Partnering for the future clinic: A multidisciplinary perinatal substance use program.

OBJECTIVE: The current model of obstetric care does not integrate multiple subspecialty services for high-risk pregnancies with substance use disorder (SUD), resulting in fragmented care. We describe the framework of our multidisciplinary and integrated perinatal substance use clinic and provide recent clinical outcomes. METHODS: We detail the Partnering for the Future (PFF) clinic, which integrates numerous subspecialty and support services for patients with SUDs and complex mental health needs. Additionally, a retrospective chart review of patients receiving care in the PFF clinic from 2017 to 2021 was completed. RESULTS: Seven integrated services are detailed with a focus on reducing stigma, providing trauma-informed care and mitigating harm. During the study period, 182 patients received care in PFF clinic, with opioid use disorder the most common indication for care. Co-occurring mental illness was common (81%). NICU admissions and severe NOWS diagnosis declined after the implementation of Eat-Sleep-Console. Social services identified care coordination, transportation assistance and adjustment counseling as the most common needs. A novel virtual behavioral health consultation service was successfully launched. CONCLUSIONS: Our integrated care model supports the holistic care of pregnant people with SUD and mental health disease. Patient-centered care and co-located services have improved perinatal outcomes, particularly for opioid-exposed pregnancies.

The Association of Religion and Spirituality with Postpartum Mental Health in Women with Childhood Maltreatment Histories.

OBJECTIVES: Although the associations between religion and spirituality and mental health and trauma have been studied extensively across various populations, relatively few studies have focused on the postpartum period. This study aimed to shed light on specific domains of religiosity and spirituality that may be resiliency factors for positive postpartum adjustment defined as low depression and high quality of life in mothers oversampled for childhood trauma histories. METHODS: We examined several religion and spirituality variables among 108 women at 6 months postpartum as well as prospective relations from religion and spirituality to postpartum depression and quality of life at 12 and 15 months postpartum. RESULTS: We found that the personal aspects of self-forgiveness and forgiveness for others were most relevant as resiliency factors predicting lower postpartum depression and better quality of life even when controlling for other risks (trauma and demographics). Surprisingly, no other religion and spirituality domain had associations with postpartum depression or quality of life, with the exception of a significant negative association for organizational religiousness with quality of life at 12 months postpartum. CONCLUSIONS: Our findings suggest that forgiveness, especially to self and to others, in women who have been physically and mentally hurt as children may be associated with mental wellness and quality of life in the late postpartum period. Further, our results point to the need to study specific religion and spirituality aspects in the context of specific populations and conditions instead of generally studying religion and spirituality as a common marker for coping.

Guideline adherence for mentally ill reproductive-aged women on treatment with valproic acid: a retrospective chart review.

OBJECTIVE: Valproic acid (VPA) use during pregnancy increases fetal risk of major congenital malformations and cognitive impairment. Given these risks, several medical societies have put forth guidelines suggesting to either limit the use of VPA or take certain precautions, such as making sure effective contraception practices and/or appropriate folic acid supplementation are in place, when treating reproductive-aged women. Our study aimed to review and assess adherence to these guidelines. METHODS: Using electronic medical record (EMR) and administrative claims data over a 19-month period (January 1, 2013-July 31, 2014), a retrospective chart review was conducted of all reproductive-aged female patients at a major medical center in the Midwest who were prescribed VPA as treatment for their psychiatric illness (n = 190; aged from 15 to 49 years). Psychiatric diagnoses were determined via ICD-9 billing codes. We assessed 3 variables of interest as an index of adherence to guidelines: chart documentation of provider-patient discussion regarding potential teratogenicity associated with VPA use, prescription of contraceptives, and co-prescription of folic acid. RESULTS: EMR documentation of provider-patient discussions regarding possible teratogenicity of VPA was rare (13.2%), as was documentation of contraception use (30%) and co-prescription of folate (7.9%). Neither patient demographic characteristics nor diagnoses were associated with outcomes. Among those not receiving treatment in the inpatient setting, patients who were seen by outpatient psychiatry or neurology clinics (rather than other outpatient settings) were more likely to have documented discussions about teratogenicity (23% and 30%, respectively; P = .003), and patients receiving neurologic care were more likely to be prescribed folate than those seen by other providers (26%, P = .004). Women who had contact with inpatient psychiatric services were less likely to be taking contraception (n = 12 [20%], P = .041). Only 22% of women under 34 years of age were documented as using contraception (P = .03). CONCLUSIONS: Adherence to standard guidelines is low even at an academic tertiary care center. To the extent that there is any documentation or co-prescription of folate, it varies by provider specialty.

Mindfulness yoga during pregnancy for psychiatrically at-risk women: preliminary results from a pilot feasibility study.

Prenatal psychopathology may have an adverse impact on mother and baby, but few women receive treatment. We offered a 10-week mindfulness yoga (M-Yoga) intervention to psychiatrically high-risk pregnant women as an alternative to pharmacological treatment. Participants (N = 18) were primiparous, 12-26 weeks pregnant, and had elevated scores (>9) on the Edinburgh Postnatal Depression Screen at baseline. In addition to a baseline diagnostic assessment, women completed self-ratings on depression, mindfulness, and maternal-fetal attachment before and after M-Yoga. Findings suggest that M-Yoga was feasible, accepted and effective. Symptoms of depression were significantly reduced (p = 0.025), while mindfulness (p = 0.007) and maternal-fetal attachment (p = 0.000) significantly increased. Overall, this pilot study is the first to demonstrate that M-Yoga may be an effective treatment alternative or augmentation to pharmacotherapy for pregnant women at high risk for psychopathology.