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Level RA, Zhang Y, Tiemeier H, Estabrook R, Shaw DS, Leve LD, Wakschlag LS, Reiss D, Neiderhiser JM, Massey SH. Unique influences of pregnancy and anticipated parenting on cigarette smoking: results and implications of a within-person, between-pregnancy study. Arch Womens Ment Health 2024; 27:301-308. [PMID: 37994923 DOI: 10.1007/s00737-023-01396-z] [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: 06/08/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Abstract
Not all pregnant individuals want to become parents and "parenting intention" can also vary within individuals during different pregnancies. Nevertheless, the potential impact of parenting intention on health-related behavior during pregnancy has been heavily underexplored. In this study, we employed a within-person between pregnancy design to estimate the effect of parenting-specific influences on smoking, separate from pregnancy-specific and individual-level influences. We quantified within-mother differences in smoking during pregnancies of infants they reared (n = 84) versus pregnancies of infants they placed for adoption at birth (n = 65) using multivariate mixed-effects Poisson regression models. Mean cigarettes/day declined as the pregnancy progressed regardless of whether infants were reared or placed. However, participants smoked fewer cigarettes/day during reared pregnancies. Relative to "adopted" pregnancies, smoking during "reared" pregnancies was lower by 24%, 41%, and 54% in first (95% CI 0.64-0.90; p = 0.001), second (95% CI 0.48-0.72; p < 0.001), and third trimesters (95% CI 0.36-0.59; p < 0.001), respectively, independent of between-pregnancy differences in maternal age, fetal sex, parity, and pregnancy complications. Female sex and nulliparity were protective. Parenting intention was associated with a protective effect on pregnancy smoking independent of pregnancy-specific influences and individual characteristics. Failure to consider the impact of parenting intention on health-related behavior during pregnancy could perpetuate an unrealistic expectation to "do what's best for the baby" and stigmatize women with unintended or unwanted pregnancies.
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Affiliation(s)
- Rachel A Level
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Yingzhe Zhang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, MA, USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois Chicago, Chicago, IL, USA
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leslie D Leve
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - David Reiss
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Jenae M Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Suena H Massey
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Caro-Cañizares I, López Carpintero N, Carmona-Camacho R. The Elephant in the Room: A Systematic Review of the Application and Effects of Psychological Treatments for Pregnant Women with Dual Pathology (Mental Health and Substance-Related Disorders). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:392. [PMID: 38673305 PMCID: PMC11050033 DOI: 10.3390/ijerph21040392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Maternal mental health and substance use, referred to as dual pathology, represent significant concerns associated with adverse pregnancy and birth outcomes, a prevalence higher than commonly anticipated. Nonetheless, a notable dearth exists ofevidence-based treatment protocols tailored for pregnant women with dual pathology. METHODS A systematic review, adhering to the PRISMA methodology, was conducted. RESULTS Out of the 57 identified papers deemed potentially relevant, only 2were ultimately included. Given the limited number of studies assessing the efficacy of psychological interventions utilizing randomized controlled trials (RCTs) for both mental health and substance misuse, and considering the diverse objectives and measures employed, definitive conclusions regarding the effectiveness of psychological interventions in this domain prove challenging. CONCLUSIONS Maternal mental health appears to be the proverbial "elephant in the room". The development of specialized and integrated interventions stands as an imperative to effectively address this pressing issue. As elucidated in the present review, these interventions ought to be grounded in empirical evidence. Furthermore, it is essential that such interventions undergo rigorous evaluation through RCTs to ascertain their efficacy levels. Ultimately, the provision of these interventions by psychology/psychiatric professionals, both within clinical practice and the RCTs themselves, is recommended to facilitate the generalizability of the results to specialized settings.
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Affiliation(s)
- Irene Caro-Cañizares
- Facultad de Ciencias de la Salud y la Educación, Universidad a Distancia de Madrid, UDIMA, 28400 Collado Villalba, Spain
| | - Nayara López Carpintero
- Departamento de Obstetricia y Ginecología, Hospital Universitario del Tajo, 28300 Aranjuez, Spain
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McNamara KA, Murnion B, Fotheringham P, Terplan M, Lintzeris N, Oei JL, Bond DM, Nassar N, Black KI. Interconnections between unintended pregnancy, alcohol and other drug use, and pregnancy, birth, infant, childhood and socioeconomic outcomes: a scoping review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202140. [PMID: 38471787 DOI: 10.1136/bmjsrh-2023-202140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
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.
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Affiliation(s)
- Kelly A McNamara
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Bridin Murnion
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Penelope Fotheringham
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- MotherSafe Counselling Service, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Mishka Terplan
- Friends Research Institute Inc, Baltimore, Maryland, USA
| | - Nicholas Lintzeris
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Ju Lee Oei
- Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Diana M Bond
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Herriott AL. "I just want the best for him." Pregnancy in the context of substance use disorders: Perspectives of postpartum women. Birth 2024; 51:81-88. [PMID: 37635414 DOI: 10.1111/birt.12761] [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: 06/17/2020] [Accepted: 07/29/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND In the United States, the incidence of substance misuse among pregnant women has been steadily increasing. While pregnant women with substance use disorder (SUD) are in critical need of support during the prenatal period, they enter prenatal care stigmatized and facing the possibility of punitive responses. Little research has been done about how women with SUDs themselves experience pregnancy and the transition to motherhood. The aim of this study was to examine women's internal experiences of pregnancy in the context of SUD. METHODS Semi-structured interviews were conducted with n = 19 postpartum women with SUD. Data were analyzed using a semantic, thematic approach. RESULTS Participants expressed their thoughts and experiences about their pregnancies in four main themes: (1) fear of harming the baby; (2) fear about child welfare involvement; (3) guilt informed by recovery stage; and (4) mixed feelings about pregnancy amidst complicated circumstances. The women expressed fear about their children's well-being, coupled with motivation to protect their child and the need for clear medical information. Their expressions of guilt depended on the severity of their SUD and their stage in recovery during their pregnancy. Women entered prenatal care with mixed emotions about their pregnancy, such as guilt and excitement, in the midst of complicated life circumstances. CONCLUSIONS These findings suggest a complexity of internal experiences for pregnant women with SUDs. Participants' feelings and experiences during pregnancy can inform practitioners' approaches to prenatal care in the context of SUDs.
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Affiliation(s)
- Anna L Herriott
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chapin Hall at the University of Chicago, University of Chicago, Chicago, Illinois, USA
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Towers EB, Williams IL, Qillawala EI, Rissman EF, Lynch WJ. Sex/Gender Differences in the Time-Course for the Development of Substance Use Disorder: A Focus on the Telescoping Effect. Pharmacol Rev 2023; 75:217-249. [PMID: 36781217 PMCID: PMC9969523 DOI: 10.1124/pharmrev.121.000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
Sex/gender effects have been demonstrated for multiple aspects of addiction, with one of the most commonly cited examples being the "telescoping effect" where women meet criteria and/or seek treatment of substance use disorder (SUD) after fewer years of drug use as compared with men. This phenomenon has been reported for multiple drug classes including opioids, psychostimulants, alcohol, and cannabis, as well as nonpharmacological addictions, such as gambling. However, there are some inconsistent reports that show either no difference between men and women or opposite effects and a faster course to addiction in men than women. Thus, the goals of this review are to evaluate evidence for and against the telescoping effect in women and to determine the conditions/populations for which the telescoping effect is most relevant. We also discuss evidence from preclinical studies, which strongly support the validity of the telescoping effect and show that female animals develop addiction-like features (e.g., compulsive drug use, an enhanced motivation for the drug, and enhanced drug-craving/vulnerability to relapse) more readily than male animals. We also discuss biologic factors that may contribute to the telescoping effect, such as ovarian hormones, and its neurobiological basis focusing on the mesolimbic dopamine reward pathway and the corticomesolimbic glutamatergic pathway considering the critical roles these pathways play in the rewarding/reinforcing effects of addictive drugs and SUD. We conclude with future research directions, including intervention strategies to prevent the development of SUD in women. SIGNIFICANCE STATEMENT: One of the most widely cited gender/sex differences in substance use disorder (SUD) is the "telescoping effect," which reflects an accelerated course in women versus men for the development and/or seeking treatment for SUD. This review evaluates evidence for and against a telescoping effect drawing upon data from both clinical and preclinical studies. We also discuss the contribution of biological factors and underlying neurobiological mechanisms and highlight potential targets to prevent the development of SUD in women.
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Affiliation(s)
- Eleanor Blair Towers
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
| | - Ivy L Williams
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
| | - Emaan I Qillawala
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
| | - Emilie F Rissman
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
| | - Wendy J Lynch
- Psychiatry and Neurobehavioral Sciences (E.B.T., I.L.W., E.I.Q., W.J.L.) and Medical Scientist Training Program (E.B.T.), University of Virginia, Charlottesville, Virginia, and Center for Human Health and the Environment and Program in Genetics, North Carolina State University, Raleigh, North Carolina (E.F.R.)
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Bruno AM, Blue NR, Allshouse AA, Haas DM, Shanks AL, Grobman WA, Simhan H, Reddy UM, Silver RM, Metz TD. Marijuana use, fetal growth, and uterine artery Dopplers. J Matern Fetal Neonatal Med 2022; 35:7717-7724. [PMID: 34470115 PMCID: PMC9080638 DOI: 10.1080/14767058.2021.1960973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Marijuana (MJ) use is associated with adverse effects on fetal growth. We aimed to investigate the timing of suboptimal fetal growth onset in MJ-exposed pregnancies. In addition, we aimed to explore the relationship between MJ-exposure and both abnormal uterine artery (UtA) Doppler parameters and small for gestational age (SGA). STUDY DESIGN This was a secondary analysis of a prospective multicenter cohort that enrolled nulliparous individuals delivering non-anomalous fetuses beyond 20 weeks' gestation. Marijuana exposure was ascertained by self-report or clinical urine toxicology testing. Ultrasound estimated fetal weights (EFWs) were assessed in participants at both 16w0d-21w6d and 22w0d-29w6d. EFWs and birth weight (BW) were converted to weight percentiles (wPCT). EFW and BW wPCTs were calculated using population-based standards. Additionally, a customized standard designed to be applicable to both EFWs and BWs within the same model was also used to allow for EFW to BW percentile trajectories. The primary outcome, longitudinal wPCT, was compared between individuals with and without MJ use in a linear mixed-effects regression model adjusting for tobacco. For modeling, wPCT was smoothed across gestational age; MJ was estimated as an intercept and linear difference in the slope of gestational age. UtA Doppler notching, resistance index (RI), and pulsatility index (PI) at 16w0d-21w6d were compared using t-test and χ2. SGA at delivery was also compared. RESULTS Nine thousand one hundred and sixty-three individuals met inclusion criteria; 136 (1.5%) used MJ during pregnancy. Individuals who used MJ were more likely to be younger, identify as non-Hispanic Black, and have had less education. Fetuses exposed to MJ had lower wPCT beginning at 28 weeks using population-based and customized standards, when compared to those without exposure. UtA notching, PI, and RI were similar between groups. SGA was more frequent in neonates exposed to MJ using both population-based (22 vs. 9%, p<.001) and customized (25 vs. 14%, p<.001) curves. CONCLUSIONS MJ-exposed fetuses were estimated to be smaller than unexposed fetuses starting at 28 weeks' gestation across both growth standards without a difference in UtA Doppler parameters.
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Affiliation(s)
- Ann M. Bruno
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Nathan R. Blue
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Amanda A. Allshouse
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - David M. Haas
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN, USA
| | - Anthony L. Shanks
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN, USA
| | - William A. Grobman
- Department of Obstetrics & Gynecology, Northwestern University, Chicago, IL, USA
| | - Hyagriv Simhan
- Department of Obstetrics & Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Uma M. Reddy
- Department of Obstetrics & Gynecology, Yale University, New Haven, CT, USA
| | - Robert M. Silver
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Torri D. Metz
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
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Massey SH, Pool LR, Estabrook R, Level RA, Shisler S, Stacks AM, Neiderhiser JM, Espy KA, Wakschlag LS, Eiden RD, Allen NB. Within-person decline in pregnancy smoking is observable prior to pregnancy awareness: Evidence across two independent observational cohorts. Addict Biol 2022; 27:e13245. [PMID: 36301213 PMCID: PMC9939010 DOI: 10.1111/adb.13245] [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] [Received: 05/11/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
Decreased consumption of nicotine and other drugs during pregnancy appears to be a cross-species phenomenon from which mechanism(s) capable of interrupting addictive processes could be elucidated. Whether pregnancy influences smoking behaviour independent of women's knowledge of the pregnancy, however, has not been considered. Using repeated measures analysis of variance (ANOVA), we estimated within-person change in mean cigarettes/day smoked across the estimated date of conception but prior to individually reported dates of pregnancy recognition using longitudinal smoking data from two independent observational cohorts, the Growing Up Healthy (GUH, n = 271) and Midwest Infant Development Studies (MIDS, n = 145). Participants smoked an average of half a pack/day in the month immediately before conception (M (SD) = 12(8.1) and 9.5(6.7) cigarettes/day in GUH and MIDS, respectively). We observed within-person declines in smoking after conception, both before (MGUH = -0.9; 95% CI -1.6, -0.2; p = 0.01; MMIDS = -1.1; 95% CI -1.9, -0.3; p = 0.01) and after (MGUH = -4.8; 95% CI -5.5, -4.1; p < 0.001; MMIDS = -3.3; 95% CI -4.4, -2.5; p < 0.001) women were aware of having conceived, even when women who had quit and women who were planning to conceive were excluded from analyses. Pregnancy may interrupt smoking-related processes via mechanisms not previously considered. Plausible candidates and directions for future research are discussed.
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Affiliation(s)
- Suena H. Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Deparment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsay R. Pool
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Deparment of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rachel A. Level
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shannon Shisler
- Research Institute on Addictions, University at Buffalo, Buffalo, New York, USA
| | - Ann M. Stacks
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, Michigan, USA
| | - Jenae M. Neiderhiser
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly A. Espy
- Department of Neuroscience, Developmental and Regenerative Biology; Department of Psychiatry and Behavioral Science, Long School of Medicine, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Lauren S. Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rina D. Eiden
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Norrina B. Allen
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Massey SH, Estabrook R, Lapping-Carr L, Newmark RL, Decety J, Wisner KL, Wakschlag LS. Are empathic processes mechanisms of pregnancy's protective effect on smoking? Identification of a novel target for preventive intervention. Soc Sci Med 2022; 305:115071. [PMID: 35660692 DOI: 10.1016/j.socscimed.2022.115071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/19/2022] [Accepted: 05/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Spontaneous cessation and reduction in smoking by pregnant women suggest that concern about others, or empathy, could be a malleable target for intervention. We examined various empathy-related processes in relations to reported and biochemically assessed smoking during pregnancy. METHODS Participants were 154 pregnant women (M = 12.4 weeks gestation, SD = 4.6) who were smoking cigarettes immediately prior to pregnancy recognition (85 had quit and 69 were still smoking at enrollment). Empathy-related processes were measured with performance-based paradigms (affect sharing, empathic concern, and theory of mind) and a speech sample (expressed emotion). Smoking was assessed with timeline follow back interviews and urine cotinine assays. Using zero-inflated Poisson regression models, we tested direct and interactive effects of empathy-related processes with respect to biologically verified smoking cessation (zero portion); and mean cigarettes/day smoked after pregnancy recognition among persistent smokers (count portion). RESULTS Affect sharing was inversely related to post-recognition cigarettes/day (B(SE) = -0.17(0.07), 95%C.I. -0.30,-0.04, p = .011) and moderated the relationship between pre-recognition smoking and post-recognition smoking consistent with a buffering effect (B(SE) = -.17(0.05); 95%C.I. - 0.28,-0.06; p = .002). Other empathy related processes showed neither direct nor interactive effects on smoking outcomes. CONCLUSIONS Further research is recommended to clarify the role of empathy in pregnancy smoking.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair Street, 19th Floor, Chicago, IL, 60611, USA.
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison Street, 1018D, Chicago, IL, 60607, USA
| | - Leiszle Lapping-Carr
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Rebecca L Newmark
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA; University of California San Francisco School of Medicine, 513 Parnassus Ave, Suite S-224, San Francisco, CA, 94143, USA
| | - Jean Decety
- Department of Psychology, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5848 South University Avenue, Chicago, IL, 60637, USA
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair Street, 19th Floor, Chicago, IL, 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan, Suite 2100, Chicago, IL, 60611, USA
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9
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Symons M, Finlay-Jones A, Meehan J, Raymond N, Watkins R. Nurturing families: One year pilot outcomes for a modified Parent Child Assistance Program in Australia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000580. [PMID: 36962438 PMCID: PMC10022323 DOI: 10.1371/journal.pgph.0000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 07/11/2022] [Indexed: 11/18/2022]
Abstract
Alcohol and Other Drug (AOD) exposure during pregnancy is linked to serious adverse child outcomes, including Fetal Alcohol Spectrum Disorder (FASD). The Parent-Child Assistance Program (PCAP) supports women with problematic AOD use, who are pregnant or have young children, and are not effectively engaging with services. PCAP has been shown to reduce alcohol exposed pregnancies, promote AOD abstinence, increase employment and family planning and improve child outcomes. This manuscript reports the first pilot evaluation of the PCAP program delivered in Australia. A pre-post-intervention repeated measures design was used. Eleven women receiving PCAP from a not-for-profit organisation were invited to take part in the study, with eight providing complete pre-post data. Home visitation case management was provided by trained and experienced case-managers. Clients were assisted to engage with existing services effectively to meet their own goals via a combination of relational theory, motivational interviewing and harm reduction concepts. The PCAP Modified Addiction Severity Index 5th Edition was adapted for use in Australia and was used to measure domains of addiction severity related problems as the primary outcome. Secondary outcomes included client satisfaction and program fidelity. There were significant changes in composite addiction severity scores from baseline to one year. 80% of participants had periods of abstinence of longer than four months. All clients had better connection to services, no subsequent AOD exposed pregnancies, and were highly satisfied with the program. Four had children returned to their care. Implementation was similar to the original PCAP program with major differences including case-managers relying on training manuals only without undertaking in-person training; being more experienced; providing more direct AOD counselling; and having less supervision. The findings will inform future program delivery and methodology for a larger longitudinal study assessing outcomes at program exit.
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Affiliation(s)
- Martyn Symons
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, West Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Amy Finlay-Jones
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, West Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | | | - Rochelle Watkins
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, West Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
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Sommer JL, Shamblaw A, Mota N, Reynolds K, El-Gabalawy R. Mental disorders during the perinatal period: Results from a nationally representative study. Gen Hosp Psychiatry 2021; 73:71-77. [PMID: 34624829 DOI: 10.1016/j.genhosppsych.2021.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study examined mental health profiles of pregnant and postpartum females, with and without perinatal complications, compared to non-perinatal females of childbearing age. METHODS We analyzed nationally representative data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309; 51.9% female). A validated semi-structured interview assessed past-year DSM-5 mental disorders. Multivariable regressions examined associations between perinatal status and mental disorders, controlling for sociodemographic characteristics. RESULTS Using females who were not pregnant in the past year as a reference group, those who were postpartum with complications during pregnancy or delivery had increased odds of any past-year mental disorder (58.7% vs. 46.8%; AOR = 1.56), any depressive/bipolar disorder (26.4% vs. 18.8%; AOR = 1.57), and posttraumatic stress disorder (14.0% vs. 7.3%; AOR = 1.99). In contrast, those who were postpartum without complications did not have increased odds of these disorders. Those who were pregnant without pregnancy complications had reduced odds of any past-year mental disorder (33.7% vs. 46.8%; AOR = 0.55) and any depressive/bipolar disorder (11.7% vs. 18.8%; AOR = 0.60). All perinatal groups had reduced odds of any substance use disorder compared to those who were not pregnant in the past year (18.9-25.7% vs. 29.8% AORs: 0.49-0.78), except those who were postpartum with pregnancy or delivery complications (28.8%). CONCLUSION Results highlight the importance of mental health screening among perinatal females, particularly those who are postpartum and experience perinatal complications. Findings may inform the development of targeted interventions for this subpopulation.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda Shamblaw
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
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11
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Continuation in Treatment and Maintenance of Custody of Newborns After Delivery in Women With Opioid Use Disorder. J Addict Med 2021; 14:119-125. [PMID: 30946092 DOI: 10.1097/adm.0000000000000534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify variables associated with continuation in treatment and maintenance of custody after pregnancies in women with opioid use disorder (OUD). METHODS The medical records of pregnant women with documented OUD from 2011 to 2018 and with at least 6 months follow-up postpartum were retrospectively reviewed. RESULTS Via multivariate analysis, women on opioid maintenance therapy (OMT) were more likely to continue in treatment and maintain custody, whereas women enrolled in a residential treatment program during pregnancy were less likely to continue in treatment or maintain custody. Women who continued in treatment were significantly more likely to maintain custody of their children than those who did not. CONCLUSIONS Continuation in treatment and maintenance of custody were closely related. Care providers should attempt to improve both outcomes.
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12
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Byatt N, Masters GA, Bergman AL, Moore Simas TA. Screening for Mental Health and Substance Use Disorders in Obstetric Settings. Curr Psychiatry Rep 2020; 22:62. [PMID: 32936340 DOI: 10.1007/s11920-020-01182-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW The objective of this review is to describe the extent to which (1) obstetric settings are currently screening for mental health and substance use disorders and social determinants of health (SDoH), and (2) screening is followed by systematic approaches for ensuring an adequate response to positive screens. Additionally, clinical and policy implications of current screening practices and recommendations are discussed. RECENT FINDINGS Screening for perinatal depression in obstetric settings has increased. Despite their prevalence and negative impact, screening for other mental health and substance use disorders and SDoH is much less common and professional society recommendations are either nonexistent, less consistent, or less prescriptive. To truly address maternal mental health, we need to move beyond focusing solely on depression and address other mental health and substance use disorders and the contextual social determinants in which they occur.
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Affiliation(s)
- Nancy Byatt
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Grace A Masters
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Aaron L Bergman
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Medical School and UMass Memorial Health Care, 55 Lake Ave North, Worcester, MA, 01655, USA
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13
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Affiliation(s)
- Claire A Wilson
- Section of Women's Mental Health, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emily Finch
- South London and Maudsley NHS Foundation Trust, London, UK
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14
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Yonkers KA, Dailey JI, Gilstad-Hayden K, Ondersma SJ, Forray A, Olmstead TA, Martino S. Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions. J Subst Abuse Treat 2020; 113:107995. [PMID: 32359666 DOI: 10.1016/j.jsat.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services. Women who screened positive for substance use were randomly assigned to either clinician-administered SBIRT, an electronically-administered brief intervention (e-SBIRT), or an enhanced usual care condition. At a 6-month follow-up assessment, compared to enhanced usual care, the clinician-administered SBIRT increased 1-month point prevalence of abstinence from the primary substance by 7.7%, and e-SBIRT increased abstinence by 12.8%. Both brief interventions were more useful than enhanced usual care and could increase substance use abstinence rates among women in reproductive healthcare clinics. The electronic brief intervention is particularly attractive given that it appears as efficacious as, but requires fewer resources than, clinician-delivered brief interventions.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06510, USA.
| | - Jason I Dailey
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Steven J Ondersma
- Wayne State University, Merrill Palmer Skillman Institute, 71 E. Ferry Ave, Detroit, MI 48202, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Todd A Olmstead
- University of Texas at Austin, PO Box Y, Austin, TX 78713, USA.
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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15
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Maternal drug-related death and suicide are leading causes of postpartum death in California. Am J Obstet Gynecol 2019; 221:489.e1-489.e9. [PMID: 31173749 DOI: 10.1016/j.ajog.2019.05.045] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Reducing maternal mortality is a priority in the United States and worldwide. Drug-related deaths and suicide may account for a substantial and growing portion of maternal deaths, yet information on the incidence of and sociodemographic variation in these deaths is scarce. OBJECTIVE We sought to examine incidence of drug-related and suicide deaths in the 12 months after delivery, including heterogeneity by sociodemographic factors. We also explored maternal decedents' health care utilization prior to death. STUDY DESIGN This retrospective, population-based cohort study followed up 1,059,713 women who delivered a live-born infant in California hospitals during 2010-2012 to ascertain maternal death. Analyses were conducted using statewide, all-payer, longitudinally-linked hospital and death data. RESULTS A total of 300 women died during follow-up, a rate of 28.33 deaths per 100,000 person-years. The leading cause of death was obstetric-related problems (6.52 per 100,000 person-years). Drug-related deaths were the second leading cause of death (3.68 per 100,000 person-years), and suicide was the seventh leading cause (1.42 per 100,000 person-years); together these deaths comprised 18% of all maternal deaths. Non-Hispanic white women, Medicaid-insured women, and women residing in micropolitan areas were especially likely to die from drugs/suicide. Two thirds of women who died, including 74% of those who died by drugs/suicide, made ≥1 emergency department or hospital visit between their delivery and death. CONCLUSION Deaths caused by drugs and suicide are a major contributor to mortality in the postpartum period and warrant increased clinical attention, including recognition by physicians and Maternal Mortality Review Committees as a medical cause of death. Importantly, emergency department and inpatient hospital visits may serve as a point of identification of, and eventually prevention for, women at risk for these deaths.
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Rutherford HJV, Mayes LC. Parenting stress: A novel mechanism of addiction vulnerability. Neurobiol Stress 2019; 11:100172. [PMID: 31193862 PMCID: PMC6543178 DOI: 10.1016/j.ynstr.2019.100172] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/10/2019] [Accepted: 05/15/2019] [Indexed: 02/03/2023] Open
Abstract
Addiction remains a significant public health concern. Despite numerous public health initiatives, many parents continue to use substances during the prenatal and postpartum period. While stress has been implicated in the maintenance of substance use disorders more generally, we propose that parenting stress specifically increases vulnerability to substance use in adults caring for young children. To explore this notion, we first consider the neurobiology of the adult transition to parenthood and the value of adopting a parenting-specific approach to understanding addictive processes. Next, we consider the neurobiology of addiction and parenting before directly addressing parenting stress in the context of addiction. Finally, we describe current interventions with parents that incorporate the management of negative affect to enhance caregiving quality and decrease substance use. Taken together, this article proposes that the unique demands of caring for a developing child may be more stressful above and beyond other forms of stress. As a consequence, intervention approaches that target stress in the parenting role hold promise for decreasing parental substance abuse.
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17
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Mota NP, Chartier M, Ekuma O, Nie Y, Hensel JM, MacWilliam L, McDougall C, Vigod S, Bolton JM. Mental Disorders and Suicide Attempts in the Pregnancy and Postpartum Periods Compared with Non-Pregnancy: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:482-491. [PMID: 30895808 PMCID: PMC6610562 DOI: 10.1177/0706743719838784] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the rate of mental disorders (i.e., mood and anxiety, substance use, psychotic disorders) and suicide attempts within the same group of women across the pre-pregnancy, pregnancy, and postpartum periods, and between this perinatal cohort and a non-perinatal reference group. METHOD Data were from an administrative repository of residents in Manitoba, Canada. The perinatal cohort consisted of women aged 18 to 45 years who experienced >1 live birth pregnancy between 2011 and 2014 (n = 45,362). Pre-pregnancy, pregnancy, and postpartum periods were defined over consecutive 40-week intervals. The non-perinatal cohort consisted of age-matched women with no pregnancies during the same period (n = 139,705). A reference 40-week interval was defined from the individual's birthdate in the year they entered the cohort. Rate ratios of diagnosed mental disorders were adjusted (aRR) for demographic factors, parity, and mental health history. RESULTS Within the perinatal cohort, pregnancy was associated with a lower rate of diagnosed mood or anxiety disorder, substance use disorder, and suicide attempt relative to pre-pregnancy (aRR range, 0.22-0.82). Pregnancy also had lower rates of all outcomes compared with the postpartum period (aRR, 0.44-0.87). Postpartum had a higher rate of psychotic disorder compared with pre-pregnancy (aRR, 1.61; 95% CI, 1.17-2.21), but a lower rate of mood or anxiety disorder and suicide attempt. Compared with non-perinatal women, pregnancy was associated with lower rates of all outcomes (aRR range, 0.25-0.87). CONCLUSIONS Compared with a non-perinatal period, the rate of a diagnosed mental disorder is lower during pregnancy but begins to rise in the postpartum period, highlighting an important period for early identification and rapid access to intervention.
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Affiliation(s)
- Natalie P Mota
- 1 Departments of Clinical Health Psychology and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- 2 Department of Community Health Sciences, University of Manitoba.,3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- 3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Yao Nie
- 3 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Jennifer M Hensel
- 4 Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Simone Vigod
- 5 Department of Psychiatry, Women's College Hospital and Research Institute, Institute for Clinical Evaluative Sciences, the University of Toronto, Toronto, Ontario, Canada
| | - James M Bolton
- 6 Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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18
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Obstetric patients' perspectives on functional magnetic neuroimaging research in pregnant women. Arch Womens Ment Health 2019; 22:115-118. [PMID: 29687161 PMCID: PMC6500439 DOI: 10.1007/s00737-018-0846-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/04/2018] [Indexed: 12/14/2022]
Abstract
Magnetic resonance neuroimaging (MRI) studies of healthy pregnant women could identify key mechanisms of spontaneous health behavior changes observed in expectant mothers as novel intervention targets, but are currently unprecedented. As balancing potential benefits of research with unknown risks, including participant perceptions of risk, is foundational to ethical conduct, we surveyed a convenience obstetric sample to understand pregnant women's perspectives on this issue. Respondents were 76 pregnant women (modal age of 30-39 years; 64% multiparous) presenting for obstetric care from April to June 2016 at privately and publicly funded clinics at an urban academic medical center in the Midwestern USA. Following a written description about functional magnetic resonance neuroimaging (fMRI) and its known and unknown risks, women were queried on their willingness to participate in a hypothetical study involving fMRI during pregnancy, and specific concerns about doing so, if hesitant or unwilling. Willingness to participate was "yes" (28.4%, n = 21), "maybe" (28.4%, n = 21), and "no" (43.2%, n = 32). Among those responding "maybe" or "no" (n = 53, 73.6%), 11 women (20.7%) articulated concern about the fetus. Other concerns expressed were time commitment (n = 11, 20.7%) and discomfort being in an MRI machine (n = 4; 7.5%). Pregnant women may be open to participating in research involving MRI provided concerns about fetal health, time, and personal comfort are addressed.
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19
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Edwards AC, Ohlsson H, Svikis DS, Sundquist J, Sundquist K, Kendler KS. Protective Effects of Pregnancy on Risk of Alcohol Use Disorder. Am J Psychiatry 2019; 176:138-145. [PMID: 30486670 PMCID: PMC6358475 DOI: 10.1176/appi.ajp.2018.18050632] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The authors sought to clarify the etiology of the association between pregnancy and reduced risk of alcohol use disorder. METHODS The authors used data from longitudinal population-wide Swedish medical, pharmacy, and criminal registries to evaluate whether rates of alcohol use disorder are lower during pregnancy. They compared pregnant women born between 1975 and 1992 (N=322,029) with matched population controls, with female relatives discordant for pregnancy, and with pre- and postpregnancy periods within individuals. They further compared rates of alcohol use disorder between pregnant women and their partners. RESULTS Pregnancy was inversely associated with alcohol use disorder across all analyses (odds ratios, 0.17-0.32). In co-relative analyses, the strength of the association increased among more closely related individuals. Within individuals, rates of alcohol use disorder were substantially decreased during pregnancy relative to the prepregnancy period (odds ratios, 0.25-0.26), and they remained reduced during postpartum periods (odds ratios, 0.23-0.31). Results were similar for second pregnancies (odds ratio, 0.23). The partners of pregnant women also exhibited reductions in alcohol use disorder (odds ratio, 0.45). Among women who became pregnant at earlier ages and those with a history of criminal behavior, the negative association between pregnancy and alcohol use disorder was especially pronounced, but no moderation was observed for a personal or maternal parental history of alcohol use disorder. CONCLUSIONS The findings suggest that pregnancy plays a critical, and likely causal, motivational role in reducing alcohol use disorder risk among women and, to a lesser extent, their partners. These results extend our understanding of the relationship between pregnancy and alcohol use, demonstrating that even a severe condition such as alcohol use disorder is subject to the protective effects of pregnancy.
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Affiliation(s)
- Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US,Corresponding author: Alexis C. Edwards; VCU, PO Box 980126, Richmond, VA, 23298-0126; Ph: +1 804-828-8591; Fax: +1 804-828-1471;
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Dace S. Svikis
- Departments of Psychology, Psychiatry, and Obstetrics/Gynecology, Virginia Commonwealth University, Richmond, VA, US
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden,Icahn School of Medicine at Mount Sinai, New York, NY, US,These authors jointly supervised this work
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, US,These authors jointly supervised this work
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Massey SH, Mroczek DK, Burns JL, Clark CAC, Espy KA, Wakschlag LS. Positive parenting behaviors in women who spontaneously quit smoking during pregnancy: Clues to putative targets for preventive interventions. Neurotoxicol Teratol 2018; 67:18-24. [PMID: 29501649 PMCID: PMC5970967 DOI: 10.1016/j.ntt.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND While the majority of pregnant smokers do not respond to intervention, little is known about how a subset of pregnant smokers known as spontaneous quitters achieve sustained biologically-confirmed abstinence through delivery in the absence of intervention. We explore a developmental framework to address this question by viewing spontaneous quitting as an adaptive parenting behavior, facilitated by abilities necessary for sensitive parenting, or responsiveness. Utilizing existing data, we examined responsiveness from parenting assessments in women who exhibited a variety of smoking patterns during pregnancy, including spontaneous quitting. METHODS Participants were N = 305 pregnant women assessed for smoking prospectively and biochemically at 16 weeks, 28 weeks, delivery, and 4 weeks postpartum, then reassessed with their children 5 years later with directly-observed home- and lab-based measures of parenting. We used linear regression analysis to compare spontaneous quitters with women who exhibited other prenatal smoking patterns on parenting responsiveness, controlling for potential confounders. RESULTS In home-based observations, spontaneous quitters (n = 22) exhibited greater responsiveness with their children relative to intermittent pregnancy smokers [n = 70; β = 0.258, p = .022]; persistent pregnancy smokers [n = 66; β = 0.228, p = .040]; former smokers (quit before pregnancy) [n = 78; β = 266, p = .028]; and never smokers [n = 69; β = 0.312, p = .009]. Hypothesized differences were not observed in lab-based and self-report measures. CONCLUSIONS Putative protective characteristics in spontaneous quitters were captured in mother-child interactions at home, but not in lab-based and maternal report measures of responsiveness. Specification of these characteristics using prospective designs that oversample for spontaneous quitters is recommended to enable translation to preventive interventions.
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Affiliation(s)
- Suena H Massey
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Suite 1000, Chicago, IL 60611, USA; Institute for Innovations in Developmental Sciences, Northwestern University, 633 N Saint Clair, 19th Floor, Chicago, IL 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair, 19th Floor, Chicago, IL 60611, USA.
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair, 19th Floor, Chicago, IL 60611, USA.
| | - James L Burns
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair, 19th Floor, Chicago, IL 60611, USA.
| | - Caron A C Clark
- Department of Educational Psychology, University of Nebraska - Lincoln, 241 Teachers College Hall, Lincoln, NE 68588-0308, USA.
| | - Kimberly A Espy
- Department of Psychology, University of Arizona, 1503 E University Blvd., P.O. Box 210068, Tucson, AZ 85721, USA; Department of Psychiatry, University of Arizona, 1503 E University Blvd., P.O. Box 210068, Tucson, AZ 85721, USA.
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, 633 N Saint Clair, 19th Floor, Chicago, IL 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair, 19th Floor, Chicago, IL 60611, USA; Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL 60208, USA.
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The Impact of Early Substance Use Disorder Treatment Response on Treatment Outcomes Among Pregnant Women With Primary Opioid Use. J Addict Med 2018. [PMID: 29538089 DOI: 10.1097/adm.0000000000000397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study examined the impact of early patient response on treatment utilization and substance use among pregnant participants enrolled in substance use disorder (SUD) treatment. METHODS Treatment responders (TRs) and treatment nonresponders (TNRs) were compared on pretreatment and treatment measures. Regression models predicted treatment utilization and substance use. RESULTS TR participants attended more treatment and had lower rates of substance use relative to TNR participants. Regression models for treatment utilization and substance use were significant. Maternal estimated gestational age (EGA) and baseline cocaine use were negatively associated with treatment attendance. Medication-assisted treatment, early treatment response, and baseline SUD treatment were positively associated with treatment attendance. Maternal EGA was negatively associated with counseling attendance; early treatment response was positively associated with counseling attendance. Predictors of any substance use at 1 month were maternal education, EGA, early treatment nonresponse, and baseline cocaine use. The single predictor of any substance use at 2 months was early treatment nonresponse. Predictors of opioid use at 1 month were maternal education, EGA, early treatment nonresponse, and baseline SUD treatment. Predictors of opioid use at 2 months were early treatment nonresponse, and baseline cocaine and marijuana use. Predictors of cocaine use at 1 month were early treatment nonresponse, baseline cocaine use, and baseline SUD treatment. Predictors of cocaine use at 2 months were early treatment nonresponse and baseline cocaine use. CONCLUSIONS Early treatment response predicts more favorable maternal treatment utilization and substance use outcomes. Treatment providers should implement interventions to maximize patient early response to treatment.
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Massey SH, Wisner KL. Understanding Pregnancy's Protective Effect on Drug Use Within a Developmental Framework. Am J Psychiatry 2018; 175:286-287. [PMID: 29490492 PMCID: PMC5920682 DOI: 10.1176/appi.ajp.2017.17101099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Suena H. Massey
- From the Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago
| | - Katherine L. Wisner
- From the Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago
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