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Chapman M, Bandoli G, Goldenberg SM. The association between depression and alcohol use among pregnant adults in the USA. Arch Womens Ment Health 2024; 27:425-433. [PMID: 38195994 PMCID: PMC11116222 DOI: 10.1007/s00737-023-01417-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The prevalence of alcohol use among pregnant women aged 18-44 years old increased in recent years. The influence of mental health issues on an individual's likelihood to use alcohol during pregnancy has not been thoroughly investigated. This study will examine the association between experiencing a major depressive episode (MDE) in the past year and past-month alcohol use among pregnant women using the 2011-2020 National Survey on Drug Use and Health (NSDUH). METHODS Pregnant women between the ages of 18 and 44 years old were included in the study for analysis. Multivariable logistic regression analysis was used to examine the association between past-year MDE and past-month alcohol use adjusting for age, race/ethnicity, marital status, and employment status. Additional logistic regression analysis was performed to investigate whether this relationship differed by trimester of pregnancy. RESULTS A total of 6745 participants were included in the analytic sample. The prevalence of past-year MDE and past-month alcohol use was 7.67% and 9.15% respectively. Logistic regression analysis showed past-year MDE was significantly associated with past-month alcohol use in pregnant women adjusting for age, race/ethnicity, marital status, and employment status (aOR = 1.96; 95% CI, 1.34-2.87). This relationship became stronger in second and third trimesters of pregnancy. CONCLUSIONS This study showed a positive association between MDE and past-month alcohol use among pregnant women, with strongest effect estimates in the third trimester. These findings may inform approaches for improved screening guidelines and health education for individuals who may be at higher risk of prenatal alcohol use.
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Affiliation(s)
- Madison Chapman
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA.
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA
| | - Shira M Goldenberg
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, USA
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Li Z, Tucker CM, Odahowski CL, Eichelberger KY, Zhang J, Hung P. Co-occurrence of mental illness and substance use among US pregnant individuals, 2012-2021. Psychiatry Res 2024; 334:115820. [PMID: 38422868 DOI: 10.1016/j.psychres.2024.115820] [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: 11/01/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
AIM Substance use disorders are increasingly prevalent among pregnant individuals, with evident risks of adverse perinatal outcomes. This study examines substance use (tobacco, alcohol and marijuana) among pregnant individuals with mental illness. METHODS A national representative sample of pregnant individuals were derived from 2012 to 2021 National Survey of Drug Use and Health data. Associations of past-year mental illness with past-month polysubstance use and each substance use were analyzed by logistic regression models, with complex sampling weights and survey year. RESULTS Among 6801 pregnant individuals, 16.4% reported having any mental illness (AMI) in 2012 and 2013, increasing to 23.8% in 2020-2021; and SMI increased from 3.3% to 9.4%. Polysubstance use increased disproportionately among those with severe mental illness (SMI), from 14.0% to 18.6%. Pregnant individuals with greater severity of mental illness had higher odds of polysubstance use (Adjusted Odds Ratio, 95% CI: AMI but no SMI vs. without AMI: 1.59 [1.04, 2.44]; SMI vs. without AMI: 5.48 [2.77, 10.82]). CONCLUSIONS Pregnant individuals with greater severity of mental illness were more likely to engage in substance use. Evidence-based educational, screening and treatment services, and public policy changes are warranted to mitigate the harmful health outcomes of substance use among US pregnant individuals with mental illness.
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Affiliation(s)
- Zhong Li
- Department of Public Administration, School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Curisa M Tucker
- Department of Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Cassie L Odahowski
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kacey Y Eichelberger
- Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville, Prisma Health, Greenville, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
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Maxwell JR, DiDomenico J, Roberts MH, Marquez LE, Rai R, Weinberg J, Jacobson SW, Stephen J, Bakhireva LN. Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation. Pediatr Res 2024; 95:350-358. [PMID: 37674025 PMCID: PMC11089775 DOI: 10.1038/s41390-023-02799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) impacts the neurodevelopment of the fetus, including the infant's ability to self-regulate. Heart rate variability (HRV), that is, the beat-to-beat variability in heart rate, is a non-invasive measurement that can indicate autonomic nervous system (ANS) function/dysfunction. METHODS The study consisted of a subset of our ENRICH-2 cohort: 80 participants (32 PAE and 48 Controls) who had completed three visits during pregnancy. The participants completed a comprehensive assessment of PAE and other substances throughout pregnancy and assessments for stress, anxiety, and depression in the third trimester. At 24 h of age, infant HRV was assessed in the hospital during the clinically indicated heel lance; 3- to 5-min HRV epochs were obtained during baseline, heel lancing, and recovery episodes. RESULTS Parameters of HRV differed in infants with PAE compared to Controls during the recovery phase of the heel lance (respiratory sinus arrhythmia (RSA) and high-frequency (HF), p < 0.05). Increased maternal stress was also strongly associated with abnormalities in RSA, HF, and low-frequency / high-frequency (LF/HF, p's < 0.05). CONCLUSIONS Alterations in ANS regulation associated with PAE and maternal stress may reflect abnormal development of the hypothalamic-pituitary-adrenal axis and have long term implications for infant responsiveness and self-regulation. IMPACT Previous studies have focused on effects of moderate to heavy prenatal alcohol exposure (PAE) on autonomic dysregulation, but little is known about the effects of lower levels of PAE on infant self-regulation and heart rate variability (HRV). Prenatal stress is another risk factor for autonomic dysregulation. Mild PAE impacts infant self-regulation, which can be assessed using HRV. However, the effect of prenatal stress is stronger than that of mild PAE or other mental health variables on autonomic dysregulation.
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Affiliation(s)
- Jessie R Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, Mexico.
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, Mexico.
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Lidia Enriquez Marquez
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Rajani Rai
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julia Stephen
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, University of New Mexico, Albuquerque, NM, Mexico
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
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De Genna NM, Coulter RWS, Goldschmidt L, Boss N, Hossain F, Richardson GA. Prenatal Substance Use Among Young Pregnant Sexual Minority People. LGBT Health 2024; 11:74-79. [PMID: 37410511 DOI: 10.1089/lgbt.2023.0026] [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: 07/07/2023] Open
Abstract
Purpose: Sexual minority (SM) youth have higher rates of substance use and pregnancy but are absent from the prenatal substance use literature. We modeled the impact of SM identity and syndemic factors on prenatal substance use among 14- to 21-year-olds. Methods: Pregnant people completed an online survey (n = 357). Prenatal substance use was regressed on SM identity, controlling for other syndemic factors (e.g., depressive symptoms, intimate partner violence) and household substance use. Results: Pregnant SM participants (n = 125) were primarily bisexual and were more likely to use tobacco and illicit drugs than heterosexual participants (n = 232). The association between SM identity and prenatal tobacco use was not attenuated by syndemic factors, prenatal cannabis use, or household tobacco use. Conclusion: SM people need increased support for smoking cessation to redress health inequities in tobacco use, prevent prenatal exposures to tobacco, and limit the long-term consequences of tobacco use on health.
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Affiliation(s)
- Natacha M De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Robert W S Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Nicole Boss
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Fahmida Hossain
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gale A Richardson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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Akbarali S, Dronamraju R, Simon J, Echols A, Collins S, Kaeberle B, Chaudhry A. Promoting Innovation in State and Territorial Maternal and Child Health Policymaking. Matern Child Health J 2023; 27:5-13. [PMID: 37792151 PMCID: PMC10692248 DOI: 10.1007/s10995-023-03779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION The Association of Maternal & Child Health Programs (AMCHP) and the Association of State and Territorial Health Officials (ASTHO) launched the PRISM (Promoting Innovation in State and Territorial MCH Policymaking) Learning Community, funded by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). The goal of PRISM was to build state and territorial health agency program and policy-making capacity to address substance use and mental health in the maternal and child health (MCH) population. Expanding access to care and treatment for perinatal substance use disorders (SUD) emerged as the issue of greatest need for state teams. METHODS The PRISM Learning Community consisted of three major components: (1) intensive capacity building for cross-agency state teams, which involved action planning, peer-to-peer learning, and technical assistance; (2) programming to inform the MCH field broadly about innovations in perinatal SUD policy and practice; and (3) a program evaluation involving pre-, mid-, and post-assessments and follow-up key informant interviews with state teams. This manuscript is not based on clinical study or patient data, therefore IRB approval was not required. RESULTS States reported that their knowledge of perinatal SUDs increased and their cross-agency partnerships were strengthened as a result of their participation in PRISM. States identified four key priorities for their continued work: to improve multisector collaborations, to institute equitable SUD screening practices for pregnant people, to strengthen the perinatal behavioral health workforce, and to enhance Medicaid coverage for perinatal SUD prevention and treatment services. The need to respond to urgent demands of COVID-19 and the stigma associated with perinatal SUDs were the most significant barriers to advancing state action plan goals. DISCUSSION Since 2018, the PRISM project has supported nine jurisdictions across two cohorts. Participation in PRISM advanced state policies and programs to improve perinatal SUD care through capacity building, technical assistance, and virtual programming. Findings and lessons learned from PRISM may inform the activities of other states seeking to address perinatal substance use disorders.
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Affiliation(s)
- Sanaa Akbarali
- Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA, 22202, USA.
| | - Ramya Dronamraju
- Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA, 22202, USA
| | - Jessica Simon
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, D.C, 20006, USA
| | - Amani Echols
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, D.C, 20006, USA
| | - Stacy Collins
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, D.C, 20006, USA
| | - Betsy Kaeberle
- Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA, 22202, USA
| | - Atyya Chaudhry
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, D.C, 20006, USA
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Perinatal Psychoactive Substances Use: A Rising Perinatal Mental Health Concern. J Clin Med 2023; 12:jcm12062175. [PMID: 36983176 PMCID: PMC10056692 DOI: 10.3390/jcm12062175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction: A significant increase in psychoactive drugs use was observed in women of childbearing age and during the perinatal period worldwide. Yet, the use of illicit drugs, alcohol and tobacco during pregnancy is a serious health risk for the mother, developing fetus and newborn. Methods: This review of current trends and consequences of psychoactive substance use in the general population and in pregnant women was conducted using the English and French literature published during the years 2000 to 2022, supplemented by guidelines, meta-analyses and reviews. Results: According to current rates of prenatal substances use, it was calculated that 380,000 offspring were exposed to illicit substances, more than 500,000 to alcohol and over one million to tobacco during uterine life. Alarmingly, drug-related pregnancy-associated mortality has shown a staggering 190% rise between 2010 and 2019 in the USA. Different drugs of abuse, when used during pregnancy, increase the risk of stillbirth, neonatal abstinence syndrome and sudden infant death. Adverse effects on pregnancy include premature rupture of membranes, placental abruption, preterm birth, low birth space? weight and small-for-gestational-age infants. There is also an increased risk of morbidity and mortality for the pregnant women. Long-term negative adverse effects of perinatal exposure to substances also include a number of neurocognitive, behavioral and emotional dysfunctions in infants. Each type of substance has its own specificities, which will be briefly summarized. Conclusion: All childbearing age women must be informed about the potential harm of the prenatal use of psychoactive substances and should be encouraged to stop their use when pregnancy is planned and, at least, when pregnancy is known. Questioning women about their alcohol consumption should be systematic at the first prenatal visit and then at every prenatal visit until delivery. Multidisciplinary prevention approaches as well as intervention measures targeted to each type of psychoactive substance can save mothers’ lives and mitigate serious adversities to the offspring.
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Tran EL, England LJ, Park Y, Denny CH, Kim SY. Systematic Review: Polysubstance Prevalence Estimates Reported during Pregnancy, US, 2009-2020. Matern Child Health J 2023; 27:426-458. [PMID: 36752906 PMCID: PMC10521102 DOI: 10.1007/s10995-023-03592-w] [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] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The objective of this systematic review is to describe polysubstance studies and their prevalence estimates among pregnant people in the US. METHODS This review was not subject to protocol preparation or registration with the International Prospective Register of Systematic Reviews (PROSPERO) because outcome data were not reported. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist was followed. Four scientific literature databases were used to identify articles published from January 1, 2009 to June 3, 2020 reporting prenatal exposure to two or more substances in the US. A standardized process of title and abstract screening followed by a two-phase full-text review was used to assess study eligibility. RESULTS A total of 119 studies were included: 7 case-control studies, 7 clinical trials, 76 cohort studies, and 29 cross-sectional studies. Studies varied with respect to study design, time period, region, sampling and participant selection, substances assessed, and method of exposure ascertainment. Commonly reported polysubstance prevalence estimates among studies of pregnant people included combinations with alcohol, marijuana, and/or tobacco/nicotine. The range of prevalence estimates was wide (alcohol 1-99%; marijuana 3-95%; tobacco/nicotine 2-95%). DISCUSSION Polysubstance use during pregnancy is common, especially with alcohol, marijuana, and/or tobacco/nicotine. Future research to assess polysubstance use during pregnancy could help better describe patterns and ultimately help mitigate its effects on maternal and infant health outcomes.
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Affiliation(s)
- Emmy L Tran
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA.
- Eagle Global Scientific, LLC, 2835 Brandywine Rd, Suite 200, Atlanta, GA, 30341, USA.
| | - Lucinda J England
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Youngjoo Park
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - 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, NE MS S106-3, Atlanta, GA, 30341, USA
| | - 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, NE MS S106-3, Atlanta, GA, 30341, USA
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Marshall AT, Bodison SC, Uban KA, Adise S, Jonker D, Charles W, Donald KA, Kan E, Ipser JC, Butler-Kruger L, Steigelmann B, Narr KL, Joshi SH, Brink LT, Odendaal HJ, Scheffler F, Stein DJ, Sowell ER. The impact of prenatal alcohol and/or tobacco exposure on brain structure in a large sample of children from a South African birth cohort. Alcohol Clin Exp Res 2022; 46:1980-1992. [PMID: 36117382 PMCID: PMC11334753 DOI: 10.1111/acer.14945] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Neuroimaging studies have emphasized the impact of prenatal alcohol exposure (PAE) on brain development, traditionally in heavily exposed participants. However, less is known about how naturally occurring community patterns of PAE (including light to moderate exposure) affect brain development, particularly in consideration of commonly occurring concurrent impacts of prenatal tobacco exposure (PTE). METHODS Three hundred thirty-two children (ages 8 to 12) living in South Africa's Cape Flats townships underwent structural magnetic resonance imaging. During pregnancy, their mothers reported alcohol and tobacco use, which was used to evaluate PAE and PTE effects on their children's brain structure. Analyses involved the main effects of PAE and PTE (and their interaction) and the effects of PAE and PTE quantity on cortical thickness, surface area, and volume. RESULTS After false-discovery rate (FDR) correction, PAE was associated with thinner left parahippocampal cortices, while PTE was associated with smaller cortical surface area in the bilateral pericalcarine, left lateral orbitofrontal, right posterior cingulate, right rostral anterior cingulate, left caudal middle frontal, and right caudal anterior cingulate gyri. There were no PAE × PTE interactions nor any associations of PAE and PTE exposure on volumetrics that survived FDR correction. CONCLUSION PAE was associated with reduction in the structure of the medial temporal lobe, a brain region critical for learning and memory. PTE had stronger and broader associations, including with regions associated with executive function, reward processing, and emotional regulation, potentially reflecting continued postnatal exposure to tobacco (i.e., second-hand smoke exposure). These differential effects are discussed with respect to reduced PAE quantity in our exposed group versus prior studies within this geographical location, the deep poverty in which participants live, and the consequences of apartheid and racially and economically driven payment practices that contributed to heavy drinking in the region. Longer-term follow-up is needed to determine potential environmental and other moderators of the brain findings here and assess the extent to which they endure over time.
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Affiliation(s)
- Andrew T. Marshall
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Stefanie C. Bodison
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Kristina A. Uban
- Department of Public Health, University of California, Irvine, CA, United States
| | - Shana Adise
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Deborah Jonker
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Weslin Charles
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kirsten A. Donald
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Eric Kan
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Jonathan C. Ipser
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Letitia Butler-Kruger
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Katherine L. Narr
- UCLA Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Shantanu H. Joshi
- UCLA Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles
- Department of Bioengineering, University of California, Los Angeles
| | - Lucy T. Brink
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Freda Scheffler
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC), Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Elizabeth R. Sowell
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
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Peltier MR, Roberts W, Verplaetse TL, Burke C, Zakiniaeiz Y, Moore K, McKee SA. Licit and illicit drug use across trimesters in pregnant women endorsing past-year substance use: Results from National Survey on Drug Use and Health (2009-2019). Arch Womens Ment Health 2022; 25:819-827. [PMID: 35737132 PMCID: PMC9359119 DOI: 10.1007/s00737-022-01244-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Given the health consequences, perinatal substance use is a significant public health concern, especially as substance use rates increase among women; ongoing data regarding the rates of substance use across trimesters of pregnancy is needed. METHODS The present study utilized cross-sectional population-based data from the National Survey of Drug Use and Health (NSDUH) between 2009 and 2019. We aimed to explore both licit and illicit substance use assessed within each trimester among women endorsing past-year substance use. The NSDUH sample included 8,530 pregnant women. RESULTS Perinatal substance use was less prevalent among women in later trimesters; however, past-month substance use was observed for all substances across trimesters. The prevalence of past-month licit substance use among pregnant women ranged from 5.77 to 22.50% and past-month illicit substance use ranged from 4.67 to 14.81%. In the second trimester, lower odds of past-month substance use were observed across tobacco, alcohol, and marijuana (odds ratios [ORs] ranging from 0.29 to 0.47), when compared to the first trimester. A similar lower rate of past-month substance use was observed in the third trimester compared to the first trimester, across tobacco, alcohol, and marijuana use, as well as cocaine, prescription pain medication, and tranquilizer use (ORs ranging from 0.02 to 0.42). The likelihood of polysubstance use was lower among women in the second and third trimesters compared to the first trimester (ORs ranging from 0.09 to 0.46). CONCLUSION Findings indicate that a minority of women continue to use substances across all trimesters. This is especially true among women using licit substances and marijuana. These results highlight the need for improved interventions and improved access to treatment for these women.
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Affiliation(s)
- MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA.
- Psychology Section, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Terril L Verplaetse
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Kelly Moore
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
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Associations of education and work status with alcohol use and cessation among pregnant women in Japan: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. BMC Public Health 2021; 21:1400. [PMID: 34266393 PMCID: PMC8281686 DOI: 10.1186/s12889-021-11461-w] [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: 07/06/2020] [Accepted: 07/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background There is inconsistent evidence on the associations of education and work status with alcohol use during pregnancy. Our aim was to examine the associations of education and work status with alcohol use and alcohol cessation during pregnancy in Japan. Methods Data were analyzed from 11,839 pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study from 2013 to 2017 in Japan. Women were dichotomized as current drinkers or non-drinkers in both early and middle pregnancy. Alcohol cessation was defined as alcohol use in early pregnancy, but not in middle pregnancy. Multivariable log-binomial regression analyses were conducted to examine associations of education and work status with alcohol use in early and middle pregnancy and alcohol cessation, adjusted for age and income. The prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated by work status and education. Results The prevalence of alcohol use in early and middle pregnancy was 20.9 and 6.4%, respectively. Higher education was associated with alcohol use in early pregnancy both among working and non-working women; the PRs of university education or higher compared with high school education or lower were 1.62 (95% CI, 1.34–1.96) and 1.29 (95% CI, 1.16–1.45), respectively. Higher education was associated with alcohol cessation during pregnancy among working women; the corresponding PR was 1.09 (95% CI, 1.01–1.17). Working was associated with alcohol use in early and middle pregnancy. Working was associated with a decreased probability of alcohol cessation among women with lower education but with an increased probability of alcohol cessation among women with higher education; the PRs of working compared with not working were 0.91 (95% CI, 0.82–1.00) and 1.10 (95% CI, 1.00–1.20), respectively. Conclusions Women with higher education were more likely to consume alcohol in early pregnancy and to cease alcohol use between early and middle pregnancy, especially working women. Working women were more likely to consume alcohol throughout pregnancy. Working women with lower education were less likely to cease alcohol use, whereas working women with higher education were more likely to cease alcohol use between early and middle pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11461-w.
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Sarieva K, Mayer S. The Effects of Environmental Adversities on Human Neocortical Neurogenesis Modeled in Brain Organoids. Front Mol Biosci 2021; 8:686410. [PMID: 34250020 PMCID: PMC8264783 DOI: 10.3389/fmolb.2021.686410] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
Over the past decades, a growing body of evidence has demonstrated the impact of prenatal environmental adversity on the development of the human embryonic and fetal brain. Prenatal environmental adversity includes infectious agents, medication, and substances of use as well as inherently maternal factors, such as diabetes and stress. These adversities may cause long-lasting effects if occurring in sensitive time windows and, therefore, have high clinical relevance. However, our knowledge of their influence on specific cellular and molecular processes of in utero brain development remains scarce. This gap of knowledge can be partially explained by the restricted experimental access to the human embryonic and fetal brain and limited recapitulation of human-specific neurodevelopmental events in model organisms. In the past years, novel 3D human stem cell-based in vitro modeling systems, so-called brain organoids, have proven their applicability for modeling early events of human brain development in health and disease. Since their emergence, brain organoids have been successfully employed to study molecular mechanisms of Zika and Herpes simplex virus-associated microcephaly, as well as more subtle events happening upon maternal alcohol and nicotine consumption. These studies converge on pathological mechanisms targeting neural stem cells. In this review, we discuss how brain organoids have recently revealed commonalities and differences in the effects of environmental adversities on human neurogenesis. We highlight both the breakthroughs in understanding the molecular consequences of environmental exposures achieved using organoids as well as the on-going challenges in the field related to variability in protocols and a lack of benchmarking, which make cross-study comparisons difficult.
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Affiliation(s)
- Kseniia Sarieva
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- International Max Planck Research School, Graduate Training Centre of Neuroscience, University of Tübingen, Tübingen, Germany
| | - Simone Mayer
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Salas-Wright CP, Goings TC, Vaughn MG, Cohen M, Andrade P, Pérez Gómez A, Duque M, Mejía Trujillo J, Maldonado-Molina MM, Schwartz SJ. Health risk behavior and cultural stress among Venezuelan youth: a person centered approach. Soc Psychiatry Psychiatr Epidemiol 2021; 56:219-228. [PMID: 32577793 PMCID: PMC7755753 DOI: 10.1007/s00127-020-01905-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In recent years, more than 5 million Venezuelans have left their once prosperous country, with several hundred thousand settling in the United States (US). At present, our understanding of the health risk behavior profiles of Venezuelan émigré youth, and their links with cultural stress, remains limited. OBJECTIVES Drawing from a sample of recently-immigrated Venezuelan youth in the US, we aim to identify subtypes of youth according to their involvement in health risk behaviors (i.e., substance use, sexual risk behavior, violence) and assess the associations between class membership and key constructs related to cultural stress theory (i.e., negative context of reception, family communication/support). METHOD Latent profile analysis and multinomial regression were performed using data from a community-based convenience sample of 402 recently-arrived Venezuelan immigrant youth (ages 10-17; 56% male). RESULTS We identified five subtype classes: (1) "Abstainer" (36%), (2) "Alcohol Only" (24%), (3) "Alcohol/Tobacco" (24%), (4) "Aggression" (8%), and (5) "Multidimensional Risk" (8%). Compared to Class #1, youth in Classes #3 and #5 reported significantly higher levels of negative context of reception and lower levels of family functioning while controlling for demographic factors. Youth in Class #5 reported the lowest levels of family economic hardship and the longest duration in the US. CONCLUSION It is vital that we support both Venezuelan youth who abstain from risk behavior and, at the same time, develop and implement programs that target the needs of those who are at elevated risk for serious consequences related to substance use, sexual risk behavior, and violence.
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Affiliation(s)
| | - Trenette C Goings
- School of Social Work, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Mariana Cohen
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, USA
| | | | | | - Maria Duque
- Harvard University Extension School, Cambridge, MA, USA
| | | | | | - Seth J Schwartz
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Maslowsky J, Stritzel H, Al-Hamoodah L, Hendrick CE, Powers D, Barrientos-Gutierrez T, Santelli J. Health Behaviors and Prenatal Health Conditions in Repeat Vs First-time Teenage Mothers in the United States: 2015-2018. J Pediatr Adolesc Gynecol 2021; 34:47-53. [PMID: 32781232 PMCID: PMC7855354 DOI: 10.1016/j.jpag.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVE Repeat teenage mothers, those who give birth to a second or higher-order infant before age 20 years, are at elevated risk for adverse perinatal outcomes compared with first-time teenage mothers. The objective of the current study was to compare the prevalence of negative pregnancy-related behaviors and gestational health conditions in the national United States population of first-time and repeat teenage mothers. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective, population-based cohort study using annual US birth data files from 2015 to 2018, N = 799,756 (673,394 [84.2%] first, 126,362 [15.8%] repeat) births to women ages 15-19 years. INTERVENTIONS None. MAIN OUTCOME MEASURES Pregnancy-related behaviors (including adequacy of prenatal care and weight gain, sexually transmitted infection, smoking, and breastfeeding) and gestational health conditions (gestational hypertension and gestational diabetes). RESULTS Repeat (vs first-time) mothers had higher prevalence of negative pregnancy-related behaviors: inadequate prenatal care, smoking, inadequate weight gain, and sexually transmitted infection during pregnancy; they were also less likely to breastfeed. Conversely, repeat teenage mothers experienced lower prevalence of gestational hypertension and gestational diabetes. CONCLUSION Repeat teenage mothers experienced lower prevalence of physical health complications during pregnancy but engaged in more negative pregnancy-related health behaviors. Negative health behavior in pregnancy can lead directly to poor perinatal outcomes for infants. To prevent adverse outcomes from repeat teenage childbearing, we must ensure access to quality, timely, prenatal and postpartum care so teenage mothers can receive support for healthy pregnancy-related behaviors as well as linkage to highly effective contraception to prevent unintended repeat births.
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Tebeka S, De Premorel Higgons A, Dubertret C, Le Strat Y. Changes in alcohol use and heavy episodic drinking in U.S. Women of childbearing-age and peripartum between 2001-2002 and 2012-2013. Addict Behav 2020; 107:106389. [PMID: 32244086 DOI: 10.1016/j.addbeh.2020.106389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/07/2020] [Accepted: 03/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Heavy episodic drinking (HED) is a frequent pattern of alcohol use in women of childbearing age with severe consequences for both women and child, making it a major public health issue. Some states in the US have reported laws that target the use of alcohol during pregnancy. Our aim was to examine the evolution of 12-month alcohol use and 12-month HED prevalence in childbearing age, pregnant and postpartum women between 2001 and 2002 and 2012-2013. METHODS Our data were drawn from the National Epidemiologic Study of Alcohol and Related Conditions (NESARC) conducted in 2001-2002 and NESARC-III conducted in 2012-2013, two independent, representative samples of U.S. POPULATION Past-year alcohol use and HED was evaluated according face-to-face interview for all participants. RESULTS Our sample consisted of 24,536 women of childbearing age, including 2846 pregnant and postpartum women. Prevalence of 12-month alcohol use increased from 2001 to 2002 to 2012-2013, in both childbearing-aged women (66.14% to 75.48%; aOR = 1.62, 95%CI = 1.46-1.80) and pregnant and postpartum women (57.81% to 66.19%; aOR = 1.56, 95%CI = 1.25-1.94). Prevalence of 12-month HED increased from 2001 to 2002 to 2012-2013, in both childbearing-aged women (22.57% to 36.34%; aOR = 1.97, 95%CI = 1.79-2.16) and pregnant and postpartum women (17.85% to 28.21%; aOR = 1.84, 95%CI = 1.47-2.30). CONCLUSIONS Alcohol use and HED increased in last 10 years in both childbearing age and pregnant and postpartum US women. That questions the impact of implemented laws, policies and alcohol guidelines in this population within the last 10 years.
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Affiliation(s)
- Sarah Tebeka
- APHP, Department of Psychiatry, Universitary Hospital Louis Mourier, 92700 Colombes, France; Université de Paris, France; Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris F-75014, France.
| | - Alix De Premorel Higgons
- APHP, Department of Psychiatry, Universitary Hospital Louis Mourier, 92700 Colombes, France; Université de Paris, France; Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris F-75014, France.
| | - Caroline Dubertret
- APHP, Department of Psychiatry, Universitary Hospital Louis Mourier, 92700 Colombes, France; Université de Paris, France; Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris F-75014, France.
| | - Yann Le Strat
- APHP, Department of Psychiatry, Universitary Hospital Louis Mourier, 92700 Colombes, France; Université de Paris, France; Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris F-75014, France.
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Preclinical methodological approaches investigating of the effects of alcohol on perinatal and adolescent neurodevelopment. Neurosci Biobehav Rev 2020; 116:436-451. [PMID: 32681938 DOI: 10.1016/j.neubiorev.2020.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 06/02/2020] [Accepted: 07/13/2020] [Indexed: 02/08/2023]
Abstract
Despite much evidence of its economic and social costs, alcohol use continues to increase. Much remains to be known as to the effects of alcohol on neurodevelopment across the lifespan and in both sexes. We provide a comprehensive overview of the methodological approaches to ethanol administration when using animal models (primarily rodent models) and their translational relevance, as well as some of the advantages and disadvantages of each approach. Special consideration is given to early developmental periods (prenatal through adolescence), as well as to the types of research questions that are best addressed by specific methodologies. The zebrafish is used increasingly in alcohol research, and how to use this model effectively as a preclinical model is reviewed as well.
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Rollins L, Sokol NA, McCallum M, England L, Matteson K, Werner E, Stroud LR. Electronic Cigarette Use During Preconception and/or Pregnancy: Prevalence, Characteristics, and Concurrent Mental Health Conditions. J Womens Health (Larchmt) 2020; 29:780-788. [PMID: 32109175 PMCID: PMC7307667 DOI: 10.1089/jwh.2019.8089] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Electronic cigarettes (e-cigarettes) are increasing in popularity in the United States. Prior prevalence estimates of e-cigarette use in pregnancy range from 1% to 15%. Materials and Methods: We assessed prevalence of e-cigarette and conventional cigarette use during preconception or pregnancy in a large sample of racially/ethnically diverse, low-income pregnant women via telephone survey (2015-2018) and compared sociodemographic characteristics and mental health conditions. Results: Of 1365 pregnant women surveyed, 54 (4.0%) reported e-cigarette use (regardless of other tobacco use), 372 (27.3%) reported conventional cigarette use without e-cigarette use (conventional cigarette use), and 939 (68.8%) reported no tobacco or nicotine replacement therapy (NRT) product use during the preconception period and/or pregnancy. Seventy-four percent of women using e-cigarettes reported also using conventional cigarettes. Women who used e-cigarettes were more likely to report high school education or greater, income <$30,000, White race, and non-Hispanic ethnicity than women who used conventional cigarettes. Women who used e-cigarettes were more likely than women who used conventional cigarettes or no tobacco/NRT to report symptoms of depression. Women who used e-cigarettes and women who used conventional cigarettes were more likely than women who used no tobacco/NRT to report a history of severe mental health conditions, alcohol use during pregnancy, and marijuana or other drug use during preconception. Conclusions: In this sample, 4% of women used e-cigarettes during preconception and/or pregnancy and most also used conventional cigarettes. Increased efforts by providers to screen for tobacco (including use of e-cigarette) and polysubstance use and to provide cessation services could improve outcomes of mothers and children.
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Affiliation(s)
- L.G. Rollins
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Natasha A. Sokol
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Meaghan McCallum
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Lucinda England
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristen Matteson
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Obstetrics and Gynecology, Brown University School of Medicine, Providence, Rhode Island
| | - Erika Werner
- Department of Obstetrics and Gynecology, Brown University School of Medicine, Providence, Rhode Island
- Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Laura R. Stroud
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
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Oh S, DiNitto DM, Powers DA. Spillover Effects of Job Skills Training on Substance Misuse Among Low-Income Youths With Employment Barriers: A Longitudinal Cohort Study. Am J Public Health 2020; 110:900-906. [PMID: 32298178 DOI: 10.2105/ajph.2020.305631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine spillover effects of job skills training (vs basic services only [e.g., adult basic education, job readiness training]) on substance misuse among low-income youths with employment barriers.Methods. Data came from the National Longitudinal Survey of Youth 1997, a longitudinal cohort study of youths born between 1980 and 1984 in the United States. Based on respondents' reports of substance misuse (past-month binge drinking and past-year marijuana and other illicit drug use) from 2000 to 2016, we estimated substance misuse trajectories of job skills training (n = 317) and basic services (n = 264) groups. We accounted for potential selection bias by using inverse probability of treatment weighting.Results. Compared with the basic services group, the job skills training group showed notable long-term reductions in its illicit drug misuse trajectory, translating to a 56.9% decrease in prevalence rates from 6.5% in year 0 to 2.8% in year 16.Conclusions. Job skills training can be an important service component for reducing substance misuse and improving employment outcomes among youths with economic disadvantages and employment barriers.
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Affiliation(s)
- Sehun Oh
- Sehun Oh is with The Ohio State University College of Social Work, Columbus. Diana M. DiNitto is with the Steve Hicks School of Social Work, University of Texas at Austin. Daniel A. Powers is with the Department of Sociology, University of Texas at Austin
| | - Diana M DiNitto
- Sehun Oh is with The Ohio State University College of Social Work, Columbus. Diana M. DiNitto is with the Steve Hicks School of Social Work, University of Texas at Austin. Daniel A. Powers is with the Department of Sociology, University of Texas at Austin
| | - Daniel A Powers
- Sehun Oh is with The Ohio State University College of Social Work, Columbus. Diana M. DiNitto is with the Steve Hicks School of Social Work, University of Texas at Austin. Daniel A. Powers is with the Department of Sociology, University of Texas at Austin
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McKeague M, Norton S, Canfield M. A review of factors associated with patterns of drinking during pregnancy. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-08-2019-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose
The purpose of this paper is to identify factors associated with drinking patterns during pregnancy.
Design/methodology/approach
A rapid evidence assessment was undertaken, scanning multiple databases for studies examining factors associated with alcohol consumption in pregnancy. Studies were included if they stratified data according to quantity of alcohol consumed and identified relevant associated factors. Drinking patterns were classified as light/moderate and heavy/binge.
Findings
In total, 15 studies were included (N=7 light/moderate; N=15 heavy/binge drinking). Factors associated with alcohol consumption during pregnancy included: smoking, age, SES, marital status, pre-pregnancy substance use and parity. While few studies reported an association between heavy/binge drinking and maternal mental health, none of the studies included explored the association between mental health and light/moderate drinking.
Research limitations/implications
Relatively few studies have looked at the association between psychological characteristics of women and their drinking patterns. There is a lack of articles examining light/moderate drinking in pregnancy compared to heavy/binge drinking. Moreover, there is marked variation in how alcohol use is measured. Further studies are needed to increase understanding of the association between psychological factors and patterns of drinking during pregnancy, and how health professionals might support women in this context.
Originality/value
The authors expand on previous work by examining two different patterns of alcohol consumption in pregnancy, rather than alcohol use simply as an isolated concept. The two groups were found to differ in a number of demographic and social factors. This information could be used to aid healthcare professionals in targeting specific interventions to those women most at risk.
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Ellis JD, Grekin ER, Resko SM. Correlates of substance use in pregnant women under community supervision after conviction for a criminal offence: The role of psychological distress. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:261-275. [PMID: 31788884 DOI: 10.1002/cbm.2133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/04/2019] [Accepted: 10/22/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Being pregnant while under community supervision after conviction for a criminal offence can be a highly stressful experience, and pregnant women under community supervision are at an elevated risk for substance use. AIMS/HYPOTHESES To test for relationships between psychological distress and use of tobacco, alcohol, or marijuana during the month prior to a research assessment among pregnant women under community supervision, controlling for demographic characteristics. METHODS Data from the National Survey on Drug Use and Health were aggregated for the years 2008-2016, inclusive. Logistic regression analyses were conducted to examine correlates of past-month use of each substance. RESULTS Of all 505,796 people in the survey, 6,974 were pregnant women of whom 280 reported being under community supervision for a criminal offence; relevant data were available for 271 of these cases. The pregnant women under community supervision reported higher rates of past-month substance use of each kind and of psychological distress than pregnant women not under community supervision. Past-month serious psychological distress, but not remitted psychological distress, corresponded strongly with past-month alcohol use even when controlling for demographic characteristics and other substance use. CONCLUSIONS Our findings add to the very sparse literature about a group of women likely to be exceptionally vulnerable during pregnancy and underscore the importance of screening for symptoms of substance use and of psychological distress amongst them. Among women under community supervision, alcohol use was less likely in the second or third trimester than the first, but as those using alcohol were more likely to report past month psychological distress, it may be important to provide additional resources and treatment services for these women.
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Affiliation(s)
| | - Emily R Grekin
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Stella M Resko
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
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Shmulewitz D, Hasin DS. Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017. Prev Med 2019; 124:75-83. [PMID: 31054285 PMCID: PMC6561097 DOI: 10.1016/j.ypmed.2019.04.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/18/2019] [Accepted: 04/28/2019] [Indexed: 12/25/2022]
Abstract
Fetal alcohol exposure can lead to severe birth and developmental defects. Determining which pregnant women are most likely to drink is essential for targeting interventions. In National Survey on Drug Use and Health data on pregnant women from 2002 to 2017 (N = 13,488), logistic regression was used to produce adjusted odds ratios (aOR) indicating characteristics associated with two past-month outcomes: any alcohol use and binge drinking. Risk factors were sociodemographic (age, race/ethnicity, marital status, education level, income) and clinical (trimester, substance use, alcohol use disorder, major depression). Where associations differed by pregnancy stage (trimester 1 vs. trimesters 2 and 3), association was evaluated by stage. Overall, higher risk for any and binge drinking was observed among those with other substance use (aORs 2.9-25.9), alcohol use disorder (aORs 4.5-7.5), depression (aORs = 1.6), and unmarried women (aORs 1.6-3.2). For any drinking, overall, higher risk was observed in adolescents (aOR = 1.5) and those with higher education (aOR = 1.4), while lower risk was observed in those with lower income (aORs = 0.7). For binge drinking, associations differed by pregnancy stage. In trimester 1, lower risk was observed in middle ages (aOR = 0.4). In trimesters 2/3, higher risk was observed in Blacks (aOR = 3.3) and those with lower income (aORs 3.5-3.9), while lower risk was observed in those with higher education (aOR = 0.3). To prevent severe prenatal harm, health care providers should focus on women at higher risk for binge drinking during pregnancy: women with tobacco or drug use, alcohol use disorder, or depression, and women who are unmarried, Black, or of lower socioeconomic status.
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Affiliation(s)
- Dvora Shmulewitz
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
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Risk factors associated to tobacco and alcohol use in a large French cohort of pregnant women. Arch Womens Ment Health 2019; 22:267-277. [PMID: 30074092 DOI: 10.1007/s00737-018-0892-4] [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: 01/18/2018] [Accepted: 07/11/2018] [Indexed: 01/13/2023]
Abstract
Tobacco and/or alcohol use during pregnancy is a major public health concern. The aim of our study was to identify risk factors associated to maternal alcohol and tobacco use assessed by maternal self-reports combined with biological measurements in meconium samples of cotinine and ethylglucuronide which reflect fetal exposure to tobacco and alcohol, respectively, during the 3rd trimester of pregnancy. We conducted a prospective study in three maternity hospitals in a large urban area during consecutive weeks (2010 and 2011). Maternal sociodemographic and clinical characteristics were assessed after delivery, using the French version of the Addiction Severity Index. Cotinine and ethylglucuronide were measured in meconium samples. Seven hundred and twenty-four women were included, and 645 meconium samples collected. Using multivariate analyses, we found that not being married or having a smoking partner predicts maternal tobacco use. In contrast, a decreased risk was associated with higher education level and wanted pregnancy. The risk for alcohol use increased when the mother had been in conflict with any relative or her partner for a long time throughout her life, as well as in case of previous treatment for any mental or emotional disorder. Using multivariate analyses and cotinine presence in meconium samples, the risks were similar except for marital status, which was not associated to cotinine presence. Community education and prevention programs should urgently be improved for all women of childbearing age with a special focus on those with past histories of mental or emotional disorders and addictive disorders. Smoking cessation should be recommended to both parents.
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Peltzer K, Pengpid S. Maternal alcohol use during pregnancy in a general national population in South Africa. S Afr J Psychiatr 2019; 25:1236. [PMID: 30899583 PMCID: PMC6424534 DOI: 10.4102/sajpsychiatry.v25i0.1236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022] Open
Abstract
Objective Alcohol use in pregnancy is linked with various negative health effects on the infant. The aim of this study was to examine the prevalence of maternal alcohol use during pregnancy and socio-demographic and health correlates. Methods Data of ever-pregnant women from the cross-sectional ‘South African National Health and Nutrition Examination Survey (SANHANES-1) 2011–2012’ were analysed. The sample included 5089 adolescents and adult women aged 15–55 years. They responded to questions on alcohol use, socio-demographic and health indicators. Results The results indicated that 3.7% (95.0% confidence interval [CI] = 3.1, 4.5) of South African women had engaged in alcohol use during their pregnancy. In adjusted analysis, being mixed race, not employed, poor self-rated health status, ever been diagnosed with tuberculosis and having partial post-traumatic stress disorder were found to be associated with alcohol use during pregnancy. Conclusions The study findings suggest links between socio-demographic and health variables and prenatal alcohol use, which may have public health policy implications.
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Affiliation(s)
- Karl Peltzer
- HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, South Africa.,Department of Research Innovation and Development, University of Limpopo, South Africa
| | - Supa Pengpid
- Department of Research Innovation and Development, University of Limpopo, South Africa.,ASEAN Institute for Health Development, Mahidol University, Thailand
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23
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Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rössler A, Soyka M, Yonkers K, Yonkers K. WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 2019; 20:17-50. [PMID: 30632868 DOI: 10.1080/15622975.2018.1510185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.
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Affiliation(s)
- Florence Thibaut
- a University Hospital Cochin , Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry and Neurosciences , Paris , France
| | - Abdeslam Chagraoui
- b Neuronal and Neuroendocrine Differentiation and Communication Laboratory , Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Normandie Univ , UNIROUEN, INSERM, U1239, CHU Rouen , Rouen , France ; Department of Medical Biochemistry , Rouen University Hospital , Rouen , France
| | - Leslie Buckley
- c Addiction Services , University Health Network, University of Toronto , Toronto , Canada
| | - Florence Gressier
- d Department of Psychiatry , INSERM UMR1178 CESP, Univ. Paris-Sud , Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre , Le Kremlin Bicêtre , France
| | - Javier Labad
- e Department of Mental Health , Parc Tauli Hospital Universitari, I3PT ; Department of Psychiatry and Legal Medicine , Universitat Autonoma de Barcelona, CIBERSAM, Sabadell , Barcelona , Spain
| | - Sandrine Lamy
- f Department of Addictology , Ramsay- General de Santé, SSR Petit Colmoulins , Harfleur , France
| | - Marc N Potenza
- g Neuroscience and Child Study , Yale University School of Medicine , New Haven , CT , USA
| | - Marta Rondon
- h Instituto Nacional Materno Perinatal , Lima , Peru
| | - Anita Riecher-Rössler
- i Center for Gender Research and Early Detection , University of Basel Psychiatric Hospital , Basel , Switzerland
| | - Michael Soyka
- j University of Munich , Munich, and Medicalpark Chiemseeblick, Bernau , Germany
| | - Kim Yonkers
- k Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences , Yale University , New Haven , CT , USA
| | - Kim Yonkers
- Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
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24
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Myers B, Koen N, Donald KA, Nhapi RT, Workman L, Barnett W, Hoffman N, Koopowitz S, Zar HJ, Stein DJ. Effect of Hazardous Alcohol Use During Pregnancy on Growth Outcomes at Birth: Findings from a South African Cohort Study. Alcohol Clin Exp Res 2017; 42:369-377. [PMID: 29197115 PMCID: PMC5887896 DOI: 10.1111/acer.13566] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
Abstract
Background Cohort studies have noted associations between hazardous alcohol use during pregnancy and infant growth outcomes, but many have not controlled for potential psychosocial confounders. To assess the unique contribution of hazardous alcohol use, we examined its effect on infant growth outcomes while controlling for maternal psychosocial stressors and hazardous tobacco and drug use in a cohort of 986 pregnant South African women enrolled into the Drakenstein Child Health Study between 2012 and 2015. Methods Data on psychosocial stressors and maternal risk behaviors were collected between 28 and 32 weeks of gestation. Participants were categorized as hazardous alcohol users if they obtained moderate or high scores (>10) on the Alcohol, Smoking and Substance Involvement Screening Test at this assessment or retrospectively reported drinking at least 2 drinks weekly during any trimester of pregnancy. Infant growth outcomes were recorded at delivery. Multivariable regression models examined correlates of hazardous alcohol use and associations between hazardous alcohol use and birth outcomes. Results Overall, 13% of mothers reported hazardous alcohol use. Recent exposure to intimate partner violence (adjusted odds ratio (aOR) = 2.08; 95% confidence interval (CI): 1.37, 3.18) and hazardous tobacco use (aOR = 5.03; 95% CI: 2.97, 8.52) were significant correlates of hazardous alcohol use. After controlling for potential psychosocial confounders, hazardous alcohol use remained associated with lower infant weight‐for‐age (B = −0.35, 95% CI: −0.56, −0.14), height‐for‐age (B = −0.46, 95% CI: −0.76, −0.17), and head‐circumference‐for‐age z‐scores (B = −0.43, 95% CI: −0.69, −0.17). Conclusions Interventions to reduce hazardous alcohol use among pregnant women in South Africa are needed to prevent alcohol‐related infant growth restrictions. As these growth deficits may lead to neurodevelopmental consequences, it is critical to identify alcohol‐related growth restrictions at birth and link exposed infants to early interventions for neurodevelopment.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Raymond T Nhapi
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lesley Workman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Nadia Hoffman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Sheri Koopowitz
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Child and Adolescent Health, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,South African Medical Research Council Unit on Anxiety and Stress Disorders, Cape Town, South Africa
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25
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Oh S, Salas-Wright CP, Vaughn MG, DiNitto DM. Marijuana use during pregnancy: A comparison of trends and correlates among married and unmarried pregnant women. Drug Alcohol Depend 2017; 181:229-233. [PMID: 29107787 DOI: 10.1016/j.drugalcdep.2017.09.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE While recent evidence indicates increases in marijuana use among adult women in the United States (US), important questions remain with respect to marijuana use during pregnancy. This study examines trends and correlates of prenatal marijuana use and the effects of marijuana-specific risk/protective factors on marijuana use trends using a nationally representative sample. METHOD Data were derived from the National Survey on Drug Use and Health (2005-2014), a nationally representative survey that included 3640 married and 3987 unmarried pregnant women in the United States. The significance of marijuana use trends was tested using logistic regression analyses while adjusting for complex sampling design effects and controlling for sociodemographic and marijuana-specific factors. RESULTS From 2005-2014, marijuana use prevalence among unmarried pregnant women increased by 85% from 5.4% to 10.0% while the prevalence among married pregnant women remained stable (mostly under 1.5%). The increasing trend among unmarried pregnant women was associated with their lower disapproval and risk perceptions of marijuana use. In addition, past-year anxiety (AOR=3.30, 95% CI=1.87-5.82) and depression (AOR=3.85, 95% CI=2.33-6.36) diagnoses were linked with marijuana use among unmarried, but not married, pregnant women. DISCUSSION Increased attention should be paid to reducing prenatal marijuana use among unmarried women. Findings also suggest the need to attend to unmarried pregnant women's mental health problems as well as their physical health-risk behaviors.
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Affiliation(s)
- Sehun Oh
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States.
| | | | - Michael G Vaughn
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States.
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States.
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26
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Schmidt KA, Lancia AJ, Alvi S, Aldag JC. Alcohol reduction in the first trimester is unrelated to smoking, patient or pregnancy characteristics. Addict Behav Rep 2017; 5:43-48. [PMID: 29450226 PMCID: PMC5800579 DOI: 10.1016/j.abrep.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Studies show alcohol-preferring mice reduce their alcohol intake during pregnancy; this study questions if the same is true for humans. The current investigation compares women's pre-pregnancy and first trimester alcohol consumption, examines if women with problem drinking diminish their alcohol intake during pregnancy, and determines if prenatal alcohol reduction is associated with characteristics of pregnancy, patients or smoking. Methods 126 participants in weeks 1-12 of pregnancy, recruited from Obstetric and Family Practices, completed a survey during their initial prenatal visit including two gender-specific AUDITs (Alcohol Use Disorders Identification Tests) querying current and pre-pregnancy alcohol use. AUDIT-C (AUDIT items 1-3) scores measuring pre-pregnancy and first trimester alcohol consumption were compared, analyzed and tested using general linear model repeated. A p ≤ 0.05 was accepted as significant. Results Most participants were multiparous, Caucasian high school graduates experiencing nausea and vomiting. Pre-pregnancy alcohol use was significantly (p = 0.019, Fisher's exact) higher among women seeing obstetricians. Pre-pregnancy AUDIT-C scores (m (mean) = 2.22, sd (standard deviation) = 2.19) were significantly higher (p < 0.001) than first trimester scores (m = 0.143, sd = 0.532). Among 49 with pre-pregnancy AUDIT-C scores ≥ 3, 45/49 (92%) reduced their alcohol use to zero during the first trimester. Age, race, education, marital status, parity, nausea and vomiting, gestational age and smoking were non-factors in score reduction. Conclusions Women reported reducing their alcohol consumption during pregnancy, including those screening positive for pre-pregnancy problem drinking. First trimester alcohol reduction cannot be accounted for by smoking, patient or pregnancy characteristics; public health initiatives, psychological factors and hormonal mechanisms may be implicated.
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Affiliation(s)
| | - Andrew J Lancia
- Department of Psychiatry, University of Illinois College of Medicine, Peoria, IL, United States
| | - Saad Alvi
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, United States
| | - Jean C Aldag
- Department of Research, University of Illinois College of Medicine, Peoria, IL, United States
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