Maternal Substance Use Research Articles

Medicaid expansion in Oregon and postpartum healthcare among people with and without prenatal substance use disorder

BackgroundPeople with a maternal substance use disorder (SUD) may experience a lack of access to necessary healthcare and more specifically, postpartum healthcare. It is not known whether increased insurance coverage introduced by Medicaid expansion has improved postpartum healthcare utilization among this population. MethodsOregon 2008–2016 birth certificates and Medicaid claims were used to examine whether continuous insurance enrollment and postpartum healthcare utilization increased post-Medicaid expansion in a population with and without SUD (n = 9,337). International Classification of Diseases codes were used to identify deliveries, SUD, and postpartum healthcare. Univariable and multivariable generalized linear regression with standard errors clustered by individual were used to estimate the association between Medicaid expansion and postpartum healthcare utilization, stratified by maternal SUD. ResultsAmong the 10.3% with SUD, expansion was not associated with increased continuous enrollment or postpartum healthcare utilization. Among those without SUD, post-expansion deliveries were associated with increased continuous enrollment (+105.0 days; 95% CI=96.9–113.2), total (+4.4; 95% CI=2.9–6.0), postpartum (+0.3; 95% CI=0.2–0.4), inpatient (+0.9; 95% CI=0.7–1.1), outpatient (+2.3; 95% CI=1.4–3.3), office (+0.9; 95% CI=0.2–1.6), and emergency department (+0.3; 95% CI=0.1–0.5) visits. Among deliveries to postpartum people with SUD, 27.2% had opioid use disorder (OUD); expansion was associated with increased OUD medication use (12.0% vs 18.3%) and number of fills (6.7 vs 16.6). ConclusionsMedicaid expansion in Oregon was only associated with increased Medicaid-financed healthcare utilization for postpartum people without SUD, with the exception of those with OUD, demonstrating the need for assessing various strategies to improve postpartum healthcare utilization.

Prenatal Reflective Functioning as a Predictor of Substance-Using Mothers' Treatment Outcome: Comparing Results From Two Different RF Measures.

Mothers with prenatal substance use disorder (SUD) often show broad deficits in their reflective functioning (RF), implying severe risk for the relationship with their baby. Two different types of prenatal maternal RF may be important for parenting: adult attachment-focused-RF (AAI-RF), regarding parent's own childhood experiences, and parenting-focused RF (PRF) regarding their own current process of becoming a parent. However, their inter-relations and potentially different roles for parenting intervention outcomes are not clear. This study examined the associations between mothers' prenatal AAI-RF and pre- and post-natal PRF, and their role in mother-infant interaction and substance use as treatment outcomes. The participants were 57 treatment-enrolled pregnant mothers with SUD and 50 low-risk comparison mothers. AAI-RF was measured with the Adult Attachment Interview. For a subsample of 30 mothers with SUD, PRF was measured with Pregnancy Interview (during pregnancy/pre-intervention), and with Parent Development Interview at 4 months (during intervention). Mother-infant interaction was measured with Emotional Availability Scales at 4 and 12 months (post-intervention), and maternal substance use by post-natal substance relapses. Prenatal AAI-RF and pre- and post-natal PRF were highly associated with each other. Only higher prenatal PRF predicted better mother-infant interaction quality at 4 months and less substance use during the child's first year. Interestingly, prenatal PRF and AAI-RF predicted opposite changes in mother-infant interaction: lower prenatal PRF, but higher AAI-RF predicting more positive change. AAI-RF was especially associated with a change in maternal intrusiveness and hostility, indicating that it represents a more general regulatory tendency. Further studies are needed in larger and lower-risk samples. Our results suggest, however, that AAI-RF and PRF are partially distinct and should be uniquely targeted in perinatal interventions.

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.

Responses to prenatal opioid and alcohol abuse: A review of US and Australian mandatory reporting laws

AbstractPrenatal substance use, specifically opioid and excessive alcohol use, can cause significant adverse effects for the unborn foetus in both the short‐and long‐term. Responses by state social systems occur on a spectrum of prevention and early intervention to support mothers. Some but not all states include reporting duties, so that professionals made aware of the situation may alert agencies that can intervene to provide appropriate support. This article will review legal duties to report maternal substance use during pregnancy in the US and Australia. We identify variations in these laws regarding who is required to report, what circumstances must be reported and what indicates child abuse or neglect. Inconsistencies in laws raise questions about the nature of different approaches, and how reforms might be made to improve provision of support. Informed by the medical literature, the contemporary context and federal policy in the US, we make recommendations for reform, and for the appropriate response to such reports.

The Survivor Moms’ Companion Trauma‐Specific Perinatal Psychoeducation Intervention in a Community Outreach Program: An Open Pilot

Posttraumatic stress disorder (PTSD) confers significant risk during the childbearing year, including for maternal substance use, inadequate prenatal care, preterm birth, and impaired maternal-infant bonding. Although several treatments are available for PTSD, few are specific to the perinatal period. The purpose of this pilot study was to evaluate outcomes of a PTSD- and pregnancy-specific psychoeducational intervention, the Survivor Moms' Companion (SMC). The SMC includes psychoeducation with tutor support to address maternal posttraumatic stress, affect regulation, and interpersonal sensitivity. This open pilot was conducted in a large city in a mid-Atlantic state within an organization that provides perinatal services via community health workers (CHWs). The majority of participants were aged 20 to 25 years and African American and had low levels of income and educational attainment. The SMC learning modules were supplied to participants by specially trained CHWs who provided weekly face-to-face support during 30-to-60-minute tutoring sessions. Pretest-to-posttest analyses using multiple imputation methodology and paired-samples t tests examined PTSD symptom counts and scores related to theorized mechanisms of affect dysregulation and interpersonal sensitivity. Nonparametric statistical tests examined clinically meaningful changes. Of 56 women who completed pretests, 38 (67.9%) completed the core dose of a minimum of 4 of 10 learning modules. Examination of intention-to-treat (n = 56) pretest-to-posttest scores revealed statistically significant improvements in PTSD symptoms (P < .001), affect regulation (depression [P < .001] and anger expression [P < .05]), and interpersonal sensitivity (P < .001). Per-protocol analyses (n = 38) revealed significant changes from clinical to nonclinical range scores for PTSD (P < .01) and depression (P < .05). These findings suggest that a psychoeducational intervention with tutor support can be influential in fostering positive mental health changes in a high-risk perinatal population. CHWs with intervention-specific training can be effective at implementing a trauma-specific intervention.

Maternal mental health and substance use disorders in sudden unexpected death in infancy using routinely collected health data in New Zealand, 2000–2016

BackgroundMortality from sudden unexpected death in infancy (SUDI) has declined dramatically since the ‘Back to Sleep’ campaign. Deaths now are more prevalent in those with socioeconomic disadvantage. The investigation of...

Maternal Smoking, Alcohol and Recreational Drug Use and the Risk of SIDS Among a US Urban Black Population.

BackgroundRates of sudden infant death syndrome (SIDS) are twice as high among Black infants compared to white infants in the US. While the contribution of sleep environment factors to this disparity is known, little is known about the risk of SIDS among Black infants in relation to maternal prenatal smoking, alcohol and drug use as well as infant smoke exposure.ObjectiveTo assess the contribution of maternal substance use during pregnancy and the potential interactions with infant bedsharing in a high-risk, urban Black population.MethodsThe Chicago Infant Mortality Study (CIMS) collected data on 195 Black infants who died of SIDS and 195 controls matched on race, age and birthweight. Risk of SIDS was calculated for maternal smoking, alcohol and drug use, adjusting for potential confounding variables and other risk factors for SIDS. Interactions between these substance use variables and bedsharing were also calculated.ResultsInfants were more likely to die from SIDS if the mother smoked during pregnancy (aOR 3.90, 95% CI 1.37–3.30) and post-pregnancy (aOR 2.49, 95% CI 1.49–4.19). There was a dose response seen between amount smoked during pregnancy and risk of SIDS. Use of alcohol (aOR 2.89, 95% CI 1.29–6.99), cocaine (aOR 4.78, 95% CI 2.45–9.82) and marijuana (aOR 2.76, 95% CI 1.28–5.93) were associated with increased risk of SIDS. In the final, multivariable model controlling for sociodemographic factors and covariates, maternal smoking (aOR 3.03, 95% CI 1.03–8.88) and cocaine use (aOR 4.65, 95% CI 1.02–21.3) during pregnancy remained significant. There were significant, positive interactions between bedsharing and maternal smoking during pregnancy and post-pregnancy, alcohol use and cocaine use.ConclusionMaternal use of tobacco, alcohol and cocaine during pregnancy is associated with significantly increased risk of SIDS in a Black, urban population. Reducing substance use and eliminating disparities in SIDS, sudden unexpected infant death (SUID) (also known as sudden unexpected death in infancy or SUDI) and infant mortality need to involve more than individual level education, but instead will require a comprehensive examination of the role of social determinants of health as well as a multi-pronged approach to address both maternal and infant health and wellbeing.

Unconditional cash transfers and maternal substance use: findings from a randomized control trial of low-income mothers with infants in the U.S.

BackgroundPolicy debates over anti-poverty programs are often marked by pernicious stereotypes suggesting that direct cash transfers to people residing in poverty encourage health-risking behaviors such as smoking, drinking, and other substance use. Causal evidence on this issue is limited in the U.S. Given the prominent role of child allowances and other forms of cash assistance in the 2021 American Rescue Plan and proposed Build Back Better legislation, evidence on the extent to which a monthly unconditional cash gift changes substance use patterns among low-income mothers with infants warrants attention, particularly in the context of economic supports that can help improve early environments of children.MethodWe employ a multi-site, parallel-group, randomized control trial in which 1,000 low-income mothers in the U.S. with newborns were recruited from hospitals shortly after the infant’s birth and randomly assigned to receive either a substantial ($333) or a nominal ($20) monthly cash gift during the early years of the infant’s life. We estimate the effect of the unconditional cash transfer on self-report measures of maternal substance use (i.e., alcohol, cigarette, or opioid use) and household expenditures on alcohol and cigarettes after one year of cash gifts.ResultsThe cash gift difference of $313 per month had small and statistically nonsignificant impacts on group differences in maternal reports of substance use and household expenditures on alcohol or cigarettes. Effect sizes ranged between − 0.067 standard deviations and + 0.072 standard deviations. The estimated share of the $313 group difference spent on alcohol and tobacco was less than 1%.ConclusionsOur randomized control trial of monthly cash gifts to mothers with newborn infants finds that a cash gift difference of $313 per month did not significantly change maternal use of alcohol, cigarettes, or opioids or household expenditures on alcohol or cigarettes. Although the structure of our cash gifts differs somewhat from that of a government-provided child allowance, our null effect findings suggest that unconditional cash transfers aimed at families living in poverty are unlikely to induce large changes in substance use and expenditures by recipients.Trial RegistrationRegistered on Clinical Trials.gov NCT03593356 in July of 2018.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-022-12989-1.

Changes in Maternal Substance Use During the COVID-19 Pandemic

Maternal stress and mental health challenges have increased since the coronavirus disease 2019 (COVID-19) pandemic began. Experts are concerned about elevated substance use given its well-known association with negative emotions, but existing research has not examined substance use among mothers during the COVID-19 pandemic. This is a crucial next step to inform policy and service supports given links between maternal substance use and adverse family experiences. Data were collected online between April 14 and 28, 2020. A total of 508 mothers (mean age = 34.8 years, SD = 5.1) with children 0-8 years old participated via the Parenting During the Pandemic study. Mothers self-reported substance use change and motivations for using substances, as well as mental health symptoms. Of participating mothers, 54.9% did not change, 39.2% increased, and 5.9% decreased their substance use. Findings indicated that mothers with an anxiety disorder or elevated anxiety symptoms were more likely to report increased substance use during the pandemic. Using substances to cope with anxiety, depression, and boredom was elevated among mothers self-reporting increased substance use during the pandemic versus those reporting no change or a decrease in usage. Using substances to cope with anxiety was a risk factor for increased substance use. Many mothers have increased their substance use since the onset of the COVID-19 pandemic. Results highlight the need to treat maternal anxiety and the importance of teaching mothers coping strategies, other than using substances, to reduce the incidence of increased substance use among mothers and its negative sequelae.

Effect of in-utero polysubstance exposure on adolescent cardiovascular disease risk: Results from the Maternal Lifestyle Study

BackgroundPolysubstance use during pregnancy typically includes use of one or more illicit substances in addition to tobacco and/or alcohol. Rates of polysubstance use during pregnancy range from 5 to 10% and continue to rise. However, to date, there are no studies using longitudinal data exploring cardiovascular disease risk in adolescents exposed to polysubstances in utero. ObjectiveThe objective of this analysis was to discover the possible association between maternal substance use and cardiovascular disease risk (i.e., increased blood pressure) in adolescence. MethodsThe National Institute on Drug Abuse (NIDA)-funded Maternal Lifestyle Study (MLS) cohort was used for this analysis. Briefly, in 1993 MLS enrolled mothers by substance use during pregnancy status (Y/N) at four US locations (Detroit, MI; Miami, FL; Providence, RI; and Memphis, TN) and followed offspring until 2011. Generalized linear modeling assessed cardiovascular disease risk in offspring via systolic blood pressure (mm Hg) at age 16 comparing those prenatally exposed and unexposed to maternal substance use. ResultsThe most prevalent singular substance used during pregnancy in this sample (n = 910) was alcohol (n = 121, 16%), while the most common polysubstance used during pregnancy was a combination of tobacco, alcohol, and cocaine (n = 123, 16%). Those born normal birthweight (≥2500 g) and exposed to tobacco, alcohol, and opioids in utero had 22 mm Hg higher systolic blood pressure at age 16 compared to those not exposed to any substances (β coefficient = 22.44, 95% CI: 10.53–34.35). ConclusionSingularly, tobacco, alcohol, and opioids are among the most used during pregnancy and when used in combination, pose great risk for cardiovascular disease in offspring. Given its recent rise and high prevalence, targeting maternal substance use is critical for cardiovascular disease prevention.

Prenatal smoking, alcohol and caffeine exposure and offspring externalizing disorders: a systematic review and meta-analysis.

Several studies have indicated an association between maternal prenatal substance use and offspring externalizing disorders; however, it is uncertain whether this relationship is causal. We conducted a systematic review to determine: (1) if the literature supports a causal role of maternal prenatal substance use on offspring externalizing disorders diagnosis and (2) whether these associations differ across externalizing disorders. We searched Web of Science, Embase, PsycINFO and Medline databases. Risk of bias assessment was conducted using the Newcastle-Ottawa Scale (NOS), and where possible meta-analysis was conducted for studies classed as low risk of bias. We included studies of any design that examined prenatal smoking, alcohol or caffeine use. Studies in non-English language, fetal alcohol syndrome and comorbid autism spectrum disorders were excluded. Participants in the included studies were mothers and their offspring. Measurements included prenatal smoking, alcohol or caffeine use as an exposure, and diagnosis of attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD) in offspring as an outcome. We included 63 studies, 46 of which investigated smoking and ADHD. All studies were narratively synthesized, and seven studies on smoking and ADHD were meta-analysed. The largest meta-analysis based on genetically sensitive design included 1 011 546 participants and did not find evidence for an association [odds ratio (OR)1-9 cigarettes = 0.90, 95% confidence interval (CI) = 0.83-1.11; OR> 10 cigarettes = 1.04, 95% CI = 0.79-1.36). Studies on alcohol exposure in all the outcomes reported inconsistent findings and no strong conclusions on causality can be made. Studies on caffeine exposure were mainly limited to ADHD and these studies do not support a causal effect. There appears to be no clear evidence to support a causal relationship between maternal prenatal smoking and offspring attention-deficit hyperactivity disorder. Findings with alcohol and caffeine exposures and conduct disorder and oppositional-defiant disorder need more research, using more genetically sensitive designs.

An algorithm using administrative data to measure adverse childhood experiences (ADM‐ACE)

ObjectiveTo develop an algorithm using administrative data to measure adverse childhood experiences (ADM‐ACE) within routinely collected health insurance claims and enrollment data.Data SourcesWe used claims and enrollment data from Tennessee's Medicaid program (TennCare) in 2018.Study DesignWe studied five types of ACEs: maltreatment and peer violence, foster care and family disruption, maternal mental illness, maternal substance use disorder, and abuse of the mother. We used diagnosis and procedure codes, prescription drug fills, and enrollment files to develop the ADM‐ACE, which we applied to measure the prevalence of ACEs and to examine prevalence by demographic characteristics among our sample of children in TennCare. We compared ADM‐ACE prevalence to child welfare records and survey results from Tennessee.Data Collection/Extraction MethodsOur study sample included children aged 0–17 years who were linked to their mothers if also enrolled in TennCare in 2018 (N = 763,836 children).Principal FindingsApproximately 19.2% of children in TennCare had indicators for ADM‐ACEs. The prevalence of ACEs was higher among children who were younger (p < 0.001), non‐Hispanic white or black (compared to Hispanic) (p < 0.001), and children residing in rural versus urban counties (p < 0.001). The prevalence of maltreatment identified through the ADM‐ACE (1.6%) falls between the percent of children in Tennessee who were reported to child welfare authorities and the percent for whom reports of maltreatment were substantiated. Comparison with survey reports from Tennessee parents suggests an advantage in measuring maternal mental illness with the ADM‐ACE using health insurance claims data.ConclusionsThe ADM‐ACE can be applied to health encounter data to study and monitor the prevalence of certain ACEs, their association with health conditions, and the effects of policies on reducing exposure to ACEs or improving health outcomes for children with ACEs.

Bipartisan bill to support moms experiencing MH, SUDs introduced

U.S. Senator Tammy Baldwin (D‐Wis.) and colleagues introduced the bipartisan, bicameral Into the Light for Maternal Mental Health and Substance Use Disorders Act of 2022 legislation to authorize a national Maternal Mental Health Hotline to help pregnant and postpartum women affected by mental health and substance use disorders and to reauthorize and expand a grant program to screen and treat these individuals. The reauthorization would create, improve and enhance state programs for better screening and treatment, WISPolitics.com reported March 15. “Every new mother deserves access to mental health care resources, but sadly, we are leaving too many moms behind, often women of color,” said Senator Baldwin. “This bicameral, bipartisan legislation will help ensure that regardless of where a new mother lives in Wisconsin or America, they have the resources they need to address their mental health and substance use disorder challenges and can go on to lead healthy lives.” The legislation will take commonsense steps to scale up the existing screening and treatment program based on feedback from states; broaden the Health Resources and Services Administration's support from seven to 30 state programs; and add trainings on trauma‐informed care, biases and culturally and linguistically appropriate services to bridge gaps for health equity. It will also codify the Maternal Mental Health Hotline, which is a national 24/7 voice and text program that is operated by licensed health care professionals who are trained on helping pregnant or postpartum women and family members affected by maternal mental health and substance use disorders. Today, the most common complication of pregnancy is a mental health condition, and suicide and overdose are leading causes of death for postpartum women. The bill is endorsed by more than 120 organizations.

Externalizing behavior in preschool children in a South African birth cohort: Predictive pathways in a high-risk context.

Mental health problems often begin in early childhood. However, the associations of various individual and contextual risk factors with mental health in the preschool period are incompletely understood, particularly in low- to middle-income countries (LMICs) where multiple risk factors co-exist. To address this gap, we prospectively followed 981 children in a South African birth cohort, the Drakenstein Child Health Study, assessing pre-and postnatal exposures and risk factors. The predictive value of these factors for child mental health (assessed by the Child Behavior Checklist) was modeled using structural equation modeling. We identified two key pathways to greater externalizing behavior: (1) prenatal exposure to substances (alcohol and smoking) directly predicted increased externalizing behavior (β = 0.24, p < 0.001); this relationship was partially mediated by an aspect of infant temperament (negative emotionality; β = 0.05, p = 0.016); (2) lower socioeconomic status and associated maternal prenatal depression predicted more coercive parenting, which in turn predicted increased externalizing behavior (β = 0.18, p = 0.001). Findings in this high-risk LMIC cohort cohere with research from higher income contexts, and indicate the need to introduce integrated screening and intervention strategies for maternal prenatal substance use and depression, and promoting positive parenting across the preschool period.

The impact of opioid exposure during pregnancy on the human neonatal immune profile.

BackgroundThe increasing magnitude of the opioid crisis and rising rates of neonatal abstinence syndrome (NAS) diagnoses highlight the need for increased research into how maternal substance use during pregnancy can impact the neonatal immune profile and its functionality. We hypothesized that neonates with opioid exposure would have reduced proportions of some immune cells, an anti-inflammatory cytokine profile, reduced T cell proliferation, and monocyte bacterial killing activity compared to the control population.MethodsThe present study compares immune cell populations, inflammatory and anti-inflammatory cytokine and chemokine levels in the serum, and monocyte and T cell functional activity using umbilical cord samples from neonates with known opioid exposure during gestation and from control neonates without known exposure.ResultsOur findings demonstrated a significant reduction in neutrophils, decreased levels of inflammatory cytokines in the serum, and reduced IL-2 production during in vitro CD4+ T cell proliferation in neonates exposed to opioids compared to controls. The neutrophil findings were supported by retrospective analysis of an extended network of deidentified patient records.ConclusionsThis study is the first of its kind to evaluate differences in neonatal immunity as a result of opioid exposure in the human population that will inform continued mechanistic studies.Impact The opioid epidemic has become a public health crisis in the United States, and the corresponding incidence of neonatal abstinence syndrome (NAS) have risen accordingly.New research is required to understand the short and long-term health impacts of opioid exposure to the neonate.This is the first human study to investigate the immunologic profile and functionality in neonates with known opioid exposure in utero.The abundance of neutrophils and the ratio of neutrophils to lymphocytes is significantly reduced along with inflammatory cytokines and chemokines following opioid exposure during pregnancy.The immune profile in opioid-exposed neonates may promote susceptibility to infection.

Child protection involvement of children of mothers with intellectual disability

BackgroundChildren born to parents with intellectual disability (ID) have been shown as disproportionally represented in child protection services however with limited population-based research. ObjectivesTo investigate child protection involvement for children born to mothers with ID in Western Australia using linked administrative data. Participants and settingA cohort of 1106 children born to a mother with ID and a comparison group of 9796 children of mothers without ID were identified in Western Australia. MethodsCox regression analyses stratified by maternal Aboriginal status were conducted to investigate risk of child involvement with child protection services and care placement. Interaction with child age, intellectual disability status, and maternal mental health and substance use was investigated. ResultsChildren born to a mother with ID were both at higher risk of having contact with child protection services (HR: 4.35 (3.70–5.12)) and placement in out-of-home care (HR: 6.21 (4.73–8.17)). For non-Aboriginal children, the risks of child protection involvement and placement for those born to mothers with ID were 7 times and 12 times higher than those of mothers without ID. The risk was lower for Aboriginal children, at 1.8 and 1.9 times, respectively. Infants born to mothers with ID were at higher risk of child protection involvement compared to other age groups. Maternal mental health and substance use moderated the increased risk. ConclusionsIntellectual disability alone is not sufficient justification for removal of children from their parents. The challenge for family services is ensuring that resources are adequate to meet the family's needs.

The Relative Influence of Family and Neighborhood Factors on Child Maltreatment at Critical Stages of Child Development.

This study examines the impact of family and neighborhood factors on physical and psychological abuse across three developmental stages of children: early childhood (age 3), young school age (age 5), and middle childhood (age 9). Data from the Fragile Families and Child Wellbeing Study, a longitudinal national cohort study of children from 20 urban U.S. cities, are used. Path analysis is employed to investigate the longitudinal relationships between family and neighborhood context variables and abuse risk, as well as the importance of different factors at key developmental stages. Economic hardship, maternal substance use, intimate partner violence, and exposure to community violence are found to be related to child abuse risk regardless of developmental stage, while maternal depression and neighborhood informal social control are found to have impacts only within certain child development stages. Findings suggest the need for early intervention and prevention strategies that specifically target economic hardship, poverty, intimate partner violence, and exposure to community violence.

Marijuana use inPregnant Women with Disabilities in the United States.

While perinatal marijuana use is increasing, limited research exists related to its use during pregnancy among vulnerable subpopulations of women with disabilities. The purpose of this study is to assess marijuana use in pregnant U.S. women with disabilities. The analytic sample using 2015-2019 National Survey on Drug Use and Health (NSDUH) data included 3657 pregnant women. Descriptive statistics were performed and adjusted logistic regression models estimated the size and direction of the association between the type of disabilityand marijuana use. Approximately 13.0% of pregnant women with disabilities used marijuana in the past month, which was higher than pregnant women without disabilities (4.4%). The highest prevalence of past month marijuana use was observed among pregnant women with sensory disabilities (17.2%) followed by women with cognitive disabilities (14.6%) and daily living limitations (11.7%). Marijuana use was also associated with younger age (≤ 25years old), Black non-Hispanic, high school education or less, non-married, and past month alcohol/tobacco use. Overall, pregnant women with any disability, and particularly those with sensory disabilities (AOR 2.32, 95% CI 1.21, 4.47), were significantly more likely (AOR 1.65, 95% CI 1.02, 2.69) to use marijuana than their counterparts without disabilities. The higher prevalence of marijuana use among pregnant women with disabilities in this study supports the American College of Obstetricians and Gynecologists recommendations for universal screening of maternal substance use. Screening for marijuana use in vulnerable populations is crucial and it may require training of health care providers to administer such screenings to women with disabilities.

A Pilot Study Examining Access to and Satisfaction with Maternal Mental Health and Substance Use Disorder Treatment via Telemedicine.

Background: Mental health (MH) and substance use disorders (SUDs) are common during pregnancy and the postpartum year, and have a significant impact on maternal and child health. Most women do not receive treatment for these conditions due to barriers to care. Increasing access to these services via telemedicine is one potential solution to overcoming barriers, but it is unknown if this type of service is acceptable to women. The purpose of this study is to evaluate patient satisfaction with, and accessibility to, a maternal MH and SUD telemedicine service delivered to obstetric practices.Methods: The Telemedicine Satisfaction Questionnaire and the Questionnaire for Assessing Patient Satisfaction with Video Consultation were collected via online surveys. Responses were scored on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). Paired t-tests were used to compare round trip travel time and distance between participants home and specialty clinic at an academic medical center versus their local obstetrics clinic where they received telemedicine services.Results: A total of 91.42% (32/35) of women agreed to take part in the study, and 43.75% (14/32) of women were living in a rural community. Patients reported high levels of satisfaction with the following: overall quality of care (mean [M] 4.66 [standard deviation, SD, 0.67]); similarity to face-to-face are (M 4.69 [SD 0.63]); and access to care (M 4.47 [SD 0.81]). Compared with in-person care at an academic medical center, women receiving care via telemedicine spent significantly less time (67.44 minutes vs. 256.31 minutes, p < 0.001) and distance (50.33 miles vs. 236.06 miles, p < 0.001) traveling round trip.Conclusions: Women receiving MH and SUD treatment via telemedicine within their obstetrician's office report high levels of satisfaction and increased access to care with this modality of treatment delivery. Telemedicine may provide one solution to removing barriers to care and mitigating the maternal and child risks associated with of untreated MH and SUDs.

Effects of Stress and Nativity on Maternal Antenatal Substance Use and Postnatal Mental Disorders.

Background: Maternal substance use and common mental disorders (CMDs) during or after pregnancy can lead to negative health outcomes among mothers and infants. We examined whether nativity (US-born versus foreign-born) and stress levels during pregnancy were associated with antenatal substance use and postnatal CMDs. Methods: We analyzed the Boston Birth Cohort, a racially diverse cohort recruited at birth with rolling enrollment since 1998. Information on antenatal substance use (tobacco and/or alcohol use) was obtained using an in-person postpartum questionnaire (n = 6,514). Information on postnatal CMDs (depression and/or anxiety) was obtained from medical records (n = 2,052). Nativity and stress during pregnancy were self-reported. We performed multivariate logistic regression to examine how nativity and stress levels were jointly associated with antenatal substance use and postnatal CMDs. We further investigated if blacks, Hispanics, and whites were differentially at risk. Results: We found that US-born mothers were at higher risk of substance use and CMDs than their foreign-born counterparts. In analyses combining nativity and stress, being US-born with high stress was associated with increased odds of antenatal substance use (adjusted odds ratio [aOR] = 14.91, 95% confidence interval [CI]: 12.09-18.39) and postnatal CMDs (aOR = 4.09, 95% CI: 2.72-6.15) compared with foreign-born mothers with low stress. The results of the subanalyses limited to black and Hispanic women separately were similar; high stress alone was associated with fourfold increased odds of CMDs among foreign-born Hispanic mothers (aOR = 4.27, 95% CI: 1.96-9.33). Conclusions: Findings suggest that identifying and alleviating high stress among pregnant women may reduce their risk of antenatal substance use and postnatal CMDs.