Association of Clinical Characteristics and Cessation of Tobacco, Alcohol, and Illicit Drug Use during Pregnancy

Abstract

Pregnancy is a time of relative urgency and opportunity for the treatment of substance use disorders in women, yet little is known about modifiable factors that contribute to successful abstinence. We examined self worth, depression, anxiety and novelty seeking in the context of substance use cessation during pregnancy in a sample of women with a high prevalence of substance abuse. Subjects were 448 birth mothers who participated in a prospective adoption study. Discontinuation rates were: tobacco 22.2%, alcohol 64.7%, marijuana 77.2%, and other drugs, 73.7 to 100 %. Depression, anxiety, and novelty seeking were lower among women who discontinued substance use, compared to those who did not. Self worth was higher in women who discontinued substance use. Among 110 polysubstance users, the number of substances discontinued during pregnancy was correlated with depression, anxiety and self worth in the hypothesized direction. Possible clinical implications are discussed.

Perinatal substance use: A prospective evaluation of abstinence and relapse

“…Other reports that have not included short interval prospective follow-up also find pregnant women are more likely to discontinue alcohol and illicit substances and least likely to discontinue cigarette use (Ebrahim and Gfroerer, 2003;Massey et al, 2011;Passey et al, 2014). The high rates of relapse following delivery in this study are consistent with the smoking literature (Gyllstrom et al, 2012;Park et al, 2009;Tran et al, 2013;Yasuda et al, 2013) and the limited literature on postpartum relapse to alcohol and illicit substances (Ebrahim and Gfroerer, 2003;Gilchrist et al, 1996;Howell et al, 1999).…”

“…Since a subject may be simultaneously in more than one risk set, marginal event modeling for multiple events, with robust sandwich estimate of the covariance matrix was used to account for within-subject correlation (Wei et al, 1989). Covariates included in multivariate Cox models were age, race, education, marital/cohabitating status and treatment group, as these are potential confounding variables (Flynn and Chermack, 2008;Havens et al, 2009;Kennare et al, 2005;Massey et al, 2011;van Gelder et al, 2010). Age was included as a categorical variable, grouped as 16 to 21 (reference group), 22 to 30 and 31 to 44 years; race was categorized as White (reference group), Black, and Hispanic/Other; marital status was coded as married/cohabitating or not married/not cohabitating (reference group); education was coded as less than high school (reference group), high school and post-high school; and treatment group indicated as either brief advice (reference group) or cognitive behavioral therapy.…”

Prenatal, perinatal, and adolescent exposure to marijuana: Relationships with aggressive behavior

“…A host of other factors may be independently associated with prenatal marijuana exposure and childhood or adolescent aggressive behavior. For instance, in one sample, mothers who continued to use substances during pregnancy reported higher depression and anxiety and lower self-worth than mothers who ceased use (Massey et al, 2010). Mothers' psychological distress predicts higher CBCL Externalizing scores (Bada et al, 2007;Minnes et al, 2010) and…”

“…Pre-adult Exposure to Marijuana: Relationships with Aggressive Behavior 13 marijuana abstain during pregnancy, some women use marijuana throughout pregnancy, and many women who abstain from marijuana during pregnancy resume use following delivery (Ebrahim, 2003;Forray, Merry, Lin, Ruger, & Yonkers, 2015;Massey et al, 2010). Prenatal marijuana use is likely associated with maternal marijuana use in following years.…”

Violência por parceiro íntimo contra a gestante: estudo sobre as repercussões obstétricas e neonatais

“…Como já citado, autores apontam um declínio do uso de álcool, tabaco e drogas após o início da gestação (MASSEY et al, 2011;MESQUITA;SEGRE, 2009;POWERS et al, 2013;. Estendendo essa abordagem à violência, no presente estudo, a não associação do hábito de fumar e uso de drogas ilícitas com a VPI na gestação poderia ter ocorrido devido ao fato de as mulheres grávidas diminuírem ou cessarem o uso destas substâncias na gravidez, que seria compreendido como menos danoso ao feto; entretanto esta relação não foi investigada neste estudo.…”