An ecological momentary assessment study examining posttraumatic stress disorder symptoms, prenatal bonding, and substance use among pregnant women

Abstract

Background: Substance use disorder (SUD) during pregnancy requires efficacious interventions based on understanding the ebb and flow of risk and protective factors for substance use across time. To assess how these fluctuations are associated temporally with substance use, we used ecological momentary assessment (EMA) to evaluate substance use risk (posttraumatic stress disorder [PTSD] symptoms) and protective (prenatal fetal bonding) factors and their associations with prenatal substance use recorded in real time.Methods: Pregnant women in SUD treatment (N=33) with prior trauma exposure received smartphones with an EMA application that queried them thrice daily for 28 days about PTSD symptoms, prenatal bonding, and substance use.Results: Nearly all (N=32) provided EMA data resulting in 2,049 EMA reports (74% compliance). Most participants reported tobacco (72%), alcohol (22%), heroin (41%), and/or other illicit drug (6% -31%) use at least once via EMA. There were moderate associations (average β=.

Ecological momentary assessment studies of comorbid PTSD and alcohol use: A narrative review

“…Overall, the studies provided strong support that PTSD symptoms are associated with alcohol-related variables (Simpson et al, 2012; Kaysen et al, 2014; Simpson et al, 2014; Gaher et al, 2014; Black et al, 2018; Cohn et al, 2014; Hruska et al, 2017; Campbell et al, 2017; but see Sanjuan et al, 2019). Notably, Cohn et al (2014) did find that previous night's drinking predicted an increase in PTSD symptoms for the following day, though this association was only significant for individuals with an existing AUD.…”

“…All publication dates were included in review; studies included were published between 2005 and 2017. Note that two studies (Sanjuan, Pearson, Poremba, Amaro, & Leeman, 2019; Simons et al, 2018), both of which explored the association between PTSD symptoms and alcohol-related variables, are referenced in the discussion, but were excluded from the review as they failed to meet this review's inclusion criterion (2) (Simons et al, 2018, and Sanjuan et al, 2019 did not select for participants with elevated PTSD symptoms/trauma exposure and elevated alcohol use, respectively). A further study (Biggs et al, 2019), which did not report the association between PTSD symptoms and alcohol-related variables, was excluded because participants were not selected for elevated alcohol use (and consequently drinking rates were low).…”

Prevalence of Illicit Drug Use During Pregnancy: A Global Perspective

“…It is also important to highlight that the studies that presented prevalence of illicit drug use above 30% in interviews, were performed in populations with characteristics that predispose them to a greater consumption of illicit drugs (Gardenal et al 2011, Muckle et al 2011, Manenti et al 2011, Sanjuan et al 2019. The study by Gardenal et al (2011) presented a prevalence of 35%, however, it included only pregnant women with hepatitis C and marginalized population characteristics.…”

Prenatal Broken Bonds: Trauma, Dissociation and the Calming Womb Model

“…Some of the major bonding obstacles include, but are not limited to; Recurrent post-traumatic stress disorder (PTSD) leading to depression, PTSD associated to prenatal substance abuse (Delker et al, 2020;Sanjuan et al, 2019), anticipatory anxiety, unplanned or unwanted pregnancy, maternal separations from loved ones, abandonment by partner, family illness, financial deficits or poverty, family deaths, hormonal and acute physiological changes, baby's gender, domestic violence history and recent occurrences, unresolved spontaneous abortion (SAB) or planned abortion (TAB) trauma or fetal demise, medical trauma, genetic fetal disorder/complications, preexisting mental disorder or concurrent multiple diagnosis, pregnancy rejection, pregnancy denial, fetal idealization, recent immigration, language barrier, cultural (Kruger, 2020), gender and racial oppression, religious restrictions, affect phobia, unresolved grief, recent flashbacks, nightmares, memories of previously dissociated trauma. Swales et al (2018) findings suggest that the effects of childhood exposure to traumatic events remained after accounting for more proximal traumatic events in adulthood, and that these early traumatic experiences foretell cortisol levels in at-risk pregnant women and prenatal covarying after adult trauma.…”