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Wohrer F, Ngo H, DiDomenico J, Ma X, Roberts MH, Bakhireva LN. Potentially modifiable risk and protective factors affecting mental and emotional wellness in pregnancy. Front Hum Neurosci 2024; 18:1323297. [PMID: 38445095 PMCID: PMC10912531 DOI: 10.3389/fnhum.2024.1323297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Impaired mental and emotional wellness often co-occurs with prenatal substance use, and both affect infant socio-emotional, cognitive, language, motor, and adaptive behavioral outcomes. Guided by the modified biopsychosocial framework, this study examined the role of common substance exposures during pregnancy (i.e., alcohol and cannabis), socio-cultural factors (social support during pregnancy, adverse childhood experiences), and reproductive health factors on maternal mental health (MMH). Methods Data were obtained from a prospective cohort study-Ethanol, Neurodevelopment, Infant, and Child Health (ENRICH-2), and included 202 pregnant persons. Alcohol and cannabis exposures were assessed through repeated prospective interviews and a comprehensive battery of drug and ethanol biomarkers. MMH outcomes were evaluated during the third trimester through the Perceived Stress Scale, Edinburgh Depression Scale, Generalized Anxiety Disorders-7, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders. Univariate and multivariable linear regression models evaluated significant predictors of MMH. Results Results of multivariable analysis indicate that both maternal adverse childhood experiences and alcohol exposure, even at low-to-moderate levels, during pregnancy were associated with poorer scores for most MMH measures, while higher level of social support and Spanish as the primary language at home (as a proxy of enculturation) had protective effects (all p's < 0.05). Conclusion These findings highlight the importance of assessing substance use, including periconceptional alcohol exposure, and mental health in pregnant persons as closely related risk factors which cannot be addressed in isolation. Our findings also emphasize a strong protective effect of socio-cultural factors on maternal mental and emotional wellbeing-a strong precursor to maternal-infant bonding and infant neurodevelopment.
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Affiliation(s)
- Fiona Wohrer
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Helen Ngo
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jared DiDomenico
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Xingya Ma
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Melissa H. Roberts
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Ludmila N. Bakhireva
- College of Pharmacy Substance Use Research and Education Center, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Cole R, Kynn M, Carberry A, Jones R, Parekh S, Whitehead E, Taylor J, Merollini K. Examining service utilisation and impact among consumers of a national mental health stepped care programme in Australia: a protocol using linked administrative data. BMJ Open 2023; 13:e072404. [PMID: 37419645 PMCID: PMC10335474 DOI: 10.1136/bmjopen-2023-072404] [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: 02/01/2023] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Mental well-being is a global public health priority with increasing mental health conditions having substantial burden on individuals, health systems and society. 'Stepped care', where services are provided at an intensity to meet the changing needs of the consumer, is the chosen approach to mental health service delivery in primary healthcare in Australia for its efficiencies and patient outcomes; yet limited evidence exists on how the programme is being rolled out and its impact in practice. This protocol outlines a data linkage project to characterise and quantify healthcare service utilisation and impacts among a cohort of consumers of a national mental health stepped care programme in one region of Australia. METHODS AND ANALYSIS Data linkage will be used to establish a retrospective cohort of consumers of mental health stepped care services between 1 July 2020 and 31 December 2021 in one primary healthcare region in Australia (n=approx. 12 710). These data will be linked with records from other healthcare service data sets (eg, hospitalisations, emergency department presentations, community-based state government-delivered mental healthcare, hospital costs). Four areas for analysis will include: (1) characterising the nature of mental health stepped care service use; (2) describing the cohort's sociodemographic and health characteristics; (3) quantifying broader service utilisation and associated economic costs; and (4) assessing the impact of mental health stepped care service utilisation on health and service outcomes. ETHICS AND DISSEMINATION Approval from the Darling Downs Health Human Research Ethics Committee (HREA/2020/QTDD/65518) has been granted. All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals, conference presentations and industry meetings.
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Affiliation(s)
- Rachel Cole
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Mary Kynn
- School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Angela Carberry
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Rhian Jones
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | | | - Emma Whitehead
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Jane Taylor
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Katharina Merollini
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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3
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Board A, D'Angelo DV, Salvesen von Essen B, Denny CH, Miele K, Dunkley J, Baillieu R, Kim SY. Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective. Drug Alcohol Depend 2023; 247:109872. [PMID: 37182339 PMCID: PMC10332334 DOI: 10.1016/j.drugalcdep.2023.109872] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Substance use during pregnancy is associated with poor health outcomes. This study assessed substance use, polysubstance use, and use of select prescription medications during pregnancy. METHODS We analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System in 25 United States jurisdictions that included questions on prescription medications, tobacco, and illicit substance use during pregnancy. Alcohol and electronic cigarette use were assessed during the last three months of pregnancy, and all other substances and medications were assessed throughout pregnancy. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated. RESULTS Nearly one-fifth of respondents who reported use of any substance reported use of at least one other substance during pregnancy. Cigarettes (8.1%; 95% CI 7.6-8.7%) and alcohol (7.4%; 95% CI 6.7-8.1%) were the most frequently reported substances, followed by cannabis (4.3%; 95% CI 3.9-4.7%). Substance use was higher among individuals who reported having depression or using antidepressants during pregnancy compared with those who did not report depression or antidepressant use. Illicit drug use prevalence was low (0.5%, 95% CI 0.4-0.7%); however, respondents reporting heroin use also frequently reported use of illicit stimulants (amphetamines: 51.7%, 95% CI 32.1-71.3% or cocaine: 26.5%, 95% CI 11.9-41.1%). Although prenatal clinician screening for alcohol and cigarette use was approximately 95%, fewer respondents (82.1%) reported being screened for cannabis or illicit substance use during pregnancy. CONCLUSIONS One in five individuals who reported use of any substance during pregnancy engaged in polysubstance use, highlighting the importance of comprehensive screening and evidence-based interventions including harm reduction.
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Affiliation(s)
- Amy Board
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States.
| | - Denise V D'Angelo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-10, Atlanta, GA 30341, United States
| | - Beatriz Salvesen von Essen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S107-2, Atlanta, GA 30341, United States; CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA 30308, United States
| | - Clark H Denny
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States
| | - Kathryn Miele
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States
| | - Janae Dunkley
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States; Oak Ridge Institute for Science and Education, P.O. Box 117, Oak Ridge, TN 37831-0117, United States
| | - Robert Baillieu
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, United States
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop S106-3, Atlanta, GA 30341, United States
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Young SL, Steane SE, Kent NL, Reid N, Gallo LA, Moritz KM. Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13144. [PMID: 36293721 PMCID: PMC9603223 DOI: 10.3390/ijerph192013144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
This study sought to determine data collection approaches in Australian cohort studies and explore the potential impact on reported prenatal alcohol exposure (PAE) prevalence and patterns. Inclusion criteria were that studies related to a general Australian antenatal population where PAE was assessed and reported. Studies were excluded if they were not peer reviewed, examined the prevalence of PAE in pregnancies complicated by alcohol-use disorders, or were published in a language other than English. A systematic search of five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) was conducted. Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. Results were synthesised using MetaXL. Data from 16 separate birth cohorts (n = 78 articles) were included. Included cohorts were either general cohorts that included alcohol as a variable or alcohol-focused cohorts that were designed with a primary focus on PAE. PAE prevalence was estimated as 48% (95% CI: 38 to 57%). When subgroup analysis was performed, estimates of PAE prevalence when self-administered surveys and interviews were used for data collection were 53% (95% CI: 41% to 64%) and 43% (95% CI: 28% to 59%), respectively. Use of trained assessors was an influencing factor of the prevalence estimates when data were collected via interview. Alcohol-focused studies reported higher prevalence of PAE, regardless of method of survey administration. Where interviewer training is not possible, self-administered questionnaires will likely provide the most reliable PAE estimates. No funding sources are relevant to mention. Review was registered with PROSPERO (CRD42020204853).
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Affiliation(s)
- Sophia L. Young
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Sarah E. Steane
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Nykola L. Kent
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Linda A. Gallo
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, QLD 4502, Australia
| | - Karen M. Moritz
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, QLD 4072, Australia
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
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Di HK, Gan Y, Lu K, Wang C, Zhu Y, Meng X, Xia WQ, Xu MZ, Feng J, Tian QF, He Y, Nie ZQ, Liu JA, Song FJ, Lu ZX. Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020. World J Pediatr 2022; 18:176-185. [PMID: 35089538 DOI: 10.1007/s12519-021-00501-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Maternal smoking during pregnancy may be associated with low birth weight (LBW) in offspring and global risk estimates have not been summarized previously. We aimed to systematically explore evidence regarding maternal smoking and the LBW risk in offspring globally and examine possible causes of heterogeneity across relevant studies. METHODS Comprehensive search of PubMed, Ovid Embase, Ovid Medline (R), and Web of science from inception until October 2021 was carried out. A random-effects meta-analysis was used to estimate the pooled odds ratio (OR) and corresponding 95% confidence interval (CI). Restricted cubic spline analysis with three knots was used to further examine the dose-response relationship. RESULTS Literature searches yielded 4940 articles, of which 53 met inclusion criteria (comprising 55 independent studies). Maternal smoking during pregnancy was significantly associated with the risk of LBW in offspring (OR = 1.89, 95% CI = 1.80-1.98). Furthermore, an obvious dose-response relationship between the amount of cigarettes daily smoked in pregnancy and the risk of LBW in offspring was observed. The results of subgroup analyses indicated that the risk of maternal smoking on LBW was larger in more recently conducted studies (P = 0.020) and longer period of active smoking during pregnancy (P = 0.002). No evidence of publication bias was found. CONCLUSIONS In summary, maternal smoking in pregnancy was significantly associated with a higher risk of LBW in offspring on a global scale. The risk of maternal smoking on infant LBW seems to be increasing over time, and was higher with longer smoking duration throughout pregnancy and more cigarettes smoked daily.
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Affiliation(s)
- Hong-Kun Di
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Kai Lu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chao Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xin Meng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Wen-Qi Xia
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Min-Zhi Xu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Qing-Feng Tian
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yan He
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhi-Qiang Nie
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Jun-An Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Fu-Jian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, NR47TJ, UK.
| | - Zu-Xun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China.
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Perez FA, Blythe S, Wouldes T, McNamara K, Black KI, Oei JL. Prenatal methamphetamine-impact on the mother and child-a review. Addiction 2022; 117:250-260. [PMID: 33830539 DOI: 10.1111/add.15509] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/02/2021] [Accepted: 03/24/2021] [Indexed: 11/29/2022]
Abstract
Methamphetamine (MA) is the second most commonly used illicit drug in the world, after cannabis. There are limited data on the outcomes of pregnant MA users but there is rapidly emerging evidence to suggest that they are more vulnerable, marginalized and impoverished compared with other drug-using mothers. MA use during pregnancy is associated with worse pregnancy outcomes and significantly higher rates of co-existing health and psychosocial problems. Newborn infants exposed to MA are at increased risk of perinatal complications, present differently at birth to infants exposed to other drugs of dependency such as opioids and have poorer neurological adaptation and feeding difficulties. Sparse literature from neuroimaging and cohort studies suggests that the neurocognitive deficits in MA exposed children persist, even into adulthood. Current clinical practice guidelines for the care of substance exposed pregnant women are opioid-centric with little attention paid to the consequences of prenatal MA exposure.
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Affiliation(s)
- Fatima Anne Perez
- Department of Newborn Care, The Royal Hospital for Women, Randwick, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University.,Ingham Institute, Liverpool, Australia
| | - Trecia Wouldes
- School of Medicine, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kelly McNamara
- Faculty of Medicine and Health, University of Sydney, Sidney, Australia.,School of Women's and Children's Health, University of New SouthWales, Sidney, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, University of Sydney, Sidney, Australia
| | - Ju Lee Oei
- Department of Newborn Care, The Royal Hospital for Women, Randwick, Australia.,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, Australia
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Kar P, Tomfohr-Madsen L, Giesbrecht G, Bagshawe M, Lebel C. Alcohol and substance use in pregnancy during the COVID-19 pandemic. Drug Alcohol Depend 2021; 225:108760. [PMID: 34102507 PMCID: PMC9758579 DOI: 10.1016/j.drugalcdep.2021.108760] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on alcohol and substance use has been a topic of concern. Pregnant women are currently experiencing elevated anxiety and depression symptoms, which may increase risk of substance use, and potentially result in poor perinatal and neurodevelopmental outcomes for children. METHODS Survey results were analyzed from an ongoing study of 7470 pregnant individuals in Canada: Pregnancy during the COVID-19 Pandemic. Participants were asked about current use of alcohol and substances, symptoms of depression and anxiety, and COVID-19 concerns: how much they worry about COVID-19 threatening their baby's life, threatening their own life, care for themselves or the baby, feelings of social isolation, and financial difficulties. RESULTS The percentage of participants who reported use during pregnancy was 6.7 % for alcohol, 4.3 % for cannabis, 4.9 % for tobacco, and 0.3 % for illicit drugs; 2.6 % were using multiple substances. Higher depression symptoms and financial difficulties were associated with more cannabis and/or tobacco use as well as the co-use of substances. There were no associations between alcohol use and mental health or COVID-19 concerns. CONCLUSIONS Self-reported rates of use and co-use were lower or comparable to previous research, perhaps reflecting pandemic-related circumstances or the demographics of this sample. Depression symptoms and pandemic-related financial difficulties were associated with more tobacco use, cannabis use, and substance co-use. It remains important to maintain access to perinatal, mental health, and financial supports during the pandemic to mitigate prenatal alcohol and substance use and prevent poor perinatal and long-term neurodevelopmental outcomes for children.
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Affiliation(s)
- Preeti Kar
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Hotchkiss Brain Institute, University of Calgary, Canada
| | - Lianne Tomfohr-Madsen
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Department of Psychology, University of Calgary, Canada,Department of Pediatrics, University of Calgary, Canada
| | - Gerald Giesbrecht
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Department of Psychology, University of Calgary, Canada,Department of Pediatrics, University of Calgary, Canada
| | - Mercedes Bagshawe
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada,Hotchkiss Brain Institute, University of Calgary, Canada,Department of Radiology, University of Calgary, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Radiology, University of Calgary, Canada.
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8
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Pentecost R, Latendresse G, Smid M. Scoping Review of the Associations Between Perinatal Substance Use and Perinatal Depression and Anxiety. J Obstet Gynecol Neonatal Nurs 2021; 50:382-391. [PMID: 33773955 PMCID: PMC8286297 DOI: 10.1016/j.jogn.2021.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate published literature on the associations between perinatal substance use (PSU), perinatal depression and anxiety (PDA), and known maternal-newborn outcomes. DATA SOURCES We conducted a systematic search of health-related databases, including PubMed, CINAHL, MEDLINE, and Embase. Search terms included maternal mental health, substance use, postpartum, opioid, alcohol, methamphetamine, addiction, dependence, pregnancy, depression, and anxiety. STUDY SELECTION We included English-language, peer-reviewed reports of primary research and systematic reviews that were published between 2010 and 2020 and focused on PSU and PDA. We excluded commentaries, nonsystematic reviews, and articles on maternal mental health other than PDA. Fourteen of 379 articles met the inclusion criteria. DATA EXTRACTION We used the Joanna Briggs Institute Review Guidelines to guide extraction of the following data: author(s), year of publication, type of study, country of origin, study sample, targeted substance(s), mental health, key findings, and recommendation(s). DATA SYNTHESIS In studies of PSU, researchers identified a strong association with PDA. Likewise, researchers investigating PDA found a strong association with PSU. Findings from these articles suggest an increasing risk for PSU with increasing severity of PDA, depending on the specific substances of use. Findings also indicated that women with polysubstance use have greater odds for comorbid perinatal mental health conditions. A relationship between PSU and PDA and adverse newborn outcomes, such as low birth weight, was found. CONCLUSION There is a paucity of published research on co-occurring PSU and PDA. However, polysubstance use appears to be associated with the greatest risk for PDA. It is essential to address PSU and PDA together to better understand the effects on maternal and infant outcomes.
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Alcohol and illicit and non-medical prescription drug use before and during pregnancy in Stockholm, Sweden: A cross-sectional study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100622. [PMID: 34010729 DOI: 10.1016/j.srhc.2021.100622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/13/2020] [Accepted: 04/07/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To provide current estimates of alcohol and drug use among pregnant women attending antenatal care lectures in preparation for childbirth in Stockholm, Sweden. STUDY DESIGN A cross-sectional study. Data was collected anonymously among women attending lectures in preparation for childbirth. MAIN OUTCOME MEASURES The prevalence of alcohol and illicit and non-medical prescription drug use among pregnant women attending antenatal care lectures in preparation for childbirth. RESULTS Nine hundred and thirty-six pregnant women attending lectures in preparation for childbirth participated. Among those answering all questions about alcohol use during pregnancy, 4.2 percent reported use (95% confidence interval (CI), 3.0-5.7%) and among those answering all questions about illicit or non-medical prescription drug use during pregnancy, 0.5 percent reported such use (95% CI, 0.1-1.3%). The prevalences of binge drinking during pregnancy and alcohol and drug use before pregnancy are presented. Comparisons of anonymously and non-anonymously collected data are included. CONCLUSIONS Approximately one in 25 women reported using alcohol and approximately one in 200 reported using illicit or non-medical prescription drugs while pregnant. Alcohol use during pregnancy may have decreased in Stockholm, Sweden.
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10
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Abdallah AY, Joho AA, Yahaya JJ. Influence of maternal lifestyle behaviors on birth weight and Apgar score. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Griffiths LJ, Johnson RD, Broadhurst K, Bedston S, Cusworth L, Alrouh B, Ford DV, John A. Maternal health, pregnancy and birth outcomes for women involved in care proceedings in Wales: a linked data study. BMC Pregnancy Childbirth 2020; 20:697. [PMID: 33198668 PMCID: PMC7667744 DOI: 10.1186/s12884-020-03370-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/28/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Under the Children Act 1989, local authorities in Wales, UK, can issue care proceedings if they are concerned about the welfare of a child, which can lead to removal of a child from parents. For mothers at risk of child removal, timely intervention during pregnancy may avert the need for this and improve maternal/fetal health; however, little is known about this specific population during the antenatal period. The study examined maternity characteristics of mothers whose infants were subject to care proceedings, with the aim of informing preventative interventions targeted at high risk mothers. METHODS Anonymised administrative data from Cafcass Cymru, who provide child-focused advice and support for family court proceedings in Wales, were linked to population-based maternity and health records held within the Secure Anonymised Information Linkage Databank. Linked data were available for 1111 birth mothers of infants involved in care proceedings between 2015 and 2018. Findings were benchmarked with reference to an age-deprivation-matched comparison group (n = 23,414), not subject to care proceedings but accessing maternity services during this period. Demographic characteristics, maternal health, reproductive history, interaction with midwifery services, and pregnancy and birth outcomes were examined. Descriptive and statistical tests of independence were used. RESULTS Half of the women in the cohort (49.4%) resided in the most deprived areas. They were more likely to be younger at entry to motherhood (63.5% < 21 years-of-age compared to 42.7% in the comparison group), to have mental health (28.6% compared to 8.2%) and substance use issues (10.4% compared to 0.6%) and to smoke (62.7% compared to 24.8%) during pregnancy. The majority first engaged with maternity services within their first trimester of pregnancy (63.5% compared to 84.4%). Babies were more likely to be born preterm (14.2% compared to 6.7%) and, for full-term babies, to have low birthweights (8.0% compared to 2.8%). CONCLUSION This novel linkage study highlights multiple vulnerabilities experienced by pregnant mothers who have experienced care proceedings concerning an infant. Policy and practice colleagues require a clearer picture of women's needs if child protection and health services are to offer effective services which prevent the need for family court proceedings and infant removal.
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Affiliation(s)
- L J Griffiths
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK.
| | - R D Johnson
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - K Broadhurst
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK
| | - S Bedston
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK
| | - L Cusworth
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK
| | - B Alrouh
- Centre for Child & Family Justice Research, Lancaster University, Lancaster, LA1 4YW, UK
| | - D V Ford
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
| | - A John
- Population Data Science, Swansea University Medical School, Swansea, SA2 8PP, UK
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Sūdžiūtė K, Murauskienė G, Jarienė K, Jaras A, Minkauskienė M, Adomaitienė V, Nedzelskienė I. Pre-existingmental health disorders affect pregnancy and neonatal outcomes: a retrospectivecohort study. BMC Pregnancy Childbirth 2020; 20:419. [PMID: 32711495 PMCID: PMC7382029 DOI: 10.1186/s12884-020-03094-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 07/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This was a hospital registry-based retrospective age-matched cohort study that aimed to compare pregnancy and neonatal outcomes of women with pre-existing mental disorders with those of mentally healthy women. METHODS A matched cohort retrospective study was carried out in the Department of Obstetrics and Gynecology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, a tertiary health care institution. Medical records of pregnant women who gave birth from 2006 to 2015 were used. The study group was comprised of 131 pregnant women with mental disorders matched to 228 mentally healthy controls. The primary outcomes assessed were antenatal care characteristics; secondary outcomes were neonatal complications. RESULTS Pregnant women with pre-existing mental health disorders were significantly more likely to have low education, be unmarried and unemployed, have a disability that led to lower working capacity, smoke more frequently, have chronic concomitant diseases, attend fewer antenatal visits, gain less weight, be hospitalized during pregnancy, spend more time in hospital during the postpartum period, and were less likely to breastfeed their newborns. The newborns of women with pre-existing mental disorders were small for gestational age (SGA) more often than those of healthy controls (12.9% vs. 7.6%, p < 0.05). No difference was found comparing the methods of delivery. CONCLUSIONS Women with pre-existing mental health disorders had a worse course of pregnancy. Mental illness increased the risk to deliver a SGA newborn (RR 2.055, 95% CI 1.081-3.908).
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Affiliation(s)
- Kotryna Sūdžiūtė
- Faculty of medicine, Clinic of Psychiatry, Lithuanian University of Health Sciences, Medical Academy, Eivenių street 2, LT-50161 Kaunas, Lithuania
| | - Greta Murauskienė
- Faculty of medicine, Clinic of Psychiatry, Lithuanian University of Health Sciences, Medical Academy, Eivenių street 2, LT-50161 Kaunas, Lithuania
| | - Kristina Jarienė
- Faculty of medicine, Clinic of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Medical academy, Eivenių street 2, LT-50161 Kaunas, Lithuania
| | - Algirdas Jaras
- Faculty of medicine, Clinic of Psychiatry, Lithuanian University of Health Sciences, Medical Academy, Eivenių street 2, LT-50161 Kaunas, Lithuania
| | - Meilė Minkauskienė
- Faculty of medicine, Clinic of Obstetrics and Gynecology, Lithuanian University of Health Sciences, Medical academy, Eivenių street 2, LT-50161 Kaunas, Lithuania
| | - Virginija Adomaitienė
- Faculty of medicine, Clinic of Psychiatry, Lithuanian University of Health Sciences, Medical Academy, Eivenių street 2, LT-50161 Kaunas, Lithuania
| | - Irena Nedzelskienė
- Faculty of Odontology, Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, Medical Academy, Eivenių Street 2, LT-50161 Kaunas, Lithuania
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Overall Maternal Morbidity during Pregnancy Identified with the WHO-WOICE Instrument. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9740232. [PMID: 32724823 PMCID: PMC7382725 DOI: 10.1155/2020/9740232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
Objective To evaluate the prevalence of nonsevere maternal morbidity (including overall health, domestic and sexual violence, functionality, and mental health) in women during antenatal care and further analyze factors associated with compromised mental functioning and clinical health by administration of the WHO's WOICE 2.0 instrument. Method A cross-sectional study was conducted at a referral center in Brazil with an interview and questionnaire administered to pregnant women at 28 weeks of gestation and beyond. Data collection and management were supported by REDCAP software. A descriptive analysis was performed, and a multiple regression analysis also investigated factors associated with impairment in mental conditions, functionality, and clinical health. Results 533 women at a mean age of 28.9 years (±6.7) were included, and the majority had a partner (77.1%) and secondary education (67.7%). Exposure to violence occurred in 6.8%, and 12.7% reported substance use. Sexual satisfaction was reported by the vast majority (91.7%), although almost one-fifth were sexually abstinent. Overall, women reported very good and good health (72%), despite being told that they had a medical condition (66%). There was an overall rate of anxiety in 29.9%, depression in 39.5%, and impaired functioning in 20.4%. The perception of an abnormal clinical condition was the only factor independently associated with impaired functioning and mental health in the multiple regression model. Obesity was independently associated with clinical impairment. Conclusion During antenatal care, pregnant women in the study reported having a high rate of anxiety, depression, impaired functioning, and substance use. These issues can affect a woman's health and should be further addressed for specific interventions and improved quality of care.
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Jussila H, Ekholm E, Pajulo M. A New Parental Mentalization Focused Ultrasound Intervention for Substance Using Pregnant Women. Effect on Self-reported Prenatal Mental Health, Attachment and Mentalization in a Randomized and Controlled Trial. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00205-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractThe effect of a novel mentalization-based parenting intervention was explored on prenatal self-reported mentalization (P-PRFQ), attachment (MFAS), depression (EPDS) and anxiety (STAI) among women with substance use problems. The participants were 90 pregnant women referred to obstetric outpatient care due to recent or current substance use and randomized into intervention (n = 46) and control (n = 44) groups. The intervention group received three interactive 4D ultrasound sessions and a week-by-week pregnancy diary. The control condition was constituted of treatment-as-usual in obstetric care. Unfortunately, the efficacy of the intervention on maternal prenatal mental health, attachment, and parental mentalization was not substantiated. The negative results may be related to the small sample size, the patient-reported outcomes, or insufficient efficacy within this high-risk group. In the context of high psychosocial risks and follow-up by Child Welfare Services, the patient-reported outcomes may have underestimated prenatal adversity. The role of the research context, methodology, and possible sources of bias in the outcome assessment are discussed.The trial registration number in the ClinicalTrials.gov: NCT03413631
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Impact of a prenatal episode and diagnosis in women with serious mental illnesses on neonatal complications (prematurity, low birth weight, and hospitalization in neonatal intensive care units). Arch Womens Ment Health 2019; 22:439-446. [PMID: 30288610 DOI: 10.1007/s00737-018-0915-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/24/2018] [Indexed: 12/18/2022]
Abstract
Pregnancy in women with mental disorders is increasingly common. The aim of this study was to determine, in women with severe mental illnesses, whether a prenatal episode was related to neonatal complications and if a specific disorder was associated with a higher risk. A population of infants and their mothers (n = 1439) jointly admitted to psychiatric Mother-Baby Units in France and Belgium (2001-2010) was assessed respectively for prematurity, low birth weight (LBW), hospitalization in neonatal intensive care units (NICUs), and maternal mental health during pregnancy. Logistic regression was used to explore the association between neonatal complications and a prenatal episode of mental illness and if the presence of a specific disorder was related to a higher risk, taking into account maternal socio-demographic characteristics, pregnancy data, and antenatal exposure to psychotropic drugs. Among the children, 145 (10.2%) were premature, 226 (15.8%) had a LBW, and 348 (24.3%) have been hospitalized in neonatology. The presence of an episode of mental illness during pregnancy was linked to LBW (OR = 2.21 [1.44-3.38]; p = 0.003) and NICU hospitalizations (OR = 1.53 [1.06-2.19], p = 0.002). Among diagnoses, the presence of a severe substance use disorder in these women was related to LBW (OR = 2.96 [1.49-5.85]; p = 0.002) and NICU (OR = 2.88 [1.56-5.29]; p = 0.04). Our results underline the importance of systematic and early detection of psychiatric symptoms and substance use disorders during pregnancy in preventing neonatal complications in women with serious mental illness.
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Miller CB, Wright T. Investigating Mechanisms of Stillbirth in the Setting of Prenatal Substance Use. Acad Forensic Pathol 2018; 8:865-873. [PMID: 31240077 DOI: 10.1177/1925362118821471] [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: 09/02/2018] [Accepted: 10/22/2018] [Indexed: 01/03/2023]
Abstract
Introduction Intrauterine fetal demise affects between 0.4-0.8% of pregnancies worldwide. This significant adverse pregnancy outcome continues to be poorly understood. In utero exposure to substances increases the risk of stillbirth to varying degrees according to the type of substance and degree of exposure. The aim of this qualitative narrative review is to investigate common biologic relationships between stillbirth and maternal substance use. Methods A PubMed literature search was conducted to query the most commonly used substances and biologic mechanisms of stillbirth. Search terms included "stillbirth," "intrauterine fetal demise," "placenta," "cocaine," "tobacco," "alcohol," "methamphetamines," "opioids/ opiates," and "cannabis." Results There are very few studies identifying a direct link between substance use and stillbirth. Several studies demonstrate associations with placental lesions of insufficiency including poor invasion, vasoconstriction, and sequestration of toxic substances that inhibit nutrient transport. Restricted fetal growth is the most common finding in pregnancies complicated by all types of substance use. Discussion More research is needed to understand the biologic mechanisms of stillbirth. Such knowledge will be foundational to understanding how to prevent and treat the adverse effects of substances during pregnancy.
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