"I just want the best for him." Pregnancy in the context of substance use disorders: Perspectives of postpartum women.

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.

Addressing Gaps and Saving Lives: Doulas' Role in Addressing Substance Use and Mental Health Challenges Among Pregnant and Postpartum Clients-A Scoping Review.

OBJECTIVES: Doulas are a potential resource for addressing substance use and mental health challenges that pregnant and postpartum individuals experience. We sought to review peer-reviewed literature that examines Doulas' role in addressing these challenges to highlight the need for more research in this area. METHODS: We conducted a scoping review (2001-2021) to identify articles that examine the way in which Doulas address maternal substance use and mental health challenges in their clients. The articles were reviewed by two members of the research team. RESULTS: Nine articles describing Doulas' role in addressing substance use and mental health challenges were identified. Six described Doulas' role in addressing mental health, five of which saw positive mental health outcomes due to Doula involvement. One additional article recommended Doulas be considered in the future to address mental health challenges. While the minority of articles addressed substance use (n = 2), it was reported that Doulas were a positive addition to interdisciplinary teams addressing substance use challenges with pregnant individuals. CONCLUSIONS: While the literature showed that Doulas can improve substance use and mental health outcomes among pregnant or postpartum individuals, a significant gap remains in research, practice, and peer-reviewed literature addressing this issue.

Prenatal incidence of cleft lip/palate and cocaine abuse in parents: a systematic review and meta-analysis.

BACKGROUND: The study aimed to investigate the association between maternal cocaine abuse during pregnancy and the prevalence of cleft lip/palate (CL/P) in offspring, synthesizing existing evidence through a systematic review and meta-analysis. CL/P is a congenital craniofacial anomaly with complex etiology, and prior research has suggested potential links between maternal cocaine use and CL/P. However, these associations remain inconclusive. METHODS: A comprehensive literature search was conducted to identify relevant studies published up to the study's cutoff date in September 2021. Several databases were systematically searched using predefined search terms. Inclusion criteria were set to encompass studies reporting on the prevalence of CL/P in infants born to mothers with a history of cocaine use during pregnancy, with a comparison group of non-cocaine-using mothers. Data were extracted, and a meta-analysis was performed using a random-effects model to calculate pooled odds ratios (OR) and relative risks (RR) with their respective 95% confidence intervals (CI). RESULTS: The review included data from 4 studies that met the inclusion criteria. The combined OR from two studies was 0.05 (95% CI: 0.00, 4.41), which does not suggest a statistically significant association between prenatal cocaine exposure and the incidence of CL/P due to the confidence interval crossing the null value. Additionally, the combined RR was 0.17 (95% CI: 0.04, 0.66), indicating a statistically significant decrease in the risk of CL/P associated with prenatal cocaine exposure. These results, with an OR that is not statistically significant and an RR suggesting decreased risk, should be interpreted with caution due to considerable heterogeneity and variability among the included studies' findings. Further research is needed to clarify these associations. CONCLUSION: The findings from this systematic review and meta-analysis suggest that maternal cocaine use during pregnancy is not a statistically significant independent risk factor for the development of CL/P in offspring. These results underscore the multifactorial nature of CL/P etiology and emphasize the importance of considering other genetic, environmental, and nutritional factors in understanding the condition's origins. While the study provides important insights, limitations such as data heterogeneity and potential confounders should be acknowledged. Future research should adopt rigorous study designs and explore a broader range of potential risk factors to comprehensively elucidate CL/P development.

Impact of Plans of Safe Care on Prenatally Substance Exposed Infants.

OBJECTIVE: To assess the impact of recent federal statute changes mandating child welfare-based Plan of Safe Care (POSC) supportive programming and community-based linkages to treatment providers, resources, and services for families of infants affected by prenatal substance exposure (IPSE). STUDY DESIGN: Retrospective review of Delaware's statewide child welfare case registry data for IPSE birth notifications and subsequent hotline reports for serious physical injury/fatality concerns from November 1, 2018-October 31, 2020. Abstracted variables included IPSE sex, substance exposure type, family characteristics (maternal personal child welfare history or mental health diagnosis, treatment engagement), and POSC referrals. RESULTS: Of 1436 IPSE, 1347 (93.8%) had POSC support. Most IPSE (67.2%) had exposure to single substance types prenatally. Nearly 90% avoided out-of-home placement. Nearly one-fourth of mothers delivered a prior IPSE; 40% of mothers had personal histories of childhood protective services involvement. Also, 43.5% of mothers and 9.1% of fathers were referred to community-based resources, including substance use, mental health treatment, parenting classes, and home visiting nursing. Nearly 58% of IPSE were referred for pediatric/developmental assessment. Notably, 0.82% (11 out of 1347) of IPSE with POSC sustained serious physical or fatal injury. CONCLUSIONS: POSC promote supportive, potentially protective linkages to community-based programming for IPSE and their families.

Prenatal substance use policies and newborn health.

We study the effect of punitive and priority treatment policies relating to illicit substance use during pregnancy on the rate of neonatal drug withdrawal syndrome, low birth weight, low gestational age, and prenatal care use. Punitive policies criminalize prenatal substance use, or define prenatal substance exposure as child maltreatment in child welfare statutes or as grounds for termination of parental rights. Priority treatment policies are supportive and grant pregnant women priority access to substance use disorder treatment programs. Our empirical strategy relies on administrative data from 2008 to 2018 and a difference-in-differences framework that exploits the staggered implementation of these policies. We find that neonatal drug withdrawal syndrome increases by 10%-18% following the implementation of a punitive policy. This growth is accompanied by modest reductions in prenatal care, which may reflect deterrence from healthcare utilization. In contrast, priority treatment policies are associated with small reductions in low gestational age (2%) and low birth weight (2%), along with increases in prenatal care use. Taken together, our findings suggest that punitive approaches may be associated with unintended adverse pregnancy outcomes, and that supportive approaches may be more effective for improving perinatal health.

Maternal pre- and postnatal substance use and attachment in young children: A systematic review and meta-analysis.

Maternal substance use has often been associated with insecure and disorganized child attachment. We evaluated this association with a meta-analysis of young children and, further, systematically reviewed mediating and moderating factors between maternal substance use and child attachment. We performed a systematic database search of quantitative English language studies on child attachment that included substance-using mothers and their children below 6 years of age. Eleven studies (N = 1,841) met the inclusion criteria and were included in the meta-analysis of attachment security and seven (N = 1,589) studies were included in the meta-analysis of attachment disorganization. We found that maternal substance use was negatively associated with secure attachment in children, but the effect size was small (r = -.10). The association with disorganized attachment was not significant (r = .15). Related to moderating and mediating factors (k = 6), we found evidence on the role of teratogenic and sociological factors on child attachment. Most importantly, the impact of cumulative risks was vital. However, literature was scarce, and studies varied in risk of bias, leaving many unanswered questions on other potential factors underlying the development of attachment in these high-risk children. We discuss the results considering clinical implications and future directions.

Pregnant and Postpartum People with Substance Use Disorders: Understanding the Obstetrical Care Provider' s Roles and Responsibilities.

Peripartum individuals with substance misuse are a high-risk population that challenge clinicians and child welfare specialists alike. Federal legislation was updated in 2016 with the Comprehensive Addiction Recovery Act (CARA) to improve care via expanded screening and treatment referrals for peripartum women with substance misuse. The implementation of CARA requires providers to update their policies and procedures in order to meet the requirements outlined by this legislation. As this is a new process, this paper reviews the new administrative reporting and safety planning requirements relevant to obstetrical care providers and provides examples of best practice for different clinical scenarios. Given the variable state laws, confidentiality concerns, influence of stigma and health inequities on substance use treatment, and the fragmented healthcare system, implementation of CARA will challenge obstetric, pediatric, and mental health care providers along with child welfare services. All entities involved must work together to create effective and efficient protocols to address the CARA requirements. Health systems must also evaluate and update methods and interventions to assure that policies improve family stability and well-being.

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.

Exploring resting frontal EEG and reflective functioning in maternal substance use.

Maternal substance use is associated with altered neural activity and poor offspring outcomes, which may be facilitated by suboptimal caregiving in the form of impaired parental reflective functioning (PRF). To investigate these associations, the resting-state frontal electroencephalography (EEG) power of 48 substance-using mothers and 37 non-substance-using mothers were examined, specifying seven frequency bands: delta, theta, alpha, alpha1, alpha2, beta, and gamma. Substance-using mothers exhibited enhanced beta and gamma spectral power compared to non-substance-using mothers, potentially reflecting higher arousal states in substance-using mothers. There were no between-group differences in any component of PRF (i.e., levels of pre-mentalizing, certainty, and interest and curiosity). Whole-sample analyses revealed significant positive correlations between pre-mentalizing and delta spectral power. Taken together, these findings suggest potential neural correlates of maternal substance use and PRF, providing an important next step into examining associations between maternal substance use and poor child outcomes.

Se asocia el uso materno de sustancias con la actividad neural alterada y el débil resultado en los hijos, lo cual pudiera ser favorecido por una prestación de cuidado subóptima en forma de un impedido funcionamiento con reflexión (PRF) en el progenitor. Para investigar estas asociaciones, se examinó la fuerza de la electroencefalografía frontal en estado de descanso de 48 madres que usaban sustancia y 37 madres que no usaban sustancias, especificando siete bandas de frecuencia: delta, theta, alpha, alpha 1, alpha 2, beta y gamma. Las madres que usaban sustancias mostraron una fuerza espectral aumentada en beta y gamma, tal como se les comparó con las madres que no usaban sustancias, lo que potencialmente refleja estados más altos de agitación en las madres que usaban sustancias. No se dieron diferencias entre grupos en ninguno de los componentes de PRF (v.g. niveles de pre-mentalización, opacidad e interés y curiosidad). Los análisis de todas las muestras revelaron correlaciones positivas significativas entre pre-mentalización y la fuerza espectral delta. Tomándolos en conjunto, estos resultados indican posibles correlaciones neurales entre del uso materno de sustancias y PRF, lo cual aporta un importante próximo paso para examinar las asociaciones entre el uso materno de sustancias y los débiles resultados en el niño.

La toxicomanie maternelle est liée à une activité neuronale altérée et de mauvais résultats sur les enfants de la personne, ce qui peut être facilité par un mode de soin suboptimal sous la forme d'un fonctionnement de réflexion parentale (PRF en anglais) altéré. Pour enquêter sur ces liens, l'électroencéphalographie frontale au repos (EEG) de 48 mères toxicomanes et de 37 mères non-toxicomanes a été examiné, plus spécifiquement sur quatre bandes de fréquences : delta, thêta, alpha, alpha1, alpha2, béta, et gamma. Les mères toxicomanes ont fait preuve d'une puissance spectrale de béta et gamma importante comparées aux mères non-toxicomanes, ce qui reflète peut-être de plus d' états d'excitation chez les mères toxicomanes. Nous n'avons observé aucune différence entre les groupes pour ce qui concerne les composantes de la PRF (soit, niveaux de pré-mentalisation, d'opacité, d'intérêt et de curiosité). Des analyses sur tout l'échantillon ont révélé des corrélations positives importantes entre la puissance spectrale de pré-mentalisation et la puissance spectrale delta. Considérés dans l'ensemble, ces résultats suggèrent un corrélat neural potentiel de la toxicomanie maternelle et de la PRF, ce qui présente une nouvelle étape importante dans l'examen des liens entre la toxicomanie maternelle et les mauvais résultats sur l'enfant.

Development and validation of a goal attainment scale for families affected by maternal substance use.

The Team for Infants Exposed to Substance use (TIES) Program is a longstanding home-based family support program that provides a multidisciplinary, community-facing model to address the complex needs of families with young children affected by maternal substance use. The model required a comprehensive assessment tool to guide creation of individualized family goals with steps to achievement and measurement of progress on those goals. This article describes the development of a goal attainment scale and the analysis conducted to validate the scale for the service population. TIES model developers and community partners developed the goal attainment scale to assess outcomes in key domains: maternal substance use, parenting, child and maternal health, income, and housing. Data were collected from 2012 to 2019 from 220 participants and analyzed in 2020. Exploratory factor analysis (EFA) and confirmatory factor analysis were conducted. Twenty-five of the original 30 items were retained in a six-factor structure. The total percentage of variance explained was 64.44% with six factors, and Cronbach's alpha was .90. For the split-half method, the reliability of scale was .90 for unbiased conditions. Therefore, the scale reached acceptable reliability and validity. The scale provides a comprehensive approach to measure family outcomes across multiple domains addressing key risk and protective factors. This family-centered scale serves both therapeutic and evaluation purposes, acting as an intervention guide and a goal attainment measurement tool.

El Programa del Equipo para los Infantes Expuestos al Uso de Sustancias (TIES) es un programa de apoyo familiar con base en el hogar que ha existido mucho tiempo y que ofrece un multidisciplinario método de cara a la comunidad que se ocupa de las complejas necesidades de familias con niños pequeños afectados por el uso materno de sustancias. Quienes desarrollaron el modelo TIES crearon una herramienta comprensiva de evaluación para guiar la creación de metas familiares individualizadas, pasos para alcanzar y el progreso en cuanto a esas metas. Esta escala de alcance de logros evalúa los resultados en dominios claves: uso materno de sustancias, crianza, salud del niño y de la madre, entradas económicas y vivienda. Este artículo describe el desarrollo y la validez de la escala de alcance de metas. Los datos recogidos del 2012 al 2019 y de 220 participantes se analizaron en 2020. Se llevaron a cabo análisis exploratorios y confirmatorios de factores. Veinticinco de los 30 puntos originales se mantuvieron en una estructura de seis factores. El porcentaje total de variación explicado fue de 64.44% con seis factores y el factor Alpha de Cronbach fue de .90. En cuanto al método dividido en mitades, la confiabilidad de la escala fue de .90 en el caso de condiciones no prejuiciadas. Por tanto, la escala alcanzo una confiabilidad y validez aceptable. La escala ofrece un acercamiento comprensivo para medir los resultados familiares a lo largo de múltiples dominios, ocupándose de factores claves de riesgo y protección. Esta escala centrada en la familia sirve propósitos terapéuticos evaluación y actúa como una guía de intervención y medida de alcance de metas.

Le Programme de l'Equipe pour les Nourrissons Exposés à la Toxicomanie (abrégé TIES, suivant l'anglais The Team for Infants Exposed to Substance use) est un programme de soutien à la famille à domicile mis en place de longue date qui offre un modèle pluridisciplinaire et tourné vers la communauté afin de répondre aux besoins complexes des familles avec de jeunes enfants affectées par la toxicomanie maternelle. Les personnes ayant conçu et développé le modèle TIES ont créé un outil d'évaluation complet afin de guider le développement d'objectifs familiaux individualisés, d'étapes de réussite et de progrès quant à ces objectifs. L'échelle d'étape de réussite évalue les résultats dans des domaines clés: la toxicomanie maternelle, le parentage, la santé de l'enfant et la santé maternelle, les revenus, et le domicile. Cet article décrit le développement et la validation de l'échelle de réussite. Les données ont été recueillies de 2012 à 2019 de 220 participantes et elles ont été analysées en 2020. Des analyses factorielles exploratoires et des analyses factorielles confirmatoires ont été faites. Vingt-cinq des 30 éléments d'origine ont été retenus dans une structure à six facteurs. Le pourcentage total de variance expliquée était de 64,44% avec six facteurs, et l'alpha de Cronbach était de 0,90. Pour la méthode à demi-fraction la fiabilité de l'échelle était de,90 pour des conditions impartiales. L'échelle a donc atteint la fiabilité et la validité. L'échelle offre une approche complète afin de mesurer les résultats de la famille au travers de multiples domaines traitant le risque clé et les facteurs de protection. Cette échelle centrée sur la famille sert un but à la fois thérapeutique et d'évaluation, agissant comme un guide d'intervention et une mesure d'atteinte du but.

Secrecy Versus Disclosure: Women with Substance Use Disorders Share Experiences in Help Seeking During Pregnancy.

OBJECTIVES: Substance misuse during pregnancy can be harmful to the health of both mothers and infants. Existing recovery services or prenatal care for pregnant women with substance use disorders (SUD) in the U.S. and other countries typically fall short in providing the necessary specialized care women with SUDs need. Disclosure of substance misuse is one key factor in gaining access to specialized prenatal care; yet, barriers such as social stigma and internal shame and guilt lead many women to under-report any substance misuse during their pregnancy. This study sought to understand the process of how and why pregnant women with SUDs choose to disclose or not disclose their substance misuse to their providers when seeking prenatal care. METHODS: Data were collected through interviews with N = 21 women with SUDs in the northeast U.S. whose young children had been exposed to opioids, cocaine, or MAT in utero. Thematic, inductive analysis using line-by-line coding was conducted to understand the perspectives of the women. RESULTS: The women's narratives suggested a clear tension regarding whether to disclose their substance misuse to any providers during their pregnancy. Four themes describing the process of disclosure or non-disclosure were found, including reasons for and ways of being secret or choosing to disclose their substance misuse during pregnancy. CONCLUSIONS FOR PRACTICE: The centrality of shame, guilt, and stigma regarding substance misuse must be addressed by medical and mental health providers in order to increase disclosure and improve access to care for women with SUDs.

An Exploration of Mothers' Successful Completion of Family-Centered Residential Substance Use Treatment.

Behavioral health and substance use centers have started focusing efforts on creating, adopting, and implementing evidence-based practices and programs that effectively address the needs of women and, particularly, mothers entering treatment with children. However, women with substance use disorders (SUDs) remain an underserved and understudied population; even less studied are the complexities and unique SUD treatment needs of women who have children. Family therapists' systemic training is a valued approach in conceptualizing and implementing treatment for mothers with SUDs and their families. This study explored the construct of mothering children during family-centered substance use treatment using a transcendental phenomenological approach. Analysis revealed themes related to motherhood, parenting, and support for mothers and children. Two themes emerged from the data: (a) grappling with motherhood and addiction leading to the decision for treatment and (b) specific aspects of the treatment program conducive to motherhood. Results indicated the positive impact of mothers' experiences in family-centered substance use treatment, aligning with previous literature that suggests mothers are more engaged in treatment when their children remain in their care. The insights gleaned from the participants in this study provide suggestions for further improving programming that supports mothers and their children during the recovery process. Treatment considerations are offered for family therapists working with mothers with SUDs and their families.

Los centros para la salud conductual y el consumo de sustancias han comenzado a centrar sus esfuerzos en la creación, la adopción y la implementación de prácticas y programas factuales que aborden eficazmente las necesidades de las mujeres y, particularmente, de las madres que ingresan en un tratamiento con hijos. Sin embargo, las mujeres con trastorno por consumo de sustancias siguen siendo una población marginada y poco estudiada; y aun menos estudiadas son las complejidades y las necesidades exclusivas de tratamiento para los trastornos por consumo de sustancias de las mujeres que tienen hijos. La capacitación sistémica de los terapeutas familiares es un enfoque valioso a la hora de conceptualizar e implementar el tratamiento para las madres con trastornos por consumo de sustancias y sus familias. Este estudio analizó el constructo de la maternidad durante el tratamiento para el consumo de sustancias centrado en la familia utilizando un enfoque fenomenológico trascendental. El análisis reveló temas relacionados con la maternidad, la paternidad y el apoyo para las madres y los hijos. De los datos surgieron dos temas: (a) la lucha con la maternidad y la adicción conducente a la decisión de recibir tratamiento y (b) aspectos específicos del programa de tratamiento favorables para la maternidad. Los resultados indicaron el efecto positivo de las experiencias de las madres en el tratamiento para el consumo de sustancias centrado en la familia en consonancia con bibliografía anterior que sugiere que las madres se comprometen más con el tratamiento cuando sus hijos quedan a su cuidado. Las apreciaciones recogidas de los participantes de este estudio ofrecen sugerencias para mejorar más las programaciones que apoyen a las madres y a sus hijos durante el proceso de recuperación. Se ofrecen consideraciones sobre el tratamiento para los terapeutas familiares que trabajan con madres con trastornos por abuso de sustancias y sus familias.

Predictors and moderators of improved social-emotional functioning in mothers with substance use disorders and their young children enrolled in a relationship-based case management program.

Mothers with substance use disorders (SUDs) typically have trauma histories and psychosocial difficulties that lead to poor social-emotional functioning and disrupted mother-child relationships. This 12-month study explored associations of family adverse circumstances and services (case management, therapeutic, and community-based) received by 57-mothers with SUDs and their infants (less than 24-months-old) with changes in social-emotional functioning. All mothers were enrolled in a relationship-based case management program (Parent-Child Assistance Program [PCAP]) that emphasized connecting mothers to appropriate community services. A subset of mothers was additionally provided a trauma-focused psychotherapeutic intervention (infant-parent psychotherapy [IPP]). Dyads in both treatment groups improved in overall social-emotional functioning as assessed by the Functional Emotional Assessment Scale (FEAS). A combined-sample regression analysis revealed that improved FEAS scores were significantly predicted by the number of community services received but not by PCAP case management hours (IPP was not included in this analysis). More adverse circumstances were associated with less improvement in social-emotional functioning in the children; but among the mothers trauma level did not predict FEAS scores. We also found a moderating effect of trauma: Dyads with relatively more adversity showed a significantly greater association of community services received with improvement in FEAS scores than did those with relatively less adversity.

Las madres con trastornos por abuso de sustancias (SUDs) típicamente tienen historias de trauma y dificultades sicosociales que conducen al débil funcionamiento socio-emocional y relaciones madre-niño trastornadas. Este estudio de 12 meses exploró asociaciones entre circunstancias adversas de familia y servicios (de dirección de caso, terapéuticos, basados en la comunidad) que recibieron 57 madres con SUDs y sus infantes (menos de 24 meses de edad) con cambios en el funcionamiento socio-emocional. Todas las madres fueron inscritas en un programa de dirección de caso con base en la relación (Programa de Asistencia al Progenitor y Niño - PCAP) que enfatizaba la conexión de las madres con adecuados servicios comunitarios. Un subgrupo de madres recibió además una intervención sicoterapéutica con enfoque en el trauma (Sicoterapia de Infante-Progenitor - IPP). Las díadas en ambos grupos de tratamiento mejoraron en el funcionamiento socio-emocional en términos generales tal como se les evaluó por medio de la Escala Funcional de Evaluación Emocional (FEAS). Un análisis de regresión que combinó los grupos muestras reveló que los mejorados puntajes en FEAS habían sido pronosticados significativamente por el número de servicios comunitarios recibidos, pero no por las horas del programa de dirección de caso PCAP (no se incluyó la IPP en este análisis). Se asociaron las circunstancias más adversas con un menor mejoramiento en el funcionamiento socio-emocional en los niños; pero entre las madres, el nivel del trauma no predijo los puntajes FEAS. También encontramos un efecto moderador del trauma: las díadas con más adversidad relativamente mostraron significativamente mayor asociación de servicios comunitarios recibidos con mejoras en los puntajes FEAS que aquellas con menor adversidad relativamente. Palabras claves: Salud mental infantil, trastornos maternos por abuso de sustancias, trauma, servicios comunitarios, Sicoterapia de Infante-Progenitor.

Les mères ayant des troubles liés à la toxicomanie (TLT) ont typiquement des passés de trauma et des difficultés psychosociales qui mènent à un mauvais fonctionnement socio-émotionnel et à des relations mère-enfant perturbées. Cette étude de 12 mois a exploré les liens de circonstances familiales adverses et les services (gestion des cas, services thérapeutiques, et services au niveau de la communauté) reçus par 57 mères ayant des TLT et leurs bébés (moins de 24 mois) avec des changements dans le fonctionnement socio-émotionnel. Toutes les mères ont été inscrites dans un programme de gestion de cas basé sur la relation (Programme d'Assistance Parent-Enfant) mettant l'accent sur la référence des mères aux services communautaires appropriés. Un sous-groupe de mères a en plus reçu une intervention psychothérapeutique centrée sur le trauma (Psychothérapie Bébé-Parent). Les dyades des deux groupes de traitement se sont améliorées dans le fonctionnement socio-émotionnel général, évalué par l'Echelle d'Evaluation Emotionnelle Fonctionnelle (Functional Emotional Assessment Scale, soir FEAS). Une analyse de régression d'échantillons combinés a révélé que les scores FEAS améliorés étaient fortement prédits par le nombre de services communautaires reçus mais pas par les heures de gestion de cas FCAP (l'IPP n'a pas été inclue dans cette analyse). Plus de circonstances adverses était lié à moins d'amélioration dans le fonctionnement socio-émotionnel chez les enfants. Mais chez les mères le niveau de trauma ne prédisait pas les scores FEAS. Nous avons aussi découvert un effet modérateur du trauma: les dyades avec relativement plus d'adversité faisaient preuve d'une association bien plus élevée avec les services communautaires reçus avec une amélioration dans les scores FEAS que les dyades avec relativement moins d'adversité. Mots clés: Santé Mentale du Nourrisson, Troubles Liés à la Toxicomanie Maternelle, Trauma, Service Communautaires, Psychothérapie Bébé-Parent.

Maternal Substance Use Disorders and Infant Outcomes in the First Year of Life among Massachusetts Singletons, 2003-2010.

OBJECTIVE: To determine the association of maternal substance use disorders (SUDs) during pregnancy with adverse neonatal outcomes and infant hospital re-admissions, observational stays, and emergency department utilization in the first year of life. STUDY DESIGN: We analyzed 2 linked statewide datasets from 2002 to 2010: the Massachusetts Pregnancy to Early Life Longitudinal data system and the Massachusetts Bureau of Substance Abuse Services Management Information System. Generalized estimating equations were used to assess the association of maternal SUDs and neonatal outcomes and infant hospital-based care in the first year of life, controlling for maternal and infant characteristics. RESULTS: Maternal SUDs increased from 19.4 per 1000 live births in 2003 to 31.1 per 1000 live births in 2009. In the adjusted analysis, exposed neonates were more likely to be born preterm (aOR 1.85; 95% CI 1.75-1.96) and low birthweight (aOR 1.94; 95% CI 1.80-2.09). After controlling for maternal characteristics and preterm birth, SUD-exposed neonates were more likely to have intrauterine growth restriction, cardiac, respiratory, neurologic, infectious, hematologic, and feeding/nutrition problems, prolonged hospital stay, and higher mortality (aOR range 1.26-3.80). Exposed infants were more likely to be rehospitalized (aOR 1.10; 95% CI 1.04-1.17) but less likely to have an observational stay (aOR 0.90; 95% CI 0.82-0.99) or use the emergency department (aOR 0.87; 95% CI 0.83-0.90) in the first year of life. CONCLUSIONS: Infants born to mothers with SUD are at higher risk for adverse health outcomes in the perinatal period and are also more likely to be rehospitalized in the first year of life.

Predictors of congenital anomalies among neonates admitted to public hospitals in eastern Ethiopia: a case-control study.

OBJECTIVE: Over 8 million newborns worldwide have congenital anomalies; 3.2 million have resultant disabilities. Ethiopia has a high burden of neonatal congenital anomalies, but research on predictors is limited. This study investigated predictors of neonatal congenital anomalies in eastern Ethiopia. METHODS: A facility-based unmatched case-control study on 387 mother-infant pairs (129 cases, 258 controls) in public hospitals was conducted. Data were obtained using an interviewer-administered structured questionnaire and a medical record review. Binary logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI) was used to identify predictors of congenital anomaly. RESULTS: Nervous system anomalies were most common 84 (65.1%), followed by gastrointestinal system anomalies 20 (15.5%). Maternal anemia (AOR: 4.37, 95% CI: 2.48-7.69), alcohol consumption during index pregnancy (AOR: 4.01, 95% CI: 1.88-8.54), khat chewing (AOR: 1.73; 95% CI: 1.04-2.85), rural residence (AOR: 1.73, 95% CI: 1.04-2.85) and antenatal care attendance (AOR: 0.43, 95% CI: 0.22-0.84) were significant predictors of congenital anomaly. CONCLUSION: Several risk factors for congenital anomalies were identified. To reduce risk, antenatal care services should be improved and mothers encouraged to avoid harmful substances during pregnancy and maintain a healthy lifestyle. Intervention strategies are needed to target these risk factors.

Evaluating the relationship of in utero nicotine exposure with hypoglycemia after delivery: An observational study.

BACKGROUND: Hypoglycemia in neonates is common and contributes to 4.0-5.8% of neonatal intensive care unit (NICU) admissions. In utero nicotine exposure is underexplored as a potential contributor to neonatal hypoglycemia. Rat models have shown that in utero nicotine exposure can be associated with a reduction in pancreatic beta cell mass, leading to glucose dysregulation. The primary aim of this work is to study the risk of developing hypoglycemia after birth in a population of in utero nicotine-exposed neonates. METHODS: We conducted a retrospective matched cohort study that augmented an existing dataset of neonates admitted to a level IV NICU with household-based in utero nicotine exposure (N = 335). Neonates in the control group parents denied household smoking (N = 325), were born within a 6-month timeframe, and were within a birthweight of 50 grams of a nicotine-exposed neonate. Data reviewed included gestational age, growth parameters, maternal history of diabetes, and glucose levels within the first three hours of life per unit protocol. RESULTS: 660 neonates were included in the analysis. In utero nicotine exposure demonstrated a 94.3% posterior probability (PP) for greater hypoglycemia risk (RR = 1.185, 95% CrI = [0.953, 1.445]). A 94.6% PP was demonstrated when neonates who were small for gestational age, intrauterine growth-restricted, and born to diabetic mothers were excluded (n = 482; RR = 1.271, 95% CrI = [0.946, 1.669]). CONCLUSION: Nicotine exposure in utero was found to be a potential risk factor for developing hypoglycemia after birth. Mechanisms of action should be explored, and additional research on in utero nicotine exposure risks should follow.

Neonatal abstinence syndrome hospitalizations in Canada: a descriptive study.

OBJECTIVE: The objective of this paper is to describe the trend of newborn hospitalizations with neonatal abstinence syndrome (NAS) in Canada, between 2010 and 2020, and to examine severity indicators for these hospitalizations. METHODS: National hospitalization data (excluding Quebec) from the Canadian Institute for Health Information's Discharge Abstract Database, from January 2010 to March 2021, and Statistics Canada's Vital Statistics Birth Database were used. Analyses were performed to examine NAS hospitalizations by year and quarter, and by severity indicators of length of stay, Special Care Unit admission and status upon discharge. Severity indicators were further stratified by gestational age at birth. RESULTS: An increasing number and rate of NAS hospitalizations in Canada between 2010 (n = 1013, 3.5 per 1000 live births) and 2020 (n = 1755, 6.3 per 1000 live births) were identified. A seasonal pattern was observed, where rates of NAS were lowest from April to June and highest from October to March. Mean length of stay in acute inpatient care was approximately 15 days and 71% of NAS hospitalizations were admitted to the Special Care Unit. Hospitalizations for pre-term births with NAS had longer durations and greater rates of Special Care Unit admissions compared to term births with NAS. CONCLUSION: The number and rate of NAS hospitalizations in Canada increased during the study, and some infants required a significant amount of specialized healthcare. Additional research is required to determine what supports and education for pregnant people can reduce the incidence of NAS hospitalizations.

RéSUMé: OBJECTIF: Le présent article a pour but de décrire la tendance des hospitalisations de nouveau-nés atteints du syndrome d'abstinence néonatale (SAN) au Canada, entre 2010 et 2020, et d'examiner les indicateurs de gravité de ces hospitalisations. MéTHODE: Les données nationales sur les hospitalisations (à l'exclusion du Québec) provenant de la base de données sur les congés des patients de l'Institut canadien d'information sur la santé, de janvier 2010 à mars 2021, ainsi que la base de données sur les naissances des statistiques de l'état civil de Statistique Canada ont été utilisées. Des analyses ont été réalisées pour examiner les hospitalisations liées au SAN par année et par trimestre, et par indicateurs de gravité de la durée du séjour, de l'admission dans une unité de soins spéciaux et de l'état à la sortie de l'hôpital. Les indicateurs de gravité ont en outre été stratifiés en fonction de l'âge gestationnel à la naissance. RéSULTATS: Un nombre et un taux croissants d'hospitalisations liées au SAN au Canada entre 2010 (n=1 013, 3,5 pour 1 000 naissances vivantes) et 2020 (n=1 755, 6,3 pour 1 000 naissances vivantes) ont été identifiés. Une tendance saisonnière a été observée, où les taux de SAN étaient les plus bas d'avril à juin et les plus élevés d'octobre à mars. La durée moyenne du séjour en soins de courte durée était d'environ 15 jours et 71 % des hospitalisations liées au SAN ont été admises à l'unité de soins spéciaux. Les hospitalisations pour les accouchements prématurés de nouveau-nés atteints du SAN avaient des durées plus longues et des taux plus élevés d'admissions dans des unités de soins spéciaux par rapport aux naissances à terme de nouveau-nés atteints du SAN. CONCLUSION: Le nombre et le taux d'hospitalisations liées au SAN au Canada ont augmenté au cours de l'étude, et certains nourrissons nécessitent une quantité importante de soins spécialisés. Des recherches supplémentaires sont nécessaires pour déterminer quels soutiens et quelle éducation pour les personnes enceintes peuvent réduire l'incidence des hospitalisations liées au SAN.

Opioid, methamphetamine, and polysubstance use: perinatal outcomes for the mother and infant.

The escalation in opioid pain relief (OPR) medications, heroin and fentanyl, has led to an increased use during pregnancy and a public health crisis. Methamphetamine use in women of childbearing age has now eclipsed the use of cocaine and other stimulants globally. Recent reports have shown increases in methamphetamine are selective to opioid use, particularly in rural regions in the US. This report compares the extent of our knowledge of the perinatal outcomes of OPRs, heroin, fentanyl, two long-acting substances used in the treatment of opioid use disorders (buprenorphine and methadone), and methamphetamine. The methodological limitations of the current research are examined, and two important initiatives that will address these limitations are reviewed. Current knowledge of the perinatal effects of short-acting opioids, OPRs, heroin, and fentanyl, is scarce. Most of what we know about the perinatal effects of opioids comes from research on the long-acting opioid agonist drugs used in the treatment of OUDs, methadone and buprenorphine. Both have better perinatal outcomes for the mother and newborn than heroin, but the uptake of these opioid substitution programs is poor (<50%). Current research on perinatal outcomes of methamphetamine is limited to retrospective epidemiological studies, chart reviews, one study from a treatment center in Hawaii, and the US and NZ cross-cultural infant Development, Environment And Lifestyle IDEAL studies. Characteristics of pregnant individuals in both opioid and MA studies were associated with poor maternal health, higher rates of mental illness, trauma, and poverty. Infant outcomes that differed between opioid and MA exposure included variations in neurobehavior at birth which could complicate the diagnosis and treatment of neonatal opioid withdrawal (NOWs). Given the complexity of OUDs in pregnant individuals and the increasing co-use of these opioids with MA, large studies are needed. These studies need to address the many confounders to perinatal outcomes and employ neurodevelopmental markers at birth that can help predict long-term neurodevelopmental outcomes. Two US initiatives that can provide critical research and treatment answers to this public health crisis are the US Environmental influences on Child Health Outcomes (ECHO) program and the Medication for Opioid Use Disorder During Pregnancy Network (MAT-LINK).

Neonatal Abstinence Syndrome: An Insight Over Impact of Maternal Substance Use.

Neonatal abstinence syndrome (NAS) highlights the intricate interplay between maternal substance use during pregnancy and the challenges neonates face from the distressing global opioid crisis. This comprehensive review captures the multilayered landscape of NAS, encircling its underlying mechanisms, epidemiology, diagnostic intricacies, clinical manifestations, continuing developmental impacts, treatment paradigms, and the crucial role of multidisciplinary care. The core pathophysiology of NAS involves the transplacental passage of addictive substances, activating chemical dependence in the maturing fetus, which is characterized by neurotransmitter dysregulation, neuroadaptations, and receptor sensitization. A diverse clinical presentation ranges from central nervous system hyperactivity and autonomic dysregulation to gastrointestinal manifestations, necessitating homogenous assessment tools such as the Finnegan Neonatal Abstinence Scoring System. The demand for a multilayered approach is essential for comprehensive management, involving pharmacological interventions like morphine or methadone and non-pharmacological strategies such as swaddling. The complications of NAS are not only limited to but are also well beyond infancy, leading to behavioral, longstanding cognitive, and socioemotional consequences. Addressing these developmental arcs demands decisive longitudinal monitoring and early interventions. NAS management is fundamentally multidisciplinary, requiring the teamwork of nurses, social workers, psychologists, pediatricians, and neonatologists. Apart from the clinical realm, managing the psychosocial needs of families traversing NAS requires resources and empathy. A crucial comprehensive approach is essential to confront the challenges and limitations of NAS. From early identification and prevention to longstanding support through pharmacological, non-pharmacological, and psychological channels, it creates a holistic structure that emerges as the basis for understanding the complicated relationship between maternal substance use and its impact on neonates. An amalgamation of community engagement, society, policy initiatives, and medical expertise is essential to mitigate the repercussions of NAS and adopt healthier outcomes for affected infants.

Criminalization of Care: Drug Testing Pregnant Patients.

This article reveals how law and legal interests transform medicine. Drawing on qualitative interviews with medical professionals, this study shows how providers mobilize law and engage in investigatory work as they deliver care. Using the case of drug testing pregnant patients, I examine three mechanisms by which medico-legal hybridity occurs in clinical settings. The first mechanism, clinicalization, describes how forensic tools and methods are cast in clinical terminology, effectively cloaking their forensic intent. In the second, medical professionals informally rank the riskiness of illicit substances using both medical and criminal-legal assessments. The third mechanism describes how gender, race, and class inform forensic decision-making and criminal suspicion in maternal health. The findings show that by straddling both medical and legal domains, medicine conforms to the standards and norms of neither institution while also suspending meaningful rights for patients seeking care.