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Allen S, Dev A, Canavan C, Goodman D. Intersecting Substance Use Disorder and Unmet Social Needs in Rural Pregnant Women. J Obstet Gynecol Neonatal Nurs 2024; 53:485-490. [PMID: 38796173 DOI: 10.1016/j.jogn.2024.04.006] [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] [Received: 01/31/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVE To describe the unique challenges faced by rural pregnant women with intersecting substance use disorder (SUD) and unmet social needs. DESIGN Secondary qualitative data analysis with an analytic expansion approach. SETTING Hospital system in northern New England. PARTICIPANTS Four rural women with food insecurity who were in recovery for SUD (three were pregnant and one had given birth in the past 15 weeks). METHODS In the primary qualitative descriptive study, we interviewed 14 women about their experience of food insecurity during the perinatal period, including facilitators and barriers to being screened and accessing referrals for food insecurity and other social needs during prenatal care. This secondary analysis centered on the perspectives of four participants who reflected specifically on receiving material and mental health support through the integration of prenatal care and SUD treatment. RESULTS Rural women with SUD who experience social needs during pregnancy have difficulty accessing appropriate prenatal care and maintaining treatment engagement due to intersecting factors (e.g., food and housing insecurity and transportation) and psychological (e.g., mental health challenges, social isolation, and stigma) factors. Participants emphasized the importance of integrating social support within prenatal and substance use care to promote physical and mental health and engagement in SUD treatment. CONCLUSION In line with The Joint Commission's 2022 policy recommendations for universal social determinants of health screening, we support one-stop clinical and social care for pregnant women who face intersecting barriers to health, such as SUD and unmet social needs. Nurses can play an important role in care coordination for people with complex medical and social determinants of health screening needs. This approach is especially relevant to rural areas, where food, housing, and transportation insecurity rates are greater than nonrural areas.
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Pinchman EV, Lende MN, Feustel P, Lynch T. Evaluating the Association between Prenatal Care Visits and Adverse Perinatal Outcome in Pregnancies Complicated by Opioid Use Disorder. Am J Perinatol 2024; 41:e2225-e2229. [PMID: 37286184 DOI: 10.1055/a-2107-1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between number of prenatal care visits and adverse perinatal outcome among pregnant individuals with opioid use disorder (OUD). STUDY DESIGN This is a retrospective cohort of singleton, nonanomalous pregnancies complicated by OUD that delivered from January 2015 to July 2020 at our academic medical center. Primary outcome was the presence of composite adverse perinatal outcome, defined as one or more of the following: stillbirth, placental abruption, perinatal death, neonatal respiratory distress syndrome, need for morphine treatment, and hyperbilirubinemia. Logistic and linear regression estimated the association between the number of prenatal care visits and the presence of adverse perinatal outcome. A Mann-Whitney U test evaluated the association between number of prenatal care visits and length of hospital stay for the neonate. RESULTS A total of 185 patients were identified, of which 35 neonates required morphine treatment for neonatal opioid withdrawal syndrome. During pregnancy, most individuals were treated with buprenorphine 107 (57.8%), whereas 64 (34.6%) received methadone, 13 (7.0%) received no treatment, and 1 (0.5%) received naltrexone. The median number of prenatal care visits was 8 (interquartile range: 4-10). With each additional visit per 10 weeks of gestational age, the risk of adverse perinatal outcome decreased by 38% (95% confidence interval [CI]: 0.451-0.854). The need for neonatal intensive care and hyperbilirubinemia also significantly decreased with additional prenatal visits. Neonatal hospital stay decreased by a median of 2 days (95% CI: 1-4) for individuals who received more than the median of eight prenatal care visits. CONCLUSION Pregnant individuals with OUD who attend fewer prenatal care visits experience more adverse perinatal outcome. Future research should focus on barriers to prenatal care and interventions to improve access in this high-risk population. KEY POINTS · Use of prenatal care affects newborn outcomes.. · More prenatal care shortens neonatal hospital stay.. · Prenatal care reduces certain adverse outcomes..
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Affiliation(s)
| | - Michelle N Lende
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | - Paul Feustel
- Department of Neuroscience, Albany Medical College, Albany, New York
| | - Tara Lynch
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
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Xu H, Kang Y, Liang T, Lu S, Xia X, Lu Z, Hu L, Guo L, Zhang L, Huang J, Ye L, Jiang P, Liu Y, Xinyi L, Zhai J, Wang Z, Liu Y. SNP-based and haplotype-based genome-wide association on drug dependence in Han Chinese. BMC Genomics 2024; 25:255. [PMID: 38448893 PMCID: PMC10919046 DOI: 10.1186/s12864-024-10117-4] [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] [Received: 10/30/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Drug addiction is a serious problem worldwide and is influenced by genetic factors. The present study aimed to investigate the association between genetics and drug addiction among Han Chinese. METHODS A total of 1000 Chinese users of illicit drugs and 9693 healthy controls were enrolled and underwent single nucleotide polymorphism (SNP)-based and haplotype-based association analyses via whole-genome genotyping. RESULTS Both single-SNP and haplotype tests revealed associations between illicit drug use and several immune-related genes in the major histocompatibility complex (MHC) region (SNP association: log10BF = 15.135, p = 1.054e-18; haplotype association: log10BF = 20.925, p = 2.065e-24). These genes may affect the risk of drug addiction via modulation of the neuroimmune system. The single-SNP test exclusively reported genome-wide significant associations between rs3782886 (SNP association: log10BF = 8.726, p = 4.842e-11) in BRAP and rs671 (SNP association: log10BF = 7.406, p = 9.333e-10) in ALDH2 and drug addiction. The haplotype test exclusively reported a genome-wide significant association (haplotype association: log10BF = 7.607, p = 3.342e-11) between a region with allelic heterogeneity on chromosome 22 and drug addiction, which may be involved in the pathway of vitamin B12 transport and metabolism, indicating a causal link between lower vitamin B12 levels and methamphetamine addiction. CONCLUSIONS These findings provide new insights into risk-modeling and the prevention and treatment of methamphetamine and heroin dependence, which may further contribute to potential novel therapeutic approaches.
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Affiliation(s)
- Hanli Xu
- College of Life Sciences and Bioengineering, School of Science, Beijing Jiaotong University, Beijing, 100028, China
| | - Yulin Kang
- Chinese Research Academy of Environmental Sciences, Beijing, 100012, China.
| | - Tingming Liang
- Jiangsu Key Laboratory for Molecular and Medical Biotechnology, School of Life Science, Nanjing Normal University, Nanjing, 210023, China
| | - Sifen Lu
- Precision Medicine Key Laboratory of Sichuan Province and Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaolin Xia
- Office of Academic Affairs, The National Police University for Criminal Justice, Baoding, 071000, China
| | - Zuhong Lu
- School of Biological Science & Medical Engineering, Southeast University, Nanjing, 211189, China
| | - Lingming Hu
- Chinese Research Academy of Environmental Sciences, Beijing, 100012, China
| | - Li Guo
- School of Geographic and Biologic Information, Nanjing University of Posts and Telecommunications, Nanjing, 210003, China
| | - Lishu Zhang
- College of Life Sciences and Bioengineering, School of Science, Beijing Jiaotong University, Beijing, 100028, China
| | - Jiaqiang Huang
- College of Life Sciences and Bioengineering, School of Science, Beijing Jiaotong University, Beijing, 100028, China
| | - Lin Ye
- Cheung Hong School of Journalism and Communication, Shantou University, Shantou, 515060, China
| | - Peiye Jiang
- Office of International Cooperation and Exchanges, Nanjing University, Nanjing, 210023, China
| | - Yi Liu
- Jiangsu Taihu Institute of Addiction Rehabilitation, Suzhou, 215111, China
| | - Li Xinyi
- College of Life Sciences and Bioengineering, School of Science, Beijing Jiaotong University, Beijing, 100028, China
| | - Jin Zhai
- Department of Social Work, Changzhou University, Changzhou, 213164, China
| | - Zi Wang
- School of Music, Nanjing Normal University, Nanjing, 210097, China
| | - Yangyang Liu
- Department of Psychology, Nanjing University, Nanjing, 210023, China.
- School of Education, Tianjin University, Tianjin, 200350, China.
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Myers AM, Bowen SE, Brummelte S. Maternal care behavior and physiology moderate offspring outcomes following gestational exposure to opioids. Dev Psychobiol 2023; 65:e22433. [PMID: 38010303 DOI: 10.1002/dev.22433] [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] [Received: 05/10/2023] [Revised: 08/31/2023] [Accepted: 09/29/2023] [Indexed: 11/29/2023]
Abstract
The opioid epidemic has resulted in a drastic increase in gestational exposure to opioids. Opioid-dependent pregnant women are typically prescribed medications for opioid use disorders ("MOUD"; e.g., buprenorphine [BUP]) to mitigate the harmful effects of abused opioids. However, the consequences of exposure to synthetic opioids, particularly BUP, during gestation on fetal neurodevelopment and long-term outcomes are poorly understood. Further, despite the known adverse effects of opioids on maternal care, many preclinical and clinical studies investigating the effects of gestational opioid exposure on offspring outcomes fail to report on maternal care behaviors. Considering that offspring outcomes are heavily dependent upon the quality of maternal care, it is important to evaluate the effects of gestational opioid exposure in the context of the mother-infant dyad. This review compares offspring outcomes after prenatal opioid exposure and after reduced maternal care and integrates this information to potentially identify common underlying mechanisms. We explore whether adverse outcomes after gestational BUP exposure are due to direct effects of opioids in utero, deficits in maternal care, or a combination of both factors. Finally, suggestions for improving preclinical models of prenatal opioid exposure are provided to promote more translational studies that can help to improve clinical outcomes for opioid-dependent mothers.
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Affiliation(s)
- Abigail M Myers
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Scott E Bowen
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA
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Townsel C, Irani S, Buis C, Lasser S, Menke N, Preston Y, Kountanis JA, Skoczylas M, Menke R, Getty B, Stout M, Muzik M. Partnering for the future clinic: A multidisciplinary perinatal substance use program. Gen Hosp Psychiatry 2023; 85:220-228. [PMID: 37992465 DOI: 10.1016/j.genhosppsych.2023.10.009] [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: 01/17/2023] [Revised: 05/29/2023] [Accepted: 10/13/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE The current model of obstetric care does not integrate multiple subspecialty services for high-risk pregnancies with substance use disorder (SUD), resulting in fragmented care. We describe the framework of our multidisciplinary and integrated perinatal substance use clinic and provide recent clinical outcomes. METHODS We detail the Partnering for the Future (PFF) clinic, which integrates numerous subspecialty and support services for patients with SUDs and complex mental health needs. Additionally, a retrospective chart review of patients receiving care in the PFF clinic from 2017 to 2021 was completed. RESULTS Seven integrated services are detailed with a focus on reducing stigma, providing trauma-informed care and mitigating harm. During the study period, 182 patients received care in PFF clinic, with opioid use disorder the most common indication for care. Co-occurring mental illness was common (81%). NICU admissions and severe NOWS diagnosis declined after the implementation of Eat-Sleep-Console. Social services identified care coordination, transportation assistance and adjustment counseling as the most common needs. A novel virtual behavioral health consultation service was successfully launched. CONCLUSIONS Our integrated care model supports the holistic care of pregnant people with SUD and mental health disease. Patient-centered care and co-located services have improved perinatal outcomes, particularly for opioid-exposed pregnancies.
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Affiliation(s)
- Courtney Townsel
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Sanaya Irani
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; University of Michigan Medical School, United States of America
| | - Carol Buis
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Sheryl Lasser
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Nathan Menke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Yolanda Preston
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Joanna A Kountanis
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Maria Skoczylas
- University of Michigan Medical School, United States of America; Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - Rena Menke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Barbara Getty
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Molly Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Maria Muzik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America.
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Smith BL. Improving translational relevance: The need for combined exposure models for studying prenatal adversity. Brain Behav Immun Health 2021; 16:100294. [PMID: 34589787 PMCID: PMC8474200 DOI: 10.1016/j.bbih.2021.100294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Prenatal environmental adversity is a risk factor for neurodevelopmental disorders (NDDs), with the neuroimmune environment proposed to play a role in this risk. Adverse maternal exposures are associated with cognitive consequences in the offspring that are characteristics of NDDs and simultaneous neuroimmune changes that may underlie NDD risk. In both animal models and human studies the association between prenatal environmental exposure and NDD risk has been shown to be complex. Maternal overnutrition/obesity and opioid use are two different examples of complex exposure epidemics, each with their own unique comorbidities. This review will examine maternal obesity and maternal opioid use separately, illustrating the pervasive comorbidities with each exposure to argue a need for animal models of compound prenatal exposures. Many of these comorbidities can impact neuroimmune function, warranting systematic investigation of combined exposures to begin to understand this complexity. While traditional approaches in animal models have focused on modeling a single prenatal exposure or second exposure later in life, a translational approach would begin to incorporate the most prevalent co-occurring prenatal exposures. Long term follow-up in humans is extremely challenging, so animal models can provide timely insight into neurodevelopmental consequences of complex prenatal exposures. Animal models that represent this translational context of comorbid exposures behind maternal obesity or comorbid exposures behind maternal opioid use may reveal potential synergistic neuroimmune interactions that contribute to cognitive consequences and NDD risk. Finally, translational co-exposure models can identify concerning exposure combinations to guide treatment in complex cases, and identify high risk children starting in the prenatal period where early interventions improve prognosis.
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Affiliation(s)
- Brittany L. Smith
- Department of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati, OH, USA
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