An ecological momentary assessment study examining posttraumatic stress disorder symptoms, prenatal bonding, and substance use among pregnant women.

BACKGROUND: Substance use disorder (SUD) during pregnancy requires efficacious interventions based on understanding the ebb and flow of risk and protective factors for substance use across time. To assess how these fluctuations are associated temporally with substance use, we used ecological momentary assessment (EMA) to evaluate substance use risk (posttraumatic stress disorder [PTSD] symptoms) and protective (prenatal fetal bonding) factors and their associations with prenatal substance use recorded in real time. METHODS: Pregnant women in SUD treatment (N = 33) with prior trauma exposure received smartphones with an EMA application that queried them thrice daily for 28 days about PTSD symptoms, prenatal bonding, and substance use. RESULTS: Nearly all (N = 32) provided EMA data resulting in 2049 EMA reports (74% compliance). Most participants reported tobacco (72%), alcohol (22%), heroin (41%), and/or other illicit drug (6%-31%) use at least once via EMA. There were moderate associations (average ß = 0.23) between greater daily peak PTSD symptoms and substance use with significant effects on illicit drug (ß = 0.37), cannabis (ß = 0.35) and cigarette use (ß = 0.24). Prenatal bonding subscales were modestly associated with substance use, with daily intensity of attachment low point associated with lower heroin (ß=-0.34), but higher alcohol (ß = 0.24) use. Quality of attachment low point was associated with higher cigarette use (ß = 0.06). CONCLUSIONS: Despite the SUD severity and social instability of this sample, we observed high rates of compliance. We found preliminary support suggesting daily PTSD symptoms as a risk factor and less consistent support for prenatal bonding as a protective factor for prenatal substance use.

Association between theta power in 6-month old infants at rest and maternal PTSD severity: A pilot study.

Compared to infants born to mothers without PTSD, infants born to mothers with active PTSD develop poorer behavioral reactivity and emotional regulation. However, the association between perinatal maternal PTSD and infant neural activation remains largely unknown. This pilot study (N=14) examined the association between perinatal PTSD severity and infant frontal neural activity, as measured by MEG theta power during rest. Results indicated that resting left anterior temporal/frontal theta power was correlated with perinatal PTSD severity (p=0.004). These findings suggest delayed cortical maturation in infants whose mothers had higher perinatal PTSD severity and generate questions regarding perinatal PTSD severity and infant neurophysiological consequences.