Drugs and pregnancy--outcomes of women engaged with a specialist perinatal outreach addictions service

Substance misuse during pregnancy may result in harm to both mother and child. The aims of this study were to assess changes in outcomes of women seen by a specialist perinatal addictions outreach service (1989-1991 versus 2002-2005) and compare outcomes to the local hospital maternity population (2004-2005). A cross-sectional audit of health-care records was conducted comparing the outcomes of women in 2002-2005 with earlier data from 1989-1991 and the local maternity population (2004-2005). The service was attended by 126 women, of whom 83% of opioid-dependent women started/continued opioid maintenance treatment. Of 118 babies delivered, there were two stillbirths and one early neonatal death, 20% were premature, 28% were low birth weight, 21% required the Special Care Baby Unit and 21% of babies born to opioid-dependent mothers were treated for neonatal abstinence syndrome (NAS). Fewer babies required treatment for NAS in 2002-2005 compared to 1989-1991 (21% versus 44%). There were higher rates of miscarriage (3% versus <1%), low birth weight (28% versus 9%) and premature babies (20% versus 9%) compared to the local maternity population (2004-2005). Integrated perinatal addictions treatment may deliver benefits; however, engaging women into treatment earlier and reducing substance use before conception remains the objective.     

Treatment needs of women with alcohol and other drug problems: experiences and views of Australian treatment personnel

One hundred treatment personnel completed a structured interview as part of an Australian national study of the treatment needs of women with alcohol and other drug problems. The aim of the survey was to ascertain personnel's experiences of, and beliefs about providing services to women. Respondents had a broad range of qualifications and experience, and were generally supportive of provision of gender-sensitive services to women. The interview addressed a number of issues, including: barriers to treatment access, ability to provide gender-sensitive services, appropriateness of women-only services, and addressing sexual abuse issues. It is concluded that while many agencies attempted to provide appropriate services for women, many experienced difficulties, such as a lack of resources and funding. There is a continuing need for research into the best method of service delivery for women.     

A comparison study of treated and untreated pregnant and postpartum cocaine-abusing women

The purpose of this study was to determine whether untreated pregnant and recently postpartum cocaine-abusing women could be differentiated from women who enrolled in drug treatment programs. The experimental sample was selected from women referred to the Georgia Addiction, Pregnancy, and Parenting Project, an intervention program for pregnant and postpartum addicted women, between January 1987 and January 1988 (n = 45). The comparison group was randomly selected from women who were admitted to two (2) day treatment programs during the same time period (n = 50). Groups were compared using the Addiction Severity Index (ASI) and the Psychiatric Symptom Checklist-90 (SCL-90). Results indicated that untreated women were less impaired socially and exhibited fewer symptoms of psychiatric distress. These findings confirm the commonly held belief that the severity of psychosocial distress may be an important motivating factor in the decision to enter drug treatment. Alternatively, the lack of gender-sensitive program components, such as childcare, and the social stigma attached to drug use in pregnancy may also account for the reluctance of pregnant and post-partum mothers to seek drug treatment. Implications for the development of intervention and treatment programs for women are discussed.     

不同病情系统性红斑狼疮患者合并妊娠的临床特征及围生结局分析

目的 探讨不同病情系统性红斑狼疮（SLE）患者合并妊娠的临床特征及围生结局.方法 回顾性分析47例SLE合并妊娠患者的临床资料,分为病情活动组（17例）和病情稳定组（30例）,比较两组的临床资料.结果 病情活动组分娩前病情重,累及脏器多,2例死亡.病情活动组子痫前期、胎儿生长受限、胎儿丢失及早产的发生率高于病情稳定组,差异均有统计学意义（均P〈0.05）.病情活动组终止妊娠的孕周明显早于病情稳定组,新生儿体重明显低于病情稳定组,差异有统计学意义（均P〈0.05）.病情活动组活产率为64.7%,提前终止妊娠多见,新生儿死亡率高达36.4%.结论 SLE患者妊娠病情活动者妊娠结局不良.     

Delivering trauma-informed treatment in a women-only residential rehabilitation service: Qualitative study

Aim: This article explores the delivery of trauma-informed residential treatment, focussing on factors that affect how it is provided by staff and received by clients, particularly the challenges encountered. Methods: Semi-structured qualitative interviews were conducted with stakeholders (n?=?3), staff (n?=?15) and clients (n?=?19) of a women-only trauma-informed residential rehabilitation service in the UK. Interview data were systematically coded and analysed using iterative categorisation (IC). Findings: Trauma-informed treatment delivery was affected by: “recruiting and retaining a stable and trained staff team”; “developing therapeutic relationships and working with clients”; and “creating and maintaining a safe and stable residential treatment environment”. Clients’ complex needs and programme intensity made trauma-informed working demanding for staff to deliver and for clients to receive. Staff working in the residential service needed sufficient training, support and supervision to work with clients and keep themselves safe. Clients required safety and stability to build trusting relationships with staff and engage with the treatment. Conclusions: Trauma-informed residential treatment seems a valuable way of working with women with co-occurring substance use and trauma. However, it is challenging to deliver and likely to require significant resource investment. These findings appear relevant given increasing international interest in trauma-informed approaches within the addictions.     

阿片类成瘾孕妇的围产儿预后分析

目的:分析阿片类成瘾孕妇的围产儿预后情况。方法:收集厦门市妇幼保健院2014年1月-2018年10月87例阿片类成瘾孕产妇分娩资料,比较阿片类成瘾孕产妇与同时段一般孕产妇基本资料及不良妊娠结局发生差异,分析影响围产儿不良预后的危险因素。所有数据使用SPSS22.0统计学软件分析。结果:本次研究的实验组87例和对照组9964例产妇的年龄、孕次、产次、孕周及产后出血无显著差异(P>0.05),RBC、HGB、MCV、PLT及MPV差异有统计学意义(P<0.05),实验组新生儿早产、低出生体重、早期新生儿死亡、死胎、新生儿戒断综合征及新生儿异常症状/体征发生率均显著高于对照组,组间差异有统计学意义(P<0.001);87例阿片类成瘾孕妇中非治疗组新生儿戒断综合征发生率高于治疗组组,组间差异有统计学意义(P<0.05);吸毒量、吸毒时间、成瘾程度是阿片类成瘾孕妇的围产儿不良预后的危险因素。结论:阿片类成瘾孕妇不良妊娠结局发生率较高,接受治疗可有效降低新生儿戒断综合征的发生,对此类高危孕妇应给予足够的重视,加强监测和治疗,确保母婴安全。     

Development of a bibliography on religion, spirituality and addictions

INTRODUCTION AND AIMS: The aim of this study was to develop a comprehensive annotated public-domain bibliography of the literature on spirituality and addictions to facilitate future research and scholarship. DESIGN AND METHODS: A search was conducted of all citations listed in the MEDLINE, PsychINFO and ALTA Religion databases covering a period from 1941 to 2004 using the following search terms: substance abuse, substance dependence, addiction, religion, spirituality. A group of experts in the field then classified each citation according to empirically derived categories. RESULTS: A total of 1353 papers met the search parameters and were classified into 10 non-exclusive categories: (1) attitudes toward spirituality and substance use, (2) commentaries, (3) spiritual practices and development in recovery, (4) spiritual and religion variables in the epidemiology of substance abuse, (5) psychoactive substances and spiritual experiences, (6) religious and spiritual interventions, (7) literature reviews, (8) measurement of spirituality and addictions, (9) 12-Step spirituality and (10) youth and development. DISCUSSION AND CONCLUSIONS: The literature is voluminous, but has focused primarily in a few areas. Common findings included an inverse relationship between religiosity and substance use/abuse, reduced use among those practising meditation and protective effects of 12-Step group involvement during recovery. Although sound instruments are available for measuring spirituality, studies have tended to use simplistic, often single-item measures.     

Psychosocial determinants of intention to abstain from drinking alcohol while pregnant among a sample of women of childbearing age

In many countries, not drinking alcohol during pregnancy is strongly recommended, since consuming alcohol can be hazardous for the unborn child. Despite this, a number of women drink alcohol while pregnant. The two objectives of the study were to identify (1) the determinants of intention to abstain from drinking alcohol while pregnant among 167 women of childbearing age between 18 and 44 years and (2) the factors that programmes promoting alcohol abstinence during pregnancy should consider. Data were collected using a questionnaire based on an extended version of the theory of planned behaviour. A large majority of the participants reported consuming alcohol on a regular basis. Although most of them expressed a strong intention to abstain from alcohol during pregnancy, about one woman in four did not have a firm intention. A logistic regression analysis revealed that the four determinants of intention were moral norm (odds ratio (OR) = 12.97; 95% confidence interval (CI_95%): 3.83–43.91), anticipated regret (OR = 11.43; CI_95%: 3.46–37.75), attitude (OR = 7.49; CI_95%: 2.37–23.64) and perceived behavioural control (OR = 3.60; CI_95% 1.11–11.65). Moreover, a discriminant analysis identified specific beliefs significantly related to intention not to consume alcohol while pregnant. These results can prove useful in guiding the development of a programme promoting alcohol abstinence among women of childbearing age in order to reduce the number of unborn children exposed to alcohol during pregnancy.     

Patterns of alcohol intake of pregnant and lactating women in Perth, Australia

Introduction and Aims. Australian alcohol consumption data for women during the period of pregnancy and lactation is limited. The purpose of this paper is to provide current alcohol consumption data for pregnant and lactating women in Perth, Western Australia (WA). Data were collected from 587 women between mid-September 2002 and mid-July 2003. Design and Methods. Women from two public hospitals with maternity wards in the Perth metropolitan area completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women, regardless of their chosen infant feeding method, were followed-up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum. Data were analysed to determine alcohol use patterns of the women during the period of pregnancy and lactation and results were compared to national guidelines for alcohol consumption. Results. Approximately 32% of women stopped drinking alcohol during pregnancy. A remaining 35% of pregnant women consumed alcohol during pregnancy, with 82.2% of these women consuming up to two standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. Discussion and Conclusions. The majority of breastfeeding women consumed up to two standard drinks per week, which is within levels recommended by national authorities. There is, however, a small proportion of women consuming alcohol at levels above national recommendations for pregnancy and lactation. The development of 'safe' alcohol intake practices, within national recommendations, during the postnatal period would remove any potential health risks to the infant from alcohol exposure at this vulnerable growth stage. [Giglia RC, Binns CW. Patterns of alcohol intake of pregnant and lactating women in Perth, Australia. Drug Alcohol Rev 2007;26:493 - 500]     

年龄对妊娠初期纤维蛋白原水平的影响

目的探讨正常年龄孕妇与35周岁以上高龄孕妇妊娠初期纤维蛋白原(Fib)值范围的差异性。方法选取2013年3月~2014年4月间诊断为妊娠的正常年龄孕妇913例和35周岁以上的高龄孕妇90例作为研究对象,使用全自动血凝分析仪测定其Fib值,并进行对比。结果正常年龄孕妇组Fib的含量在2.08~4.98 g/L之间,平均值为(3.72±0.49)g/L;35周岁以上的高龄孕妇组测得的Fib含量在2.74~4.98 g/L之间,平均为(3.80±0.49)g/L。正常年龄孕妇组和高龄孕妇组相比,两组最小值与平均值之间差异均具有统计学意义(P<0.05)。结论妊娠初期孕妇的年龄和Fib值呈正相关的关系,检测妊娠初期的孕妇Fib的含量,可有效预防妊娠期血栓病的发生。     

Gender differences in adolescents attending a drug and alcohol withdrawal service

Introduction and Aims . Gender differences have been reported in adult substance users, but little research has examined gender differences in adolescents presenting to treatment services. This study aimed to explore gender differences in adolescents presenting to a withdrawal service. Design and Methods. All presentations to a withdrawal service between March 2000 and September 2004 were identified. For each presentation, the following information was extracted from clinical databases: sociodemographics, drug use, risk‐taking behaviour, mental health symptoms, reasons and context of drug use. Significant gender differences identified at bivariate analysis were then incorporated into multivariate models exploring predictors of heroin use, cannabis use and sharing injecting equipment. Results. A total of 262 young people were admitted during the study period (53% male, mean age 16.8 years; SD 1.13). Bivariate analysis indicated that girls were more likely to report: being homeless, using a greater number of substances, using heroin and amphetamines, higher rates of injecting, sharing injecting equipment and using with a partner. Multivariate analysis identified that being female was an independent predictor of heroin use and that being male was an independent predictor of cannabis use. Significant predictors of sharing injecting equipment were using with a partner and current use of heroin; the effect of gender was not significant after controlling for other factors. Discussion and Conclusions. Our findings indicate that male and female adolescents presenting to a withdrawal treatment service exhibit differences in substance use characteristics. Future research should examine the role of gender in determining optimal treatment approaches in substance‐using adolescents.[Dean AJ, McBride M, Macdonald EM, Connolly Y, McDermott BM. Gender differences in adolescents attending a drug and alcohol withdrawal service. Drug Alcohol Rev 2010]     

孕妇及乳妇安全合理用药科普干预研究

目的：帮助孕妇及乳妇解答日常用药中存在的疑难问题,做好孕妇及乳妇安全合理用药的科普宣传教育工作,以期促进孕妇及乳妇安全合理用药工作开展。方法：组织从事妇幼保健工作的临床药师和药师,设计活动策划方案与发放编写材料、在微信公众号上传科普文章、举办公益科普讲座、发放调查问卷并评估科普活动效果。 结果：科普活动效果调查显示,接受多种形式科普宣教与未进行科普宣的用药观点和用药行为比较,科普宣教效果优于未进行科普宣教,P<0.001,表明孕妇及乳妇在科普干预后,用药观点和用药行为上发生较大变化。结论：采用上述丰富多彩的科普教育宣传活动,能使孕妇及乳妇更好地掌握孕妇及乳妇安全合理用药科普知识,有助于树立良好用药观点,养成良好用药行为,且可向亲朋好友宣传推广,学以致用。     

孕妇及乳妇安全合理用药科普干预研究

为帮助孕妇及乳妇解答日常用药中存在的疑难问题,对其开展用药科普宣教,包括编写发放科普材料、在微信公众号上发布科普文章、举办科普讲座.调查问卷并评估科普活动效果显示,孕、乳妇在科普宣教后,用药观点和用药行为上发生了积极变化.     

Racial and Ethnic Differences in Substance Use Diagnoses,Comorbid Psychiatric Disorders,and Treatment Initiation among HIV-Positive and HIV-Negative Women in an Integrated Health Plan

Access to substance use disorder (SUD) treatment is a critical issue for women with HIV. This study examined differences in SUD diagnoses, comorbid psychiatric diagnoses, and predictors of SUD treatment initiation among a diverse sample of HIV-positive women (n = 228) and a demographically similar cohort of HIV-negative women (n = 693). Diagnoses and service utilization data were obtained from electronic health records of members of a large integrated healthcare system in Northern California. HIV-positive women were less likely to initiate SUD treatment. Significant racial/ethnic differences were found among both HIV-positive and HIV-negative women with respect to SUD diagnosis type and diagnosis of comorbid psychiatric disorders. Among the HIV-negative women, rates of SUD treatment initiation were lower for black women than for white or Latina women. Multivariable logistic regression models showed that alcohol, cannabis, and opiate diagnoses were predictive of SUD treatment initiation for both cohorts, while amphetamine diagnoses, comorbid depressive disorder, and being white or Latina were predictive of SUD treatment initiation for HIV-negative, but not HIV-positive, women. Findings suggest that clinicians need to be aware of differences in substances of abuse, comorbid psychiatric disorders, and to consider the demographic and social factors that may contribute to differences in SUD treatment initiation among HIV-positive and HIV-negative women.     

Maternal welfare, morbidity and mortality 6-15 years after a pregnancy complicated by alcohol and substance abuse: A register-based case-control follow-up study of 524 women

Background

A register-based retrospective case-control study to investigate the long-term morbidity, mortality, and welfare among women with alcohol and/or substance misuse identified during pregnancy.

Methods

Cohort of 524 women followed-up ante- and perinatally 1992-2001 at special out-patient clinics of maternity hospitals in the capital area of Finland. The control group of 1792 women with no evidence of alcohol or substance misuse was matched for maternal age, parity, date of birth and hospital of index delivery. Both groups were followed-up until end of 2007.

Results

7.9% (42/524) of the cases and 0.2% (4/1792) of the controls had died by the end of the median follow-up of 9 years (OR 38, 95% CI 14-108). The cases displayed significant morbidity requiring in-patient care in the areas of mental disorders (AOR 8.8, 95% CI 6.5-11.9), viral (AOR 23.5, 95% CI 8.8-62.7) and bacterial (AOR 6.1, 95% CI 3.5-10.4) infections, skin diseases (AOR 3.9, 95% CI 2.0-7.8) and injury and poisoning (AOR 4.2, 95% CI 3.1-5.6). The cases displayed more out-patient visits (OR 2.7, 95% CI 2.7-2.8). Their mean length of hospital stay was longer compared to controls (10.3 vs. 4.4 days, p < 0.001). The risk of pension granted due to a disorder, disease or disability (OR 8.8, 95% CI 6.0-13.0) and the risk for minimum unemployment benefit were higher compared to controls (OR 2.1, 95% CI 1.8-2.5).

Conclusions

These women display significant long-term morbidity, mortality and loss of productivity after delivery. The results emphasize the importance of adequate postnatal follow-up and treatment for misuse.     

A peer-led mobile outreach program and increased utilization of detoxification and residential drug treatment among female sex workers who use drugs in a Canadian setting

Background

The objectives of this study were to examine the determinants of using a peer-led mobile outreach program (the Mobile Access Project [MAP]) among a sample of street-based female sex workers (FSWs) who use drugs in an urban Canadian setting and evaluate the relationship between program exposure and utilizing addiction treatment services.

Methods

A detailed questionnaire was administered at baseline and bi-annual follow-up visits over 18 months (2006-2008) to 242 FSWs in Vancouver, Canada. We used bivariate and multivariate logistic regression with generalized estimating equations for both objectives, reporting unadjusted and adjusted odds ratios (AOR) with 95% confidence intervals (CIs).

Results

Over 18 months, 42.2% (202) reports of peer-led mobile outreach program use were made. High-risk women, including those servicing a higher weekly client volume (10+ compared to <10; AOR: 1.7, 95%CIs: 1.1-2.6) and those soliciting clients in deserted, isolated settings (AOR: 1.7, 95%CIs: 1.1-2.7) were more likely to use the program. In total, 9.4% (45) reports of using inpatient addiction treatment services were made (7.5% detoxification; 4.0% residential drug treatment), and 33.6% (161) using outpatient treatment (28.8% methadone; 9.6% alcohol/drug counsellor). Women who used the peer-led mobile outreach were more likely to use inpatient addiction treatment (AOR: 4.2, 95%CIs: 2.1-8.1), even after adjusting for drug use, environmental-structural factors, and outpatient drug treatment.

Discussion

Our findings demonstrate that FSWs at higher risk for sexually transmitted infections and violence are more likely to access this peer-led mobile outreach program and suggest that the program plays a critical role in facilitating utilization of detoxification and residential drug treatment.     

某社区围孕期及孕期妇女健康教育效果观察

目的：分析围孕期及孕期妇女强化健康教育后的效果观察。方法：选取2014年6月—2015年2月期间上海某社区早孕建册孕妇126例,其中经过优生优育检查备孕者纳入观察组63例,选取63例为对照组,干预后,比较两组对象随访期内孕妇孕期体重增长幅度、孕期保健知识、新生儿出生时的剖宫产率、巨大儿发生率的差别。结果：观察组孕期保健知识知晓情况高于对照组,孕期体重增长幅度和剖宫产率低于对照组,差别均有统计学意义。结论：加强科学生活方式的宣教,早期干预以减少不良妊娠结局的发生,可有效提高母婴健康。     

Personality disorders and the prediction of alcohol use outcomes for women: Dimensional versus categorical classification

The impending shift in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders from categorical to a hybrid categorical-dimensional diagnosis scheme has generated considerable interest in the relative merits of these respective approaches. This is particularly true for the diagnostically complex category of personality disorders (PDs). The present study assessed whether categorical or dimensional measures better predicted alcohol consumption in a sample of 102 women enrolled in a clinical trial comparing individual cognitive behavioral therapy (CBT) to conjoint CBT for alcohol use disorders (AUDs). Linear regression was used to evaluate whether each PD diagnosis (categorical), or the number of PD symptoms endorsed per PD (dimensional) better predicted percent days drinking over the course of six months of treatment. PD criteria (dimensional) better predicted drinking for Paranoid, Borderline, and Obsessive-Compulsive PDs, while diagnosis (categorical) was a better predictor only for passive-aggressive PD. Both schemes predicted drinking outcomes for avoidant, dependent, and depressive PDs, and neither was predictive for narcissistic PD. These findings suggest that the addition of a dimensional approach for PDs potentially enhances the prediction of alcohol use outcomes.     

围产期孕妇生殖道B族链球菌感染和耐药性及不良妊娠结局的研究

目的 通过分析围产期孕妇生殖道B族链球菌(GBS)的感染和耐药性及不良妊娠结局,为临床医师制定有效的预防和治疗措施提供依据.方法 2013年1月至2015年2月,对795例围产期孕妇生殖道分泌物进行GBS培养鉴定与药敏试验,并观察临床症状及不良妊娠结局,对结果进行统计学分析.结果 795例孕妇中共检出GBS携带者256例,带菌率为32.2％.＜30岁组(28.9％)与≥30岁组(42.3％)的带菌率差异具有统计学意义(x2=19.095,P＜0.01).GBS阳性者与GBS阴性者的临床症状发生率(18.8％ vs 8.0％)差异具有统计学意义(x 2=39.514,P＜ 0.01).10种抗菌药物(万古霉素、利奈唑胺、青霉素、氨苄西林、头孢曲松、呋喃妥因、左氧氟沙星、克林霉素、红霉素及四环素)耐药率分别为:0％、0％、0.6％、3.1％、6.6％、9.6％、21.9％、23.8％、29.9％及58.1％.D-抑菌圈试验阳性率为23.9％.GBS阳性组与GBS阴性组比较,胎膜早破、早产、宫内感染及新生儿感染发生率的差异均有统计学意义(P＜0.01).结论 该区围产期孕妇GBS带菌率较高,且高龄者易于感染;围产期孕妇感染GBS可增加不良妊娠结局的发生,应据药敏试验结果选择敏感性抗生素予以临床干预.