Psychosocial Background History of Pregnant Women with Opioid Use Disorder: A Prospective Cohort StudyFunding This study was partially funded by the Blue Cross Blue Shield Research Foundation of Tennessee.
16 April 2019
18 April 2019
02 June 2019 (online)
Objective This study aimed to evaluate the psychosocial background history and confounding social factors in pregnant women with opioid use disorder (OUD).
Study Design We performed a prospective observational cohort study of pregnant women from a dedicated obstetrical OUD clinic. Data collection came from extensive interview sessions regarding psychosocial background events and other social factors that might impact prenatal care.
Results From February 1, 2017, through September 30, 2018, 411 pregnant women were evaluated and 294 (72%, 95% confidence interval [CI]: 67–76%) reported abuse of which 217 (53%, 95% CI: 48–58%) involved sexual abuse (prior to the age of 13 years in 54% of cases) and 209 (51%, 95% CI: 46–56%) involved cases of other physical abuse. Only 10% reported habitual opioid use for managing chronic pain. Only 9% had a valid driver's license with access to a car making transportation to office visits difficult.
Conclusion A history of abuse (mainly sexual and/or physical) appears to be the main precipitating event leading to OUD in our pregnant population. Transportation was the primary social factor limiting access to prenatal care. For primary prevention to be successful in our region, early identification of young women who have experienced abuse needs to occur followed by psychotherapy health care intervention before opioid drugs are used.
- 1 Salihu HM, Mogos MF, Salinas-Miranda AA, Salemi JL, Whiteman VE. National trends in maternal use of opioid drugs among pregnancy-related hospitalizations in the United States, 1998 to 2009. Am J Perinatol 2015; 32 (03) 289-298
- 2 Patrick SW, Dudley J, Martin PR. , et al. Prescription opioid epidemic and infant outcomes. Pediatrics 2015; 135 (05) 842-850
- 3 Davie-Gray A, Moor S, Spencer C, Woodward LJ. Psychosocial characteristics and poly-drug use of pregnant women enrolled in methadone maintenance treatment. Neurotoxicol Teratol 2013; 38: 46-52
- 4 Bresnahan K, Zuckerman B, Cabral H. Psychosocial correlates of drug and heavy alcohol use among pregnant women at risk for drug use. Obstet Gynecol 1992; 80 (06) 976-980
- 5 Bayatpour M, Wells RD, Holford S. Physical and sexual abuse as predictors of substance use and suicide among pregnant teenagers. J Adolesc Health 1992; 13 (02) 128-132
- 6 Moylan PL, Jones HE, Haug NA, Kissin WB, Svikis DS. Clinical and psychosocial characteristics of substance-dependent pregnant women with and without PTSD. Addict Behav 2001; 26 (03) 469-474
- 7 Brogly SB, Saia KE, Werler MM, Regan E, Hernández-Díaz S. Prenatal treatment and outcomes of women with opioid use disorder. Obstet Gynecol 2018; 132 (04) 916-922
- 8 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596): 1453-1457
- 9 Stein MD, Conti MT, Kenney S. , et al. Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder. Drug Alcohol Depend 2017; 179: 325-329
- 10 Conroy E, Degenhardt L, Mattick RP, Nelson EC. Child maltreatment as a risk factor for opioid dependence: comparison of family characteristics and type and severity of child maltreatment with a matched control group. Child Abuse Negl 2009; 33 (06) 343-352
- 11 Bulik CM, Prescott CA, Kendler KS. Features of childhood sexual abuse and the development of psychiatric and substance use disorders. Br J Psychiatry 2001; 179: 444-449
- 12 Heffernan K, Cloitre M, Tardiff K, Marzuk PM, Portera L, Leon AC. Childhood trauma as a correlate of lifetime opiate use in psychiatric patients. Addict Behav 2000; 25 (05) 797-803
- 13 Harrison PA, Fulkerson JA, Beebe TJ. Multiple substance use among adolescent physical and sexual abuse victims. Child Abuse Negl 1997; 21 (06) 529-539
- 14 Edwall GE, Hoffmann NG, Harrison PA. Psychological correlates of sexual abuse in adolescent girls in chemical dependency treatment. Adolescence 1989; 24 (94) 279-288
- 15 Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry 2008; 165 (02) 179-187