Postpartum psychoactive substance abuse after severe maternal morbidity

Abstract

Objective To evaluate drug use among mothers during the postpartum period after a severe pregnancy‐related complication. Methods A retrospective cohort study of maternal morbidity including maternal near‐miss and control groups conducted in a tertiary hospital in Campinas, Brazil, between July 2008 and June 2012. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess drug use during lifetime, pregnancy, and in the previous 3 months. Results Of 638 women evaluated, drug use was reported by 165 (25.8%). Alcohol was the most common substance used (n=133, 20.6%), followed by tobacco (n=85, 13.2%), and cocaine (n=15, 2.3%). The highest risk for postpartum drug use was among those using drugs during pregnancy. There were no differences between the morbidity and control groups, but there was a significant difference in the need for intervention to reduce alcohol consumption in the severe maternal morbidity group. Risk for substance abuse intervention increased three‐fold in women with PTSD criteria, and all aspects of quality of life were worse among drug users. Conclusion Drug use during pregnancy and maternal complications are linked to postpartum drug abuse. These women should be managed during pregnancy; postpartum follow‐up requires updated guidance and must go beyond family planning.

Quality of life after maternal near miss: A systematic review

“…Although the country of origin differed greatly between the studies, the majority were set in Africa (n = 8) [10][11][12][15][16][17]22,23 and South America (n = 5). 9,13,[18][19][20] One study was set in Europe (Sweden) 21 and one in Asia (India) 14 (Table 1). A total of 31 558 women were enrolled in the studies.…”

“…10,12,16,17,22 The remaining seven studies reported age as an interval between ≤19 and ≥40. 9,13,15,[18][19][20][21] Time to follow-up ranged from 5 months to 5 years.…”

“…Five studies assessed QoL through the WHOQOL-BREF questionnaire 10,14,15 or SF36 questionnaire. 9,19 Eight studies 11,14,[16][17][18]20,22,23 solely focused on mental health as a proxy measure for quality life and used the following tools to measure this: K10, 11,17,22,23 Edinburgh postpartum depression scale, 14,16 Post traumatic stress disorder civilian checklist, 18 and the Alcohol, Smoking, and Substance Involvement…”

“…Screening (ASSIST) test. 20 Economic aspects of QoL were assessed in various ways, for example through hospital bills and food insecurity using the Maxwell food insecurity grid. 10 The female sexual function index (FSFI) was used as tool to measure sexual health.…”

“…14,[16][17][18]21,23 16 Further, one study found lower psychological well-being among the MNM group (mean MNM : 21.9 ± 3.6 SD vs mean none-MNM: 26.0 ± 2.7 SD; p < 0.001). 15 The four studies that did not find an association between MNM and mental health, investigated K10-score (mean MNM : 4.37, mean uncomplicated delivery : 4.15, p = 0.003), 22 posttraumatic stress disorder (OR 1.09, 95% CI 0.77-1.56), 18 drug use (exposed: 27.3% vs non-exposed: 24.5%, p = 0.41) 20 and mental disorder such as depression, anxiety and schizophrenia (exposed: 22.7% vs non-exposed: 16.8%, p = 0.076). 9…”