A New Parental Mentalization Focused Ultrasound Intervention for Substance Using Pregnant Women. Effect on Self-reported Prenatal Mental Health, Attachment and Mentalization in a Randomized and Controlled Trial

Heidi Jussila,Eeva Ekholm,Marjukka Pajulo

doi:10.1007/s11469-019-00205-y

Abstract

The effect of a novel mentalization-based parenting intervention was explored on prenatal self-reported mentalization (P-PRFQ), attachment (MFAS), depression (EPDS) and anxiety (STAI) among women with substance use problems. The participants were 90 pregnant women referred to obstetric outpatient care due to recent or current substance use and randomized into intervention (n = 46) and control (n = 44) groups. The intervention group received three interactive 4D ultrasound sessions and a week-by-week pregnancy diary. The control condition was constituted of treatment-as-usual in obstetric care. Unfortunately, the efficacy of the intervention on maternal prenatal mental health, attachment, and parental mentalization was not substantiated. The negative results may be related to the small sample size, the patient-reported outcomes, or insufficient efficacy within this high-risk group. In the context of high psychosocial risks and follow-up by Child Welfare Services, the patient-reported outcomes may have underestimated prenatal adversity. The role of the research context, methodology, and possible sources of bias in the outcome assessment are discussed.The trial registration number in the ClinicalTrials.gov: NCT03413631

Highlights

The effect of a novel mentalization-based parenting intervention was explored on prenatal self-reported mentalization (P-PRFQ), attachment (MFAS), depression (EPDS) and anxiety (STAI) among women with substance use problems
This study emphasizes the lessons learned from conducting an randomized controlled trial (RCT) study among a high-risk sample of pregnant women with recent or current substance use in a real-world setting
Our findings were negative or inconclusive as to whether or not prenatal maternal mental health, attachment and parental mentalization improved in response to the intervention

Summary

Introduction

The effect of a novel mentalization-based parenting intervention was explored on prenatal self-reported mentalization (P-PRFQ), attachment (MFAS), depression (EPDS) and anxiety (STAI) among women with substance use problems. In Finland, the number of problem drug users has increased, and the proportion of fertile-aged women among them (Ollgren et al 2014) Despite this knowledge, the number of psychosocial interventions designed for pregnant women with substance use disorders is surprisingly low (Stein et al 2014; Forray and Foster 2015; Howard et al 2014; Terplan et al 2015a). A recent population-based cohort study has revealed that the interaction effect of substance use in pregnancy and maternal mental disorder predicts an increased risk of low birth weight in newborns; the poorest neonatal outcome observed was among pregnant women with poly or illicit drug use and a comorbid mental disorder (Zhao et al 2017). 2D and 3D/4D ultrasound imaging have been found effective means to improve prenatal attachment, 4D ultrasound technology offers better visualization of the fetus and may contribute to more positive and intensive maternal-fetal attachment (de Jong-Pleij et al 2013)

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