Perinatal substance use: A prospective evaluation of abstinence and relapse

Abstract

Background-Substance use decreases in pregnancy but little prospective data are available on the rates of abstinence and relapse for specific substances. This study compared rates of abstinence in pregnancy and relapse postpartum for nicotine cigarettes, alcohol, marijuana, and cocaine.Methods-Data from 152 women drawn from a randomized controlled trial comparing psychological treatments for substance use in pregnancy were analyzed. Self-reports of substance use and urine for toxicology testing throughout pregnancy and 3-months, 12-months and 24-months post-delivery were collected. Multivariate Cox models were used to compare rates of abstinence and relapse across substances.Results-In pregnancy, 83% of all women achieved abstinence to at least one substance. The mean (SE) days to abstinence was 145.81 (9.17), 132.01 (6.17), 151.52 (6.24), and 148.91 (7.68) for cigarettes, alcohol, marijuana and cocaine, respectively. Participants were more likely to achieve abstinence from alcohol (HR 7.24 (95% CI 4.47-11.72), marijuana (HR 4.06; 95% CI 1.87-6.22), and cocaine (HR 3.41; 95% CI 2.53-6.51), than cigarettes. Postpartum, 80% of women © 2015 Published by Elsevier Ltd.Please address correspondence to Ariadna Forray at: 40 Temple Street, Suite 6B, New Haven, Connecticut, 06510 USA Fax: (203) 764-6766; ariadna.forray@yale.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Contributors:Drs. Yonkers and Ruger were responsible for the conduct of the study. Drs. Forray, Yonkers, Lin and Mr. Merry were responsible for the statistical analyses and interpretation of the data. Dr. Forray was responsible for initial draft of the manuscript, with contributions from Dr. Yonkers and Mr. Merry. Drs. Forray, Yonkers, Ruger, Lin, and Mr. Merry were responsible for critical review and editing of the manuscript. Conflict of Interest:In the past year, Dr. Yonkers received royalties from Up To Date, the content of which has no relationship to this project. Drs. Forray, Ruger, Lin and Mr. Merry have nothing to disclose. Conclusions-Pregnancy-related abstinence rates were high for all substances except cigarettes. Postpartum relapse was common, with cocaine using women being less likely to relapse after attaining abstinence compared to women using cigarettes, alcohol or marijuana. HHS Public Access

Impact of pregnancy on psychoactive substance use among women with substance use disorders recruited in addiction specialized care centers in France

“…Most of these studies assessed the fetal effect of drug intake or the effectiveness of different treatment approaches on pregnancy outcome and thus did not provide data about patterns of psychoactive drug use in this specific population. Finally, some studies tried to measure abstinence rate among pregnant women with a product based-approach and retrospective collection of consumption data before pregnancy [5].…”

Postpartum psychoactive substance abuse after severe maternal morbidity

“…The finding of the present study that around 13.0% of women refrained from using any type of substance during pregnancy but resumed drug use in the postpartum period agrees with another study of reproductive-aged women. 6 Our study showed that approximately 20% of pregnant women reported consuming alcohol in the previous 3 months at the time of the interview. The II National Alcohol and Drug Survey in Brazil conducted in 2012 showed that 38.0% of nonpregnant women included in the study reported drinking alcohol at least once a week, and 49.0% of these women were binge alcohol drinkers.…”

“…4 The World Drug Report 2015 highlighted that drug use has increased in women, particularly among those of reproductive age 5 ; however, during pregnancy most women decrease or discontinue using drugs, primarily to protect their unborn baby. 6 In the USA, the 2015 National Survey on Drug Use and Health demonstrated that 4.7% of pregnant women aged 15-44 years had consumed an illicit substance in the previous month, with 13.9% using tobacco and 9.3% using alcohol. 7 Research on drug use during the postpartum period shows that women may resume psychoactive substance use after childbirth.…”

“…According to a prospective study of 152 women, there was a sharp increase in substance use from 6 months to 1 year after childbirth even among those who did not use drugs during pregnancy. 6 An association exists between mental health and substance use, where a traumatic event may trigger drug use. 8 In women who experience a severe pregnancy-related complication, psychological morbidity may be even more prevalent and its impact may be profound.…”

Toward Enhancing Treatment for Pregnant Smokers: Laying the Groundwork for the Use of Complementary and Alternative Medicine Approaches

“…Only a handful of studies have examined the factors that are most strongly associated with changes in smoking during pregnancy, or what factors distinguish quitters from persistent smokers. Further, the few studies in this area have focused primarily on treatment-seeking samples (e.g., Forray, Merry, Lin, Ruger, & Yonkers, 2015;Ma et al, 2005;Wakschlag et al, 2003), and treatment-seekers may be more highly motivated to quit than non-treatment-seekers. In other words, exactly what enables some women to make changes for themselves and their growing families when others are unable to do so is still poorly understood.…”