Integrated Care for Pregnant Women and Parents With Methamphetamine-Related Mental Disorders

Abstract

Background: Methamphetamine use is a rapidly increasing cause of morbidity and mortality. Pregnant women and new parents who consume methamphetamine are at high risk since they seldom seek health services despite having multiple needs. We addressed this care gap by implementing an easily accessible program that pools resources from psychiatric, obstetric, and pediatric departments as well as community and government agencies.Method: This real-life observational study evaluated an integrated care program in 27 expecting parents and 57 parents of minors. The outcome criteria were treatment retention, psychosocial functioning, and abstinence. We compared participant demographics according to outcome and applied ordinal logistic regression to predict treatment success.Results: Patients received integrated care for almost 7 months on average. Nearly half achieved stable abstinence and functional recovery. Only one pregnant woman dropped out before a care plan could be implemented, and all women who gave birth during treatment completed it successfully. Three-fourths of patients had psychiatric comorbidities. Patients with depressive disorders were almost 5 times less likely to succeed with treatment. Attention-deficit hyperactivity disorder (ADHD) was diagnosed in nearly 30% of patients who dropped out of a care plan, which was about 4 times more often than in the successful outcome group.Conclusion: Our program engaged pregnant women and parents in treatment and helped them recover from methamphetamine-related mental disorders. Management of comorbid ADHD and depression should be an integral part of care initiatives to counter the methamphetamine crisis that affects parents and children across the globe.

Maternal Methamphetamine Exposure Influences Behavioral Sensitization and Nucleus Accumbens DNA Methylation in Subsequent Generation

“…In humans, loss of the KIRREL3 gene was associated with neurodevelopmental disorders, such as Jacobson’s syndrome, intellectual disability, and autism spectrum disorder ( Bhalla et al, 2008 ). Knockout of the Kirrel3 gene in mice led to auditory sensory and motor skill impairment and ADHD (attention deficit and hyperactivity disorder) ( Hisaoka et al, 2018 ), as well as an increased risk of ADHD in children following prenatal METH exposure ( Pendergast et al, 2012 ; Petzold et al, 2021 ). Lrpprc is a leucine-rich PPR motif-containing protein, and mutation of the LRPPRC gene may lead to Leigh syndrome in French Canadians ( Mootha et al, 2003 ).…”

Housing Correlates in Pregnant and Parenting Women Using Methamphetamine and Accessing Psychiatric Care

“…Psychiatric comorbidities and social complexities were frequent in our naturalistic sample of pregnant and parenting women, echoing the multiple burdens reported in association with methamphetamine use ( 19 , 24 ). We previously found that comorbid attention-deficit hyperactivity disorder and depression jeopardized treatment engagement in integrated care ( 27 ). Yet in contrast to social challenges, psychiatric comorbidities were not significantly related to housing at discharge.…”

“…We studied all 102 women who accessed psychiatric care within Mamadam since its start in 2016 and left or completed treatment before July 30, 2020. This naturalistic sample included the 73 women whose treatment adherence was previously analyzed ( 27 ). Adherence was categorized as early discontinuation (before implementing a care plan), partial completion of the program (late discontinuation), or successful completion (requiring stable abstinence).…”

“…Previous studies described the Mamadam concept in detail and added to the evidence that pregnancy and parenthood provide opportunities to motivate change ( 13 , 19 , 24 ), thereby decreasing substance use and child removal ( 15 , 25 – 27 ). Patients could be engaged in outpatient psychiatric treatment over months, but more research is imperative to evaluate and optimize care strategies.…”

“There’s a big tag on my head”: exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia

“…Participants in the study had needs across multiple domains, encompassing physical and mental health needs, income support, social support and justice involvement. This need for is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) integrated care to support the whole of a person's health needs through effective working across healthcare and other services has also been highlighted by other studies with people with substance use disorders (Petzold et al, 2021;Savic, Best, Manning, & Lubman, 2017).…”