Preconception Substance Use and Risk of Unintended Pregnancy: Pregnancy Risk Assessment Monitoring System 2016-17

Pregnancy intention, preconception health, health behaviours, and information and health advice seeking among expectant male partners

BACKGROUND

Attempting pregnancy as a conscious decision (pregnancy intention) can impact the likelihood that a future parent receives or seeks preconception health information, initiates discussions with health professionals, and ultimately optimises their health and behaviours in preparation for healthy pregnancy and child. Knowledge about the relationship between men's preconception health behaviours and their pregnancy intention is only emerging.

METHODS

This study aimed to describe the preconception health status, behaviours, information- and advice-seeking of male expectant partners, and to explore differences in these preconception factors based on pregnancy intention. An online retrospective cross-sectional survey was completed by male reproductive partners of pregnant females. Their pregnancy intention was assessed using the London Measure of Unplanned Pregnancy (LMUP). Participants were recruited via social media and all variables were self-reported by expectant partners. Chi-square tests examined differences by LMUP categories (planned or ambivalent/unplanned).

RESULTS

Of 156 expectant partners who consented to survey participation, 138 completed all LMUP questions and were included in analysis. Most expectant partners reported their partner's current pregnancy as planned (n = 90;65.2%), less than half reported looking for and finding information about becoming pregnant (40.0%). Expectant partners with planned pregnancy more often reported physical exercise three months before pregnancy compared with partners with unplanned/ambivalent pregnancy (p = 0.001). Expectant partners with ambivalent/unplanned pregnancy more often experienced longstanding illness, disability, or infirmity (p = 0.002) or disregarded contraception (p < 0.001). Despite perceiving good or excellent health, and undertaking physical exercise, numerous expectant partners with planned pregnancy had overweight. Further research exploring the reproductive life plan process for males with longstanding chronic illness or disability may help promote pregnancy planning and preconception health amongst this sub-population.

CONCLUSIONS

Further large-scale studies are needed to enable clinicians to better understand pregnancy intentions and preconception health of males and for policy makers to formulate health policies aimed at supporting male preconception health and awareness.

Effect of E-learning clinical management of substance-dependent pregnant women on the knowledge and clinical skill performance of midwives: a randomized controlled trial

BACKGROUND

Drug use during pregnancy and post-partum undoubtedly significantly affects maternal and infant morbidity. Healthcare providers, especially midwives who care for pregnant and postpartum women, must possess adequate knowledge and clinical skills to manage their patients appropriately. This study aimed to determine the effect of an e-learning intervention on midwives' knowledge and clinical performance skills in caring for substance-dependent pregnant women during labor and post-partum.

METHODS

A randomized controlled trial based on e-learning was conducted in Shiraz, Iran. One hundred midwives working in governmental maternity hospitals were recruited and randomly assigned to the intervention (n = 50) or control (n = 50) group through blocked randomization. The intervention group underwent e-learning for 4 weeks on clinical considerations during labor and post-partum of substance-dependent mothers. The control group received no educational intervention from the research group. Pre-test, post-test, and one-month retention tests included a knowledge assessment questionnaire and an objective structured clinical examination test to assess clinical skill performance in both groups. The data were analyzed using SPSS 16 software at a significance level of P < .05. Analysis of variance with repeated measures was used to compare the mean data between and within the groups.

RESULTS

A total of 93 midwives with a mean age of 36.78 ± 8.06 years were recruited and randomly assigned to the control group (n = 47) and the intervention group (n = 46). Seven midwives dropped out for different reasons. Immediately after and one month after the intervention, both the level of knowledge and the level of clinical skill performance of the midwives in the intervention group increased compared to those before the intervention (P < .001) and compared to those in the control group (P < .001). The knowledge of the intervention group in the one-month retention test was significantly reduced compared to that immediately after the intervention (P < .001), but clinical skill performance in the intervention group at one month after the intervention was not significantly different from that immediately after the intervention (P = 1.00).

CONCLUSIONS

E-learning about clinical considerations during labor and post-partum in substance-dependent mothers can be an effective way to improve midwives' knowledge and clinical skill performance. Although knowledge decreased one month after training, clinical skill performance improved.

TRIAL REGISTRATION

http://www.irct.ir/ , IRCT20180928041164N1 registered November 13, 2018.

Navigating recovery while postpartum: examining the relationship between maternal functioning and substance use disorders

Our current understanding of postpartum people's functioning while managing substance use disorder (SUD) recovery is limited. This study explored whether having a SUD impacts maternal functioning and examined the reliability of the Barkin Index of Maternal Functioning (BIMF) in postpartum people with SUDs. We conducted a prospective, cross-sectional survey (n = 141) by administering the BIMF and a demographic questionnaire with a sample of postpartum people with SUD (n = 48) and a comparative sample of postpartum people without SUD (n = 93). The internal reliability (Cronbach's alpha = .86) was consistent with previous studies. SUD diagnosis was significantly associated with lower functioning, with individuals in the SUD group having an 8-point lower BIMF score compared to persons without SUDs, although both groups reported moderately high BIMF scores (>80). While not statistically significant, participants with SUDs had reduced functioning scores over time. Considering the increasing rate of overdose deaths in postpartum persons, further examination of functioning in postpartum persons with SUDs is warranted. Integration of the BIMF into SUD screening and treatment can provide a holistic view of postpartum experiences in this high-risk population and serve as a unique tool to understand the needs of new mothers navigating SUD recovery.

Planning postpartum contraception for women with substance use disorders: Utilisation of the birth admission

BACKGROUND

Women with substance use disorders (SUD) use less contraception, and experience higher rates of unintended pregnancy, compared to women without SUD. Contraception is discussed at the six-week postnatal appointment, which many women with SUD do not attend. Therefore, it is important women have the opportunity to formulate contraception plans before discharge from the birth admission.

AIMS

To assess postpartum contraception plans, including initiation and method of interest, among women with SUD and compare these to women without SUD.

MATERIALS AND METHODS

All births from January 2011 to September 2019 from one New South Wales local health district were analysed. Data included maternal demographics, SUD, and contraception plans. Chi-squared statistics and multivariate multinomial regression analyses were used to compare outcomes for women with and without SUD.

RESULTS

Of 59 195 mothers, 429 (0.7%) had a SUD. There were 50.1% of women with SUD and 56.2% without SUD (P = 0.03) who had no documented plan for contraception. There were 37.3% of women with SUD and 42.4% without SUD (P = 0.06) who had a prescription for contraception or a referral to discuss contraception. There were 12.5% of women with SUD and 1.4% without SUD (P < 0.001) who initiated contraception in hospital.

CONCLUSIONS

Although postpartum contraception initiation was higher among women with SUD, half of all women (with or without SUD) were discharged without a plan for contraception initiation. Embedding provision of postpartum contraception into maternity care, or investigating other opportunities, may improve access for all women, including those with SUD.

Interconnections between unintended pregnancy, alcohol and other drug use, and pregnancy, birth, infant, childhood and socioeconomic outcomes: a scoping review

BACKGROUND

Unintended pregnancy (UIP) and substance use disorder share underlying root causes with similar impacts for women and their offspring in pregnancy, birth and beyond. Furthermore, intoxication with alcohol and other drugs (AOD) increases the risk of UIP.

OBJECTIVES

To assess the available evidence on associations between UIP and health, social and economic outcomes, in women who use AOD.

SEARCH STRATEGY

The review utilised the Joanna Briggs Institute Methodology for Scoping Reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. The search was conducted across multiple databases, including Scopus and Medline, and limited to studies published between January 2000 to June 2023.

SELECTION CRITERIA

Studies reporting on interactions between AOD use and UIP, and pregnancy, birth, infant, childhood, social or economic outcomes. All patterns and types of AOD use, except isolated use of tobacco, were included. Studies were available in English and conducted in high-income countries.

DATA COLLECTION AND ANALYSIS

Selected articles were reviewed, and data collected by two independent reviewers using a standardised data extraction sheet. Findings were summarised and reported descriptively.

MAIN RESULTS

A total of 2536 titles and abstracts were screened, 97 full texts were reviewed, and three studies were selected for inclusion in the scoping review. There was heterogeneity in types and patterns of AOD use, differences in study design and tools to assess pregnancy intention, and each focused on disparate outcomes. No study assessed or reported on birth outcomes.

CONCLUSION

There is a paucity of data examining the intersection between AOD use and UIP and further research is needed.

Exploring the harm reduction paradigm: the role of Board-Certified Psychiatric Pharmacists

Deaths related to opioid overdoses continue to climb, and there remains a need for innovative strategies to address this ongoing crisis. Harm reduction (HR), a nonjudgmental philosophy aimed at reducing consequences associated with drug use and other potentially unsafe behavior, has emerged as a compassionate and effective approach. Harm reduction further emphasizes overdose prevention and fosters a shift in perspective that recognizes substance use disorder as a disease and not a moral failing. The tenets of HR collectively advocate for the well-being of individuals who use substances and support any positive change as defined by the individual. Given the high rate of morbidity and mortality associated with substance misuse and barriers or ambivalence to receiving treatment, awareness of and advocacy for HR practice is essential. This manuscript aims to describe evidence-based HR interventions, provide a foundation for the implementation of services, and further promote the importance of providing humanistic care without judgment. As valued members of the multidisciplinary treatment team, Board-Certified Psychiatric Pharmacists should implement and engage in HR services in the settings where people with substance use disorders receive care.

Contraception use among individuals with substance use disorder increases tenfold with patient-centered, mobile services: a quasi-experimental study

BACKGROUND

Individuals with substance use disorders (SUD) have disproportionately high rates of unintended pregnancy. Reducing harm associated with this risk and its biopsychosocial consequences requires evidence-based, non-coercive interventions that ensure access to contraception for individuals who choose to prevent pregnancy. We examined feasibility and impact of SexHealth Mobile, a mobile unit-based intervention that aimed to increase access to patient-centered contraceptive care for individuals in SUD recovery programs.

METHODS

We conducted a quasi-experimental study (enhanced usual care [EUC] followed by intervention) at three recovery centers with participants (n = 98) at risk for unintended pregnancy. EUC participants were offered printed information on community locations where they could access contraception care. SexHealth Mobile participants were offered same-day, onsite clinical consultation on a medical mobile unit and contraception if desired. The primary outcome was use of contraception (hormonal or intrauterine device) at one-month post-enrollment. Secondary outcomes were at two-weeks and three-months. Confidence in preventing unintended pregnancy, reasons for non-use of contraception at follow-up, and intervention feasibility were also assessed.

RESULTS

Participants (median age = 31, range 19-40) enrolled in the intervention period were almost 10 times more likely to be using contraception at one-month (51.5%) versus the those enrolled in the EUC period (5.4%) (unadjusted relative risk [URR] = 9.3 [95%CI: 2.3-37.1]; adjusted relative risk [ARR] = 9.8 [95%CI: 2.4-39.2]). Intervention participants were also more likely to be using contraception at 2-weeks (38.7% vs. 2.6%; URR = 14.3 [95%CI: 2.0-104.1]) and three-months (40.9% vs. 13.9%; URR = 2.9 [95% CI: 1.1-7.4]). EUC participants reported more barriers (cost, time) and less confidence in preventing unintended pregnancies. Mixed-methods feasibility data indicated high acceptability and feasible integration into recovery settings.

CONCLUSIONS

Mobile contraceptive care based on principles of reproductive justice and harm reduction reduces access barriers, is feasible to implement in SUD recovery settings, and increases contraception use. Expanding interventions like SexHealth Mobile may help reduce harm from unintended pregnancies among individuals in SUD recovery. Trial Registration NCT04227145.