Treatment of Substance Use Disorders Among Women of Reproductive Age by Depression and Anxiety Disorder Status, 2008-2014

Trajectory on postpartum depression of Chinese women and the risk prediction models: A machine-learning based three-wave follow-up research

BACKGROUND

Our study delves into postpartum depression (PPD) extending observation up to six months postpartum, addressing the gap in long-term follow-ups and uncover critical intervention points.

METHOD

Through a continuous three-wave cohort study involving 3174 of 10,730 invited postpartum women, we utilized machine learning to predict PPD risk, incorporating self-reported surveys and health records from October 2021 to Jan 2023.

RESULTS

PPD prevalence slightly decreased from 30.9 % to 29.1 % over six months. The Random Forest model emerged as the most effective, identifying key predictors of PPD at different stages. The top three factors at first month were newborn's birth weight, maternal weight before delivery and before pregnancy. The EPDS scores of last time, newborn's birth weight and maternal weight before pregnancy and before delivery were main predictors for EPDS scores at third and sixth months postpartum.

LIMITATION

The study faces limitations such as potential selection bias due to the convenience sampling method and the reliance on self-reported measures, which may introduce reporting bias. Furthermore, the high attrition rate could affect the representativeness of the sample and the generalizability of the findings.

CONCLUSION

There is a slight decrease in PPD rates over six months, yet the prevalence remains high. This underscores the need for early and ongoing mental health support for new mothers. Our study highlights the efficacy of machine learning in enhancing PPD risk assessment and tailoring intervention strategies, paving the way for more personalized healthcare approaches in postpartum care.

Timing of treatment for opioid use disorder among birthing people

BACKGROUND

The number of pregnant women with opioid use disorder (OUD) has increased over time. Although effective treatment options exist, little is known about the extent to which women receive treatment during pregnancy and at what stage of pregnancy care is initiated.

METHODS

Using a national private health insurance claims database, we identified women aged 13-49 who gave birth in 2006-2019 and had an OUD or nonfatal opioid overdose (NFOO) diagnosis during the year prior to or at delivery. We then identified women who received their first OUD treatment prior to or during pregnancy. In this cross-sectional study, we investigated how rates and timing of the initial OUD treatment changed over time. Furthermore, we examined factors associated with early initiation of OUD treatment among birthing people.

RESULTS

Of the 7057 deliveries from 6747 women with OUD or NFOO, 63.3 % received any OUD treatment. Rates of OUD treatment increased from 42.9 % in 2006 to 69 % in 2019. Of those treated, in 2006, 54.5 % received their first treatment prior to conception and 24.2 % initiated care during the 1st trimester. In 2019, 68.9 % received their first treatment prior to conception, and 15.1 % initiated care during the 1st trimester. The percentage of women who were first treated in the 2nd trimester or later decreased from 21.2 % in 2006 to 16.1 % in 2019. Factors associated with early treatment initiation include being 25 years or older (age 25-34: aOR, 1.51, 95 % CI, 1.28-1.78; age 35-49: aOR, 1.82, 95 % CI, 1.39-2.37), living in urban areas (aOR, 1.28; 95 % CI, 1.05-1.56), having pre-existing behavioral health comorbidities such as anxiety disorders (aOR, 1.8; 95 % CI, 1.40-2.32), mood disorders (aOR, 1.63; 95 % CI, 1.02-2.61), and substance use disorder other than OUD (aOR, 2.56; 95 % CI, 2.03-3.32).

CONCLUSION

Overall, rates of OUD treatment increased over time, and more women initiated OUD treatment prior to conception. Despite these improvements, over one-third of pregnant women with OUD/NFOO either received no treatment or did not initiate care until the 3rd trimester in 2019. Future research should examine barriers to OUD treatment initiation among pregnant women.

The impact of intimate partner violence on PrEP adherence among U.S. Cisgender women at risk for HIV

BACKGROUND

Cisgender women account for 1 in 5 new HIV infections in the United States, yet remain under-engaged in HIV prevention. Women experiencing violence face risk for HIV due to biological and behavioral mechanisms, and barriers to prevention, such as challenges to Pre-Exposure Prophylaxis for HIV Prevention (PrEP) adherence. In this analysis, we aim to characterize intimate partner violence (IPV) among cisgender heterosexual women enrolled in a PrEP demonstration project and assess the associations with PrEP adherence.

METHODS

Adherence Enhancement Guided by Individualized Texting and Drug Levels (AEGiS) was a 48-week single-arm open-label study of PrEP adherence in HIV-negative cisgender women in Southern California (N = 130) offered daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). From 6/2016 to 10/2018, women completed a survey reporting HIV risk behavior and experiences of any IPV (past 90-days) and IPV sub-types (past-year, lifetime) and biological testing for HIV/STIs at baseline, and concentrations of tenofovir-diphosphate (TFV-DP) in dried blood spots at weeks 4, 12, 24, 36, and 48. Outcomes were TFV-DP concentrations consistent with ≥ 4 or ≥ 6 doses/week at one or multiple visits. Multivariable logistic regression models were conducted to examine associations.

RESULTS

Past-90-day IPV was reported by 34.4% of participants, and past-year and lifetime subtypes reported by 11.5-41.5%, and 21.5-52.3%, respectively. Women who engaged in sex work and Black women were significantly more likely to report IPV than others. Lifetime physical IPV was negatively associated with adherence at ≥ 4 doses/week at ≥ 3 of 5 visits, while other relationships with any IPV and IPV sub-types were variable.

CONCLUSION

IPV is an indication for PrEP and important indicator of HIV risk; our findings suggest that physical IPV may also negatively impact long-term PrEP adherence.

CLINICAL TRIALS REGISTRATION

NCT02584140 (ClinicalTrials.gov), registered 15/10/2015.

Social Determinants Associated with Substance Use and Treatment Seeking in Females of Reproductive Age in the United States

Introduction: Females of reproductive age (FoRA; 15-49 years) are the demographic most likely to be diagnosed with a substance use disorder. Preventative treatment prior to or during pregnancy is critical. Stigma and social inequities can delay access to care. There is limited research examining social determinants of health (SDoH) and how they are related to substance use and treatment seeking in this demographic. Methods: We analyzed the 2016-2019 data from the United States National Survey on Drug Use and Health using multivariable logistic regression models. Statistically significant variables were conceptually linked to the Office of Disease Prevention and Health Promotion's (ODPHP's) SDoH framework's five domains. Results: From a total sample of 1,477,336 (weighted) pregnant people and 39,600,523 (weighted) FoRA, substance use was reported by 879,209 (2.14% [95% confidence interval = 2.13-2.15]). Pregnancy status was not associated with substance use or treatment seeking. Past-month substance use was associated with high educational attainment, an annual income <$20,000, a history of criminality, low religiosity, and having health insurance. Past-month treatment-seeking behavior was associated with older age, an annual income >$20,000, a history of criminality, and greater religiosity. Behavioral health support seeking in the past month was associated with some college education. Higher depression severity was associated with all the three models. Conclusions: Using the ODPHP's SDoH framework, we begin to elicit critical connections that can describe substance use and treatment-seeking practices in FoRA. We encourage additional research to inform public health, health care, behavioral health, and other support service programming.

Maternal psychological risk and the neural correlates of infant face processing: A latent profile analysis

Maternal psychological factors, including anxiety, depression, and substance use, may negatively affect parenting. Previous works with mothers have often assessed each of these factors in isolation despite their frequent co-occurrence. Psychological factors have also been associated with neural processing of facial stimuli, specifically the amplitude (i.e., size) and latency (i.e., timing) of the face-specific N170 event-related potential. In the current study, 106 mothers completed measures assessing maternal psychological factors-anxiety, depression, and substance use. A latent profile analysis was used to identify profiles of psychological factors and assess profile associations with the N170 elicited by infant faces and with parental reflective functioning (PRF) as a measure related to caregiving. Two profiles (termed high and low psychological risk) were identified, with the higher risk profile associated with delayed N170 latency responses to infant faces. An exploratory analysis evidenced an indirect effect between the higher psychological risk profile and lower PRF through delayed N170 latency responses to infant faces. Taken together, maternal psychological risk across multiple indicators may together shape neural processing of infant faces, which may have downstream consequences for caregiving.

Predictors of cigarette smoking in pregnant women with substance use disorders

BACKGROUND

Cigarette smoking is common among pregnant women with substance use disorders (SUD) and may contribute to more adverse health consequences for the infant than alcohol and illicit drug use. However, most studies focused on stopping illicit drug use and paid little attention to cigarette smoking in pregnant women with SUD.

PURPOSE

To identify predictors of current smoking among pregnant women with SUD, given past-month psychological distress, alcohol use and illicit drug use, the receipt of past-year mental health and substance use treatment controlling for potential confounders.

METHODS

Secondary analysis of cross-sectional data from the National Survey on Drug Use and Health (NSDUH) 2015-2019 was conducted. The NSDUH included 3,540 pregnant women aged 18-44 years; among them were 195 lifetime smokers with SUD. Multiple logistic regression modeling was used to examine the probability of prenatal smoking.

RESULTS

Sixty-one percent of pregnant women with SUD reported current cigarette smoking. The likelihood of prenatal smoking increased with a higher level of past-month psychological distress (Adjusted Odds Ratio [AOR] 1.14; 95% Confidence Interval [CI]: 1.02-1.28), past-month illicit drug use (AOR: 5.68; 95% CI: 1.59-20.21), and past-year substance use treatment receipt (AOR: 5.73; 95% CI: 1.88-17.45).

CONCLUSION

The receipt of substance use treatment markedly increased the probability of smoking in pregnant women with SUD. Treatment and policy initiatives are required to address and integrate cigarette smoking within other substance use treatment modalities for pregnant women with SUD.

Buprenorphine use and setting type among reproductive-aged women self-reporting nonmedical prescription opioid use

INTRODUCTION

Screening for opioid misuse and treatment for opioid use disorder are critical for reducing morbidity and mortality. We sought to understand the extent of self-reported past 30-day buprenorphine use in various settings among women of reproductive age with self-reported nonmedical prescription opioid use being assessed for substance use problems.

METHODS

The study collected data from individuals being assessed for substance use problems using the Addiction Severity Index-Multimedia Version in 2018-2020. We stratified the sample of 10,196 women ages 12-55 self-reporting past 30-day nonmedical prescription opioid use by buprenorphine use and setting type. We categorized setting types as: buprenorphine in specialty addiction treatment, buprenorphine in office-based opioid treatment, and diverted buprenorphine. We included each woman's first intake assessment during the study period. The study assessed number of buprenorphine products, reasons for using buprenorphine, and sources of buprenorphine procurement. The study calculated frequency of reasons for using buprenorphine to treat opioid use disorder outside of a doctor-managed treatment, overall and by race/ethnicity.

RESULTS

Overall, 25.5 % of the sample used buprenorphine in specialty addiction treatment, 6.1 % used buprenorphine prescribed in office-based treatment, 21.7 % used diverted buprenorphine, and 46.7 % reported no buprenorphine use during the past 30 days. Among women who reported using buprenorphine to treat opioid use disorder, but not as part of a doctor-managed treatment, 72.3 % could not find a provider or get into a treatment program, 21.8 % did not want to be part of a program or see a provider, and 6.0 % reported both; a higher proportion of American Indian/Alaska Native women (92.1 %) reported that they could not find a provider or get into a treatment program versus non-Hispanic White (78.0 %), non-Hispanic Black (76.0 %), and Hispanic (75.0 %) women.

CONCLUSIONS

Appropriate screening for nonmedical prescription opioid use to assess need for treatment with medication for opioid use disorder is important for all women of reproductive age. Our data highlight opportunities to improve treatment program accessibility and availability and support the need to increase equitable access for all women.

Timing of Postpartum Depressive Symptoms

Introduction

Postpartum depression is a serious public health problem that can adversely impact mother-child interactions. Few studies have examined depressive symptoms in the later (9-10 months) postpartum period.

Methods

We analyzed data from the 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) linked with data from a telephone follow-up survey administered to PRAMS respondents 9 to 10 months postpartum in 7 states (N = 1,954). We estimated the prevalence of postpartum depressive symptoms (PDS) at 9 to 10 months overall and by sociodemographic characteristics, prior depression (before or during pregnancy), PDS at 2 to 6 months, and other mental health characteristics. We used unadjusted prevalence ratios (PRs) to examine associations between those characteristics and PDS at 9 to 10 months. We also examined prevalence and associations with PDS at both time periods.

Results

Prevalence of PDS at 9 to 10 months was 7.2%. Of those with PDS at 9 to 10 months, 57.4% had not reported depressive symptoms at 2 to 6 months. Prevalence of PDS at 9 to 10 months was associated with having Medicaid insurance postpartum (PR = 2.34; P = .001), prior depression (PR = 4.03; P <.001), and current postpartum anxiety (PR = 3.58; P <.001). Prevalence of PDS at both time periods was 3.1%. Of those with PDS at both time periods, 68.5% had prior depression.

Conclusion

Nearly 3 in 5 women with PDS at 9 to 10 months did not report PDS at 2 to 6 months. Screening for depression throughout the first postpartum year can identify women who are not symptomatic early in the postpartum period but later develop symptoms.

Assessment of prenatal depression among U.S. pregnant women without access to paid sick leave and regular place of care: National Health Interview Survey of U.S.-born and non-U.S.-born

Prenatal depression is one of the most common risks during pregnancy. This study examined the prevalence and likelihood of prenatal depression association with sociodemographic factors, paid sick leave, and place of care among U.S. pregnant women. We conducted bivariate Chi-square tests to assess the statistical difference and multivariable logistic regression models to assess the association of prenatal depression using the National Health Interview Survey, cross-sectional data from 2010 to 2019 of pregnant women aged 18-44 years (N = 957). The prevalence of prenatal depression was 40.6%, 28.5%, and 27.2% among White, Black, and other racial pregnant women, respectively. Pregnant women with no regular/routine place of care had a prenatal depression prevalence rate of 58.1%, and those without access to paid sick leave had 46.9%. Also, pregnant women without access to paid sick leave were found to have an increased likelihood of reporting prenatal depression ([adjusted odds ratio] AOR = 2.50, 95% CI = 1.72-3.64), as well as those without a regular place of care (AOR = 2.43, 95% CI = 1.32-4.47). The findings identify factors that need to be addressed to minimize depression among U.S. pregnant women and establish the need for tailored interventions to address prenatal depression.

New Directions in Child Psychiatry: Shaping Neurodevelopmental Trajectories

Historically, the field of child psychiatry has lagged behind the field of general psychiatry in terms of research innovations and the availability of empirically supported treatment modalities. However, over the last two decades there has been increasing interest in and research focused on the developmental origins of mental disorders examining both neurobiological and psychosocial etiologies.1 This has catalyzed the field leading to advances in understanding the developmental psychopathology of mental disorders and the generation of novel early interventions that have shown significant promise.2-4 Further, catalyzing this effort is new data demonstrating the powerful impact of psychosocial forces on neurodevelopment. New methodologies and discoveries in the basic areas of early childhood developmental psychology have led to a greater appreciation for the emotional and cognitive sophistication of children in the first three years of life. Advances in methods to understand preverbal children's emotional and attentional responses (through measures of eye gaze and suck for example) as well as observational methods to glean a variety of mental health relevant behaviors early in life (e.g. behavioral inhibition, pro-social behaviors and social motivation) have further elucidated and validated these capacities. In addition, measures of neural function using electroencephalogram and evoked response potentials (EEG/ERP) and functional magnetic resonance imaging (fMRI) as early as the neonatal period, with many analysis methods developed at WUSTL, have further informed this domain providing new insight into early brain and behavioral relationships as well as how intervention impact brain function.5-7.

Sex- and Gender-Specific Drug Abuse Dynamics: The Need for Tailored Therapeutic Approaches

Sex and gender have been gaining ever greater attention due to their associated risks, dynamics, patterns and protective factors underlying substance abuse and addiction. Such differentiations and the clarification of complexities thereof take on even greater relevance in light of drug abuse scope worldwide. According to the 2022 World Drug Report released by the United Nations Office on Drugs and Crime (UNODC), in 2020 an estimated 284 million people worldwide aged 15-64 had used a drug within the last 12 months. The authors have set out to shed a light on determinants and contributing factors of drug abuse based on sex and gender and outline policy and medicolegal remarks aimed at delineating sex- and gender-based approaches towards drug abuse therapeutic interventions that are both therapeutically and ethically/legally viable and grounded in an evidence-based set of standards. Neurobiological data suggest that estrogen may facilitate drug taking by interacting with reward- and stress-related systems. In animal research, the administration of estrogen increases drug taking and facilitates the acquisition, escalation, and reinstatement of cocaine-seeking behavior. From a medicolegal perspective, it is of utmost importance to take into account the whole picture constituting each patient profile, which certainly includes gender factors and contributors, when outlining a therapeutic approach. Failure to do so could lead to negligence-based malpractice allegations, in light of the scientific findings representing best practices with which clinicians need to comply when caring for SUD patients.

Parental substance use and home visiting programs: Implementation considerations for relationship-based treatment

Home visiting programs can provide critical support to mothers in recovery from substance use disorders (SUDs) and young children prenatally exposed to substances. However, families impacted by maternal SUDs may not benefit from traditional child-focused developmental home visiting services as much as families not impacted by SUDs, suggesting the need to adjust service provision for this population. Given the need to implement tailored services within home visiting programs for families impacted by SUDs, we sought to investigate the implementation barriers and facilitators to inform future integration of a relationship-based parenting intervention developed specifically for parents with SUDs (Mothering from the Inside Out) into home visiting programs. We conducted nine interviews and five focus groups with a racially diverse sample (N = 38) of parents and providers delivering services for families affected by SUDs in the USA. Qualitative content analysis yielded three most prominent themes related to separate implementation domains and their associated barriers and facilitators: (1) engagement, (2) training, and (3) sustainability. We concluded that the home visiting setting may mitigate the logistical barriers to access for families affected by SUDs, whereas relationship-based services may mitigate the emotional barriers that parents with SUDs experience when referred to home visiting programs.

Examining the relationship between maternal mental health-related hospital admissions and childhood developmental vulnerability at school entry in Canada and Australia

BACKGROUND

It is well established that maternal mental illness is associated with an increased risk of poor development for children. However, inconsistencies in findings regarding the nature of the difficulties children experience may be explained by methodological or geographical differences.

AIMS

We used a common methodological approach to compare developmental vulnerability for children whose mothers did and did not have a psychiatric hospital admission between conception and school entry in Manitoba, Canada, and Western Australia, Australia. We aimed to determine if there are common patterns to the type and timing of developmental difficulties across the two settings.

METHOD

Participants included children who were assessed with the Early Development Instrument in Manitoba, Canada (n = 69 785), and Western Australia, Australia (n = 19 529). We examined any maternal psychiatric hospital admission (obtained from administrative data) between conception and child's school entry, as well as at specific time points (pregnancy and each year until school entry).

RESULTS

Log-binomial regressions modelled the risk of children of mothers with psychiatric hospital admissions being developmentally vulnerable. In both Manitoba and Western Australia, an increased risk of developmental vulnerability on all domains was found. Children had an increased risk of developmental vulnerability regardless of their age at the time their mother was admitted to hospital.

CONCLUSIONS

This cross-national comparison provides further evidence of an increased risk of developmental vulnerability for children whose mothers experience severe mental health difficulties. Provision of preventative services during early childhood to children whose mothers experience mental ill health may help to mitigate developmental difficulties at school entry.

Maternal Mediterranean Diet Adherence and Its Associations with Maternal Prenatal Stressors and Child Growth

Background

Psychosocial and physiologic stressors, such as depression and obesity, during pregnancy can have negative consequences, such as increased systemic inflammation, contributing to chronic disease for both mothers and their unborn children. These conditions disproportionately affect racial/ethnic minorities. The effects of recommended dietary patterns in mitigating the effects of these stressors remain understudied.

Objectives

We aimed to evaluate the relations between maternal Mediterranean diet adherence (MDA) and maternal and offspring outcomes during the first decade of life in African Americans, Hispanics, and Whites.

Methods

This study included 929 mother-child dyads from the NEST (Newborn Epigenetics STudy), a prospective cohort study. FFQs were used to estimate MDA in pregnant women. Weight and height were measured in children between birth and age 8 y. Multivariable linear regression models were used to examine associations between maternal MDA, inflammatory cytokines, and pregnancy and postnatal outcomes.

Results

More than 55% of White women reported high MDA during the periconceptional period compared with 22% of Hispanic and 18% of African American women (P < 0.05). Higher MDA was associated with lower likelihood of depressive mood (β = -0.45; 95% CI: -0.90, -0.18; P = 0.02) and prepregnancy obesity (β = -0.29; 95% CI: -0.57, -0.0002; P = 0.05). Higher MDA was also associated with lower body size at birth, which was maintained to ages 3-5 and 6-8 y-this association was most apparent in White children (3-5 y: β = -2.9, P = 0.02; 6-8 y: β = -3.99, P = 0.01).

Conclusions

If replicated in larger studies, our data suggest that MDA provides a potent avenue by which effects of prenatal stressors on maternal and fetal outcomes can be mitigated to reduce ethnic disparities in childhood obesity.

Maternal major depression disorder misclassification errors: Remedies for valid individual- and population-level inference

Individual and population level inference about risk and burden of MDD, particularly maternal MDD, is often made using case-finding tools that are imperfect and prone to misclassification error (i.e. false positives and negatives). These errors or biases are rarely accounted for and lead to inappropriate clinical decisions, inefficient allocation of scarce resources, and poor planning of maternal MDD prevention and treatment interventions. The argument that the use of existing maternal MDD case-finding instruments results in misclassification errors is not new; in fact, it has been argued for decades, but by and large its implications and particularly how to correct for these errors for valid inference is unexplored. Correction of the estimates of maternal MDD prevalence, case-finding tool sensitivity and specificity is possible and should be done to inform valid individual and population-level inferences.

Screening for Postpartum Depression in a Neonatal Intensive Care Unit

BACKGROUND

Postpartum depression (PPD) is a common mental health condition that affects approximately 13% of postpartum women in the United States. However, the prevalence in the neonatal intensive care unit (NICU) has been shown to be higher. Routine screening for maternal PPD is recommended at infant primary care well-child visits up to 6 months of age. The absence of a routine PPD screening program in a level IV NICU created a large gap in screening in an at-risk population.

PURPOSE

To develop and implement a screening program in the NICU to increase the identification of maternal PPD symptoms and to develop both a referral algorithm for NICU staff to follow and a referral resource packet to be given to mothers with positive PPD screenings.

METHODS

Mothers with infants in the NICU were screened for PPD using the Edinburgh Postnatal Depression Scale (EPDS). Bedside nurses administered the screening tool and used a referral algorithm to determine appropriate follow-up. EPDS scores of 10 or more were considered positive and indicated a need for referral.

RESULTS

The overall EPDS screening compliance was 66% with a positive rate of 26%. Nurses followed the referral algorithm appropriately 100% of the time. It was confirmed that 93% of the mothers with positive EPDS screenings sought help from a mental health provider.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Routine maternal PPD screening should be implemented in all NICU settings. Postpartum mental health issues should not be the sole responsibility of obstetricians, mental health providers, or maternal primary care providers.

Physical Activity and Its Relationship with Preterm Birth in the Presence of Depressive Symptomology

OBJECTIVE

To examine the relationship between physical activity (PA) and preterm birth (PTB) within the context of depressive symptoms (DS).

METHODS

Data are from the Life-course Influences of Fetal Environments (LIFE) Study, a cohort comprised of 1410 Black women, age 18-45 years who delivered a singleton in Metropolitan Detroit, MI. DS were measured with the Center for Epidemiologic Studies Depression Scale (CES-D); a score > 23 indicates severe DS. Traditional leisure time PA (LTPA) and non-LTPA during pregnancy (walking for a purpose, climbing stairs) were both measured. Modified Poisson regression models were used to estimate the association between PTB and PA. Effect modification by severe DS was assessed via stratification.

RESULTS

Approximately 16% of women had a PTB; 20% had CES-D scores > 23. Walking for a purpose was the most frequently reported type of PA (79%), followed by any LTPA (37.7%) and climbing stairs (13.5%). Compared with women who reported no PA, women who reported walking for a purpose (PR = 0.70, 95% CI 0.61, 1.10), partaking in LTPA (PR = 0.67, 95% CI 0.50, 0.90), or climbing stairs (PR = 0.61, 95% CI 0.45, 0.81) were less likely to have PTB. Results stratified by severe DS show the association between LTPA and PTB was more pronounced in women with severe DS, while the non-LTPA relationship with PTB was more heterogeneous.

CONCLUSIONS

Women who participated in traditional LTPA (any or walking only) and non-LTPA experienced improved birth outcomes. LTPA may buffer against PTB among pregnant Black women with severe DS as well as none or mild DS.

Association of Prepregnancy Substance Use and Substance Use Disorders with Pregnancy Timing and Intention

Background: Limited research exists on the association between substance use disorders (SUDs) and dimensions of pregnancy intention. This study sought to examine the independent relationships between prepregnancy substance use and SUDs with pregnancy timing and intentions. Materials and Methods: Secondary analysis of data from three prenatal care sites in Connecticut, Massachusetts, and Michigan, 2016-2017. Associations were estimated using modified Poisson regression with robust error variance to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), controlling for relevant covariates. Results: The total sample size was 1115 women. Respectively, 61.1% and 15.5% of women used any substance in the 30 days prepregnancy or had any SUD in the past 12 months. After adjustment, any prepregnancy substance use was associated with a reduced likelihood of a well-timed (aPR 0.85; 95% CI: 0.77-0.93) and intended (aPR 0.80; 95% CI: 0.72-0.89) pregnancy; similarly, any SUD was associated with a reduced likelihood of a well-timed (aPR 0.66; 95% CI: 0.55-0.80) and intended (aPR 0.79; 95% CI: 0.67-0.93) pregnancy. Conclusions: Women with prepregnancy substance use or SUD have decreased prevalence of well-timed and intended pregnancies. Greater efforts are needed to address substance use and family planning in routine, well-woman, prenatal, and postpartum care.

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). Methods: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. Results: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal–infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. Conclusion: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities.

Specifying the Relations among PTSD Symptom Clusters and Parenting Stress in Mothers Engaged in Substance Use Treatment

INTRODUCTION

Parenting stress is often heightened in mothers receiving treatment for substance use. Experiences of trauma are commonly seen in this population, which may give rise to Posttraumatic Stress Disorder (PTSD) symptoms, including intrusion, avoidance, negative cognition and mood, and affective arousal. While past research has demonstrated a significant relation between PTSD symptoms and parenting stress, no studies have examined the relative contributions of these symptoms to parenting stress in mothers engaged in substance use treatment.

METHODS

Seventy-four mothers attending outpatient substance use treatment who were parenting children aged 0-3 years completed measures of parenting stress, PTSD, substance use, and depression symptoms.

RESULTS

A canonical correlation analysis indicated two canonical variates accounting for significant variance between PTSD symptom clusters and parenting stress measures. The first canonical variate, primarily reflecting depressive and PTSD cognition and mood symptoms, was predominantly related to the parental distress aspect of parenting stress (40%). The second canonical variate, primarily reflecting intrusion and avoidance PTSD symptoms, was associated with increased parental perceptions of their child as difficult (10%).

CONCLUSION

Future research directions and clinical implications of these results are discussed for designing parenting interventions with mothers attending substance use treatment who present with PTSD symptoms.

The association between depression and contraceptive behaviors in a diverse sample of new prescription contraception users

OBJECTIVE

Among women initiating new prescription contraception, we investigated the relationship between recent depression and a range of contraceptive behaviors.

STUDY DESIGN

We used medical and pharmacy records of 52,325 women ages 19 to 29 who initiated prescription contraception (pills, patches or rings, injectables, and long-acting reversible contraceptives) in 2014-2016 at a large integrated healthcare system in Northern California. Women had continuous enrollment for a year before and after initiating, and no records of prescription contraceptive use in the year before initiating. Depression in the year prior to initiation was dichotomized into (1) no depression indicator (reference group) or (2) depression diagnosis or redeemed antidepressant. Multinomial logistic regression models examined the associations between depression and method type initiated, and contraceptive patterns, timing of discontinuation, inconsistent use, and switching methods over a year after initiating, adjusting for sociodemographics and testing for interactions between depression and having a recent birth or abortion.

RESULTS

Women with recent depression were more likely to initiate methods other than the pill, and the association was stronger for patches or rings vs pills among those with a recent birth compared to those without. Among women initiating all methods and the pill, those with depression were more likely to discontinue their method, use it inconsistently, and switch from it than use it continuously for a year.

CONCLUSION

Women with recent depression were less likely to initiate the pill; and when the pill was initiated, those with depression were more likely to discontinue use, use it inconsistently, and switch from it.

IMPLICATIONS

Women with recent depression indicators should be followed closely to ensure they have the support they need to meet their reproductive goals. Those who wish to avoid pregnancy may benefit from methods that do not require daily use.

Integrating Screening and Treatment of Unhealthy Alcohol Use and Depression with Screening and Treatment of Anxiety, Pain, and Other Substance Use Among People with HIV and Other High-Risk Persons

We review and synthesize results from a series of analyses estimating the benefit of screening for unhealthy alcohol use, depression, and tobacco to detect individuals at heightened risk for co-occurring anxiety, pain, depression, unhealthy alcohol use, and other substance use among people with HIV and HIV-uninfected individuals in the Veterans Aging Cohort Study. We also examine the potential impact of reducing unhealthy alcohol use and depressive symptoms on the incidence of co-occurring conditions. We found that screening for alcohol and depression may help identify co-occurring symptoms of anxiety, depression, and pain interference, treating unhealthy alcohol use may improve co-occurring pain interference and substance use, and improving depressive symptoms may improve co-occurring anxiety, pain interference, and smoking. We propose that an integrated approach to screening and treatment for unhealthy alcohol use, depression, anxiety, pain, and other substance use may facilitate diagnostic assessment and treatment of these conditions, improving morbidity and mortality.

Mental health among pregnant women with COVID-19-related stressors and worries in the United States

BACKGROUND

Few studies have evaluated whether pandemic-related stressors, worries, and social distancing have affected the mental health of pregnant women during the COVID-19 pandemic.

METHODS

Data came from an online survey of United States pregnant women (n = 715), conducted in May 2020. The Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder Scale were used to assess depressive symptoms, thoughts of self-harm, and moderate or severe anxiety. Multiple logistic regressions were used to examine the associations of COVID-19 experiences with mental health outcomes.

RESULTS

Participants were racially diverse. The prevalence of adverse mental health outcomes was 36% for probable depression, 20% for thoughts of self-harm, and 22% for anxiety. Women who reported family members dying from COVID-19 had four times higher odds of having thoughts of self-harm than women who did not experience family death. Depression was more prevalent among women who canceled or reduced medical appointments. Women were more likely to have worse mental health outcomes if they expressed worry about getting financial or emotional/social support, about their pregnancy, or about family or friends. Strict social distancing was positively associated with depression. A higher proportion of adults working from home was inversely associated with depression and thoughts of self-harm.

CONCLUSION

High percentages of pregnant women had symptoms of depression or anxiety, suggesting an urgent need to screen and treat mental health conditions among pregnant women during the pandemic. Pandemic-related risks and protective factors are relevant to developing tailored interventions to address the mental health of pregnant women during pandemic circumstances.

Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008-17

Each year approximately 700 people die in the United States from pregnancy-related complications. We describe the characteristics of pregnancy-related deaths due to mental health conditions, including substance use disorders, and identify opportunities for prevention based on recommendations from fourteen state Maternal Mortality Review Committees (MMRCs) from the period 2008-17. Among 421 pregnancy-related deaths with an MMRC-determined underlying cause of death, 11 percent were due to mental health conditions. Pregnancy-related mental health deaths were more likely than deaths from other causes to be determined by an MMRC to be preventable (100 percent versus 64 percent), to occur among non-Hispanic White people (86 percent versus 45 percent), and to occur 43-365 days postpartum (63 percent versus 18 percent). Sixty-three percent of pregnancy-related mental health deaths were by suicide. Nearly three-quarters of people with a pregnancy-related mental health cause of death had a history of depression, and more than two-thirds had past or current substance use. MMRC recommendations can be used to prioritize interventions and can inform strategies to enable screening, care coordination, and continuation of care throughout pregnancy and the year postpartum.

Virtual Engagement in a Social Media Community of Mothers With Substance Use Disorders: Content Analysis

BACKGROUND

Co-occurring substance use disorder is common among pregnant and parenting women with mental illness, but their engagement with and utilization of relevant services and treatment is low. Social media has the potential to convey benefits and facilitate engagement among this target group.

OBJECTIVE

This study aimed to explore the reach and engagement of specific social media posts among pregnant women and mothers with substance use disorders.

METHODS

Eighteen posts providing content related to substance use (cannabis, opioids, or alcohol), varying in type of content (informational or experiential) and target (policy-, practice-, or perception-related), were posted in a closed Facebook community page comprising over 33,000 pregnant women and mothers between May 2019 and October 2019.

RESULTS

The overall level of reach of these Facebook posts ranged from 453 to 3045 community members. Engagement levels, measured via the number of likes, comments, or posts shared, varied based on the type of post content (ie, informational or experiential).

CONCLUSIONS

Participation in a virtual community via social media platforms can facilitate engagement among pregnant women and mothers with mental illness by communicating relevant information about substance use, as well as potentially promoting awareness of, access to, and engagement with treatment services.

Promoting Children's Mental, Emotional, and Behavioral (MEB) Health in All Public Systems, Post-COVID-19

The COVID-19 pandemic exacerbates the mental, emotional, and behavioral (MEB) health problems of children and adolescents in the United States (U.S.). A collective and coordinated national economic and social reconstruction effort aimed at shoring up services to promote children's MEB, like the Marshall Plan that helped rebuild Europe post-World War II, has been proposed to buttress against the expected retrenchment. The plan prioritizes children's well-being as a social objective. We propose strategically reconstructing the public safety-net systems serving youth, including early education, maternal and child health, child welfare, corrections, and mental health. That plan called for a concentrated focus on coalition-building and contracting by state mental health systems to establish a foundation for an improved health system. This paper offers a complementary set of suggestions for the four non-mental health systems mentioned above by recommending actionable steps based on scientific evidence to support improved services for children at risk for MEB problems. For each system we describe examples of evidence-informed services, policies or programs that (1) prevent disabilities and promote health, (2) protect and preserve families and neighborhoods, and (3) provide quality care. Prioritizing the promotion of children's MEB health by all state systems can shape U.S. children's health and well-being for generations to come.

Maternal Substance Abuse and the Mother-Child Relationship in Late Childhood

This study examines the relationship between maternal substance abuse and various aspects of the mother-child relationship in late childhood while accounting for mental health and comorbid substance abuse and mental health among a predominantly racial minority sample. Using 369 mother-child dyads from the Rochester Intergenerational Study (64% Black, 17% Hispanic, and 8% mixed race/ethnicity), multilevel generalized linear models examined the effects of a maternal substance abuse history, a history of clinical depression, and comorbid substance abuse and depression histories on both maternal and child reports of five aspects of the mother-child relationship (i.e. warmth, consistent discipline, maternal knowledge, involvement, and conflict).

RESULTS

A maternal substance abuse history alone was unrelated to each aspect of the mother-child relationship as perceived by the mother or child, with the exception of child perceptions of maternal knowledge of behavior. Alternatively, a history of depression or comorbid histories of substance abuse and depression was negatively related to warmth, consistent discipline, involvement, and conflict but only as perceived by the mother.

CONCLUSIONS

This study reinforces the need for integrated treatment programs for women with substance use problems, particularly programs that incorporate mental health and parenting components. Moreover, it highlights specific targets for intervention that can reduce subsequent maternal substance abuse and improve offspring outcomes. The divergence in observed effects across reporter also suggests that future research should use multiple reporters to examine the interpersonal consequences associated maternal substance abuse.

The MATernaL and Infant NetworK to Understand Outcomes Associated with Treatment of Opioid Use Disorder During Pregnancy (MAT-LINK): Surveillance Opportunity

Pregnant women with opioid use disorder (OUD) are at risk of overdose, infectious diseases, and inadequate prenatal care. Additional risks include adverse pregnancy and infant outcomes, such as preterm birth and neonatal abstinence syndrome. Management and treatment of OUD during pregnancy are associated with improved maternal and infant outcomes. Professional organizations, including the American College of Obstetricians and Gynecologists, recommend offering opioid agonist pharmacotherapy (i.e., methadone or buprenorphine) combined with behavioral therapy as standard treatment for pregnant women with OUD. Other medications and herbal supplements have also been used by pregnant women for OUD. Determining which OUD treatments optimize maternal and infant outcomes is challenging given the host of potential factors that affect these outcomes. The Centers for Disease Control and Prevention initiated the MATernaL and Infant NetworK to Understand Outcomes Associated with Treatment of Opioid Use Disorder during Pregnancy (MAT-LINK) to monitor more than 2000 mothers and their infants, using data collected from geographically diverse clinical sites. Information learned from MAT-LINK will inform the future management and treatment of pregnant women with OUD.

Maternal Depression in Early Childhood and Developmental Vulnerability at School Entry

OBJECTIVES

To assess the relation between exposure to maternal depression before age 5 and 5 domains of developmental vulnerability at school entry, overall, and by age at exposure.

METHODS

This cohort study included all children born in Manitoba, Canada, who completed the Early Development Instrument between 2005 and 2016 (N = 52 103). Maternal depression was defined by using physician visits, hospitalizations, and pharmaceutical data; developmental vulnerability was assessed by using the Early Development Instrument. Relative risk of developmental vulnerability was assessed by using log-binomial regression models adjusted for characteristics at birth.

RESULTS

Children exposed to maternal depression before age 5 had a 17% higher risk of having at least 1 developmental vulnerability at school entry than did children not exposed to maternal depression before age 5. Exposure to maternal depression was most strongly associated with difficulties in social competence (adjusted relative risk [aRR] = 1.28; 95% confidence interval [CI]: 1.20-1.38), physical health and well-being (aRR = 1.28; 95% CI: 1.20-1.36), and emotional maturity (aRR = 1.27; 95% CI: 1.18-1.37). For most developmental domains, exposure to maternal depression before age 1 and between ages 4 and 5 had the strongest association with developmental vulnerability.

CONCLUSIONS

Our finding that children exposed to maternal depression are at higher risk for developmental vulnerability at school entry is consistent with previous findings. We extended this literature by documenting that the adverse effects of exposure to maternal depression are specific to particular developmental domains and that these effects vary depending on the age at which the child is exposed to maternal depression.