for Research in Health Care University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh PA 15213, USA.
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