Preventing Alcohol and Tobacco Exposed Pregnancies: CHOICES Plus in Primary Care

Velasquez, Mary M.; Sternberg, Kirk L Von; Floyd, R. Louise; Parrish, Danielle E.; Kowalchuk, Alicia; Stephens, Nanette S; Ostermeyer, Britta; Green, Charles; Seale, J. Paul; Mullen, Patricia Dolan

doi:10.1016/j.amepre.2017.02.012

Cited by 31 publications

(57 citation statements)

References 45 publications

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“…Furthermore, enhancement of preconception education and delivery of evidence-based information are needed, along with interventions to optimize preconception health. 35 Specific interventions to address preconceptional alcohol and tobacco use and effective contraception for those at risk of unintended pregnancy have been demonstrated 24 and may be an important step to address the increased risk of unfavorable pregnancy context measures we observe among women with periconceptional substance use. For example, the CHOICES Plus trial demonstrated a preconception intervention reduced the risk of alcohol-and tobacco-exposed pregnancies within primary health care settings, 24 and future efforts integrating similar approaches within reproductive health care and family planning settings should be evaluated.…”

Section: Discussionmentioning

confidence: 99%

Is Periconceptional Substance Use Associated with Unintended Pregnancy?

Lundsberg

Pensak

Gariepy

2020

Women's Health Reports

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Background: To evaluate the relationship between periconceptional (period before and/or after conception) substance use and unfavorable pregnancy contexts, including unintended pregnancy. Materials and Methods: This is a cross-sectional analysis of English-or Spanish-speaking women aged 16-44 years with pregnancies <24 weeks' gestation presenting to pregnancy testing clinics and enrolled between June 2014 and June 2015. Participants self-reported periconceptional substance use (tobacco, alcohol, marijuana, and other illicit substances during the 3 months before enrollment), and pregnancy ''contexts,'' including pregnancy intention, wantedness, planning, timing, desirability, and happiness. Multivariable logistic regression was performed adjusting for potential confounding variables. Results: We enrolled 123 women, averaging 27 -6 years, and mean gestational age 7.5 -3.0 weeks. Most participants were black, non-Hispanic (37%), or Hispanic (46%), and chose to complete the study in English (69%). Sixty-five percent participants reported use of one or more substances during prior 3 months: alcohol (54%), tobacco (31%), and marijuana (21%). In multivariate analysis, periconceptional alcohol use was associated with increased odds of unintended or ambivalent pregnancy and unwanted or mixed feelings regarding pregnancy (odds ratios [OR] = 3.29, 95% confidence interval [CI] 1.08-10.08 and OR = 2.81, 95% CI 1.07-7.36, respectively). Weekly or daily tobacco use was associated with unhappiness about pregnancy (OR = 7.56, 95% CI 1.65-34.51) and undesired or unsure pregnancy (OR = 4.00, 95% CI 1.14-14.06). Conclusions: Periconceptional alcohol or tobacco use demonstrates increased odds of specific unfavorable pregnancy contexts, including pregnancy described as undesired, unintended, unwanted, and unhappiness with pregnancy. Primary prevention of periconceptional substance use and the negative effects of alcohol and tobacco may be improved by increasing contraception access for women at risk for unfavorable pregnancy contexts.Keywords: alcohol; pregnancy; tobacco; unintended pregnancy; unplanned pregnancy However, focusing on preconception care in this way may be insufficient as it assumes that women have control over their reproductive lives, that contraception never fails, that all pregnancies are planned, and that such assumptions are inherently flawed. 5,6 For example, purposeful abstinence regarding tobacco, alcohol,

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Section: Discussionmentioning

confidence: 99%

Is Periconceptional Substance Use Associated with Unintended Pregnancy?

Lundsberg

Pensak

Gariepy

2020

Women's Health Reports

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“…Given the known long-term effects of prenatal alcohol exposure and updated prevalence rates of FASD, continued efforts to decrease drinking during pregnancy are needed to reduce the long-term risk for developmental disorders for all women, including those with OUD. Additional public health efforts should be devoted to preconceptional prevention of alcohol-exposed pregnancies by reducing risky drinking and/or use of effective contraception in women at risk, such as that which has been demonstrated in the CHOICES Program (Hanson et al, 2017;Velasquez et al, 2017). Given high unintended pregnancy rates in women with SUD, additional efforts should be devoted to effective family planning services.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of alcohol use in pregnant women with substance use disorder

Bakhireva

Shrestha

Garrison

et al. 2018

Drug and Alcohol Dependence

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“…However, cohort studies of cardiovascular, metabolic, or other general health tend to focus on older populations (at higher risk for most conditions) and frequently either exclude pregnant women, or, in the case of younger populations, assess health status outside pregnancy only. Studies assessing preconception health care are often geared towards women with clinical conditions or who are at otherwise high risk …”

Section: Introductionmentioning

confidence: 99%

The Preconception Period analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium

Harville

Mishra

Yeung

et al. 2019

Paediatric Perinatal Epid

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Background Preconception health may have intergenerational influences. We have formed the PrePARED (Preconception Period Analysis of Risks and Exposures influencing health and Development) research consortium to address methodological, conceptual, and generalisability gaps in the literature. Objectives The consortium will investigate the effects of preconception exposures on four sets of outcomes: (1) fertility and miscarriage; (2) pregnancy‐related conditions; (3) perinatal and child health; and (4) adult health outcomes. Population A study is eligible if it has data measured for at least one preconception time point, has a minimum of selected core data, and is open to collaboration and data harmonisation. Design The included studies are a mix of studies following women or couples intending to conceive, general‐health cohorts that cover the reproductive years, and pregnancy/child cohort studies that have been linked with preconception data. The majority of the participating studies are prospective cohorts, but a few are clinical trials or record linkages. Methods Data analysis will begin with harmonisation of data collected across cohorts. Initial areas of interest include nutrition and obesity; tobacco, marijuana, and other substance use; and cardiovascular risk factors. Preliminary results Twenty‐three cohorts with data on almost 200 000 women have combined to form this consortium, begun in 2018. Twelve studies are of women or couples actively planning pregnancy, and six are general‐population cohorts that cover the reproductive years; the remainder have some other design. The primary focus for four was cardiovascular health, eight was fertility, one was environmental exposures, three was child health, and the remainder general women's health. Among other cohorts assessed for inclusion, the most common reason for ineligibility was lack of prospectively collected preconception data. Conclusions The consortium will serve as a resource for research in many subject areas related to preconception health, with implications for science, practice, and policy.

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Preventing Alcohol and Tobacco Exposed Pregnancies: CHOICES Plus in Primary Care

Abstract: This study is registered at clinicaltrials.gov NCT01032772.

Cited by 31 publications

References 45 publications

Is Periconceptional Substance Use Associated with Unintended Pregnancy?

Is Periconceptional Substance Use Associated with Unintended Pregnancy?

Prevalence of alcohol use in pregnant women with substance use disorder

The Preconception Period analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium

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