Salud mental, abuso de sustancias y trastornos duales en el embarazotasas de prevalencia y tratamiento en un país desarrollado

  1. Rodrigo Carmona Camacho 1
  2. Nayara López Carpintero 2
  3. María Luisa Barrigón 1
  4. Cristina Ruiz Nogales 1
  5. Inés Menéndez 1
  6. Montserrat Sánchez Alonso 1
  7. Irene Caro Cañizares 1
  8. Juan José Hernández Aguado 2
  9. Benjamin Le Cook 3
  10. Margarita Alegría 4
  11. Ricardo Saviron Cornudella 5
  12. Javier Plaza 6
  13. Enrique Baca-García 1
  1. 1 Departamento de Psiquiatría. Fundación Jiménez Díaz, Madrid, España.
  2. 2 Hospital Infanta Leonor, Madrid, España
  3. 3 Cambridge Health Alliance. Cambridge, EE. UU.
  4. 4 Escuela de Medicina de Harvard
  5. 5 Hospital General de Villalba, Madrid, España.
  6. 6 Fundación Jiménez Díaz, Madrid, España.
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Journal:
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Year of publication: 2022

Volume: 34

Issue: 4

Pages: 299-307

Type: Article

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More publications in: Adicciones: Revista de socidrogalcohol

Abstract

Smoking and substance use during pregnancy are major preventable causes of mortality and morbidity, having a bidirectional and delete - rious relationship with the mental health of the mother and child. As part of the WOMAP (Woman Mental Health and Addictions on Pregnancy) initiative, our study aimed to describe the prevalence of co-occurring mental illness and substance use problems, diagnoses and severity of those considered at risk and rates of treatment. A screening of 2,014 pregnant women was done using the AC-OK scale and they were asked about their smoking habits and services use for mental health/substance abuse. Of these, 170 women were considered at risk of co-occurring mental illness and substance use problems (≥ 2 positive responses to the AC-OK-Mental Health sub- scale, ≥ 1 positive response to the AC-OK-Substance Abuse subscale and/or smoking more than once a month and no use of specialized services) and were assessed with a more extensive battery of measures (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Posttraumatic stress disorder [PTSD] Checklist for DSM-5 [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] and Fagerström). In the last year, 614 women (30.5%) smoked tobacco (42.5% daily) and 9.8% were positive for both substance use and mental illness per the AC-OK. Only 11.1% of them received specific treatment in the previous three months while another 13.6% were scheduled to attend services in the following month. From the subsample assessed in depth, 62(36.5%) endorsed at least moderate depression, 35(20.6%) endorsed at least moderate anxiety, 32(18.8%) endorsed PTSD on the PCL, and 37 out of 88 alcohol users scored above the threshold in AUDIT (≥ 3). In conclusion, high prevalence and low treatment rates suggest that effective detection mechanisms should be integrated into usual care, allowing for early interventions.

Bibliographic References

  • ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. (2012). Obstet Gynecol, 119, 1070-1076. doi:10.1097/AOG.0b013e318256496e.
  • Austin, M. P., Priest, S. R. & Sullivan, E. A. (2008). Antenatal psychosocial assessment for reducing perinatal mental health morbidity. Cochrane Database Systematic Revision, 4, CD005124. doi:10.1002/14651858.CD005124.pub2.
  • Barrigon, M. L., Berrouiguet, S., Carballo, J. J., Bonal-Gimenez, C., Fernandez-Navarro, P., Pfang, B.,… Baca-Garcia, E. (2017). User profiles of an electronic mental health tool for ecological momentary assessment: MEmind. International Journal of Methods in Psychiatric Research, 26, e1554. doi:10.1002/mpr.1554.
  • Bayrampour, H., Hapsari, A. P. & Pavlovic, J. (2018). Barriers to addressing perinatal mental health issues in midwifery settings. Midwifery, 59, 47-58. doi:10.1016/j.midw.2017.12.020.
  • Blanchard, E. B., Jones-Alexander, J., Buckley, T. C. & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669-673.
  • Blasco-Alonso, M., Gonzalez-Mesa, E., Galvez Montes, M., Lozano Bravo, I., Merino Galdon, F., Cuenca Campos, F.,… Bellido Estevez, I. (2015). Exposure to tobacco, alcohol and drugs of abuse during pregnancy. A study of prevalence among pregnant women in Malaga (Spain). Adicciones, 27, 99-108.
  • Blatt, K., Moore, E., Chen, A., Van Hook, J. & DeFranco, E. A. (2015). Association of reported trimester-specific smoking cessation with fetal growth restriction. Obstetrics & Gynecology, 125, 1452-1459. doi:10.1097/aog.0000000000000679.
  • Bohn, M. J., Babor, T. F. & Kranzler, H. R. (1995). The Alcohol Use Disorders Identification Test (AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol, 56, 423-432. doi:10.15288/jsa.1995.56.423.
  • Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Reserach, 6 (Suppl. 2), S125-140. doi:10.1080/14622200410001669187.
  • Cook, J. L., Green, C. R., de la Ronde, S., Dell, C. A., Graves, L., Ordean, A.,… Wong, S. (2017). Epidemiology and effects of substance use in pregnancy. Journal of Obstetrics and Gynaecology Canada, 39, 906-915. doi:10.1016/j.jogc.2017.07.005.
  • Chang, G., Orav, E. J., Jones, J. A., Buynitsky, T., Gonzalez, S. & Wilkins-Haug, L. (2011). Self-reported alcohol and drug use in pregnant young women: A pilot study of associated factors and identification. Journal of Addiction Medicine, 5, 221-226. doi:10.1097/ADM.0b013e318214360b
  • Chavez, L. M., Shrout, P. E., Wang, Y., Collazos, F., Carmona, R. & Alegria, M. (2017). Evaluation of the AC-OK mental health and substance abuse screening measure in an international sample of Latino immigrants. Drug and Alcohol Dependence, 180, 121-128. doi:10.1016/j.drugalcdep.2017.07.042.
  • Cherry, A. L. & Dillon, M. E. (2013). The AC-OK cooccurring screen: Reliability, convergent validity, sensitivity, and specificity. Journal of Addiction, 2013, 573906. doi:10.1155/2013/573906.
  • Dahlin, S., Gunnerbeck, A., Wikstrom, A. K., Cnattingius, S. & Edstedt Bonamy, A. K. (2016). Maternal tobacco use and extremely premature birth - a population-based cohort study. British Journal of Obstetrics and Gynaecology, 123, 1938-1946. doi:10.1111/1471-0528.14213.
  • Donald, K. A., Eastman, E., Howells, F. M., Adnams, C., Riley, E. P., Woods, R. P.,… Stein, D. J. (2015). Neuroimaging effects of prenatal alcohol exposure on the developing human brain: A magnetic resonance imaging review. Acta Neuropsychiatrica, 27, 251-269. doi:10.1017/neu.2015.12.
  • Ebrahim, S. H. & Gfroerer, J. (2003). Pregnancy-related substance use in the United States during 1996-1998. Obstetrics & Gynecology, 101, 374-379.
  • Ekblad, M., Gissler, M., Lehtonen, L. & Korkeila, J. (2010). Prenatal smoking exposure and the risk of psychiatric morbidity into young adulthood. Archives of General Psychiatry, 67, 841-849. doi:10.1001/archgenpsychiatry.2010.92.
  • England, M. C., Benjamin, A. & Abenhaim, H. A. (2013). Increased risk of preterm premature rupture of membranes at early gestational ages among maternal cigarette smokers. American Journal of Perinatology, 30, 821-826. doi:10.1055/s-0032-1333408.
  • Fairbrother, N., Janssen, P., Antony, M. M., Tucker, E. & Young, A. H. (2016). Perinatal anxiety disorder prevalence and incidence. Journal of Affective Disorders, 200, 148-155. doi:10.1016/j.jad.2015.12.082.
  • Forray, A. & Foster, D. (2015). Substance use in the perinatal period. Current Psychiatry Reports, 17, 91. doi:10.1007/s11920-015-0626-5.
  • Garg, M., Garrison, L., Leeman, L., Hamidovic, A., Borrego, M., Rayburn, W. F. & Bakhireva, L. (2016). Validity of self-reported drug use information among pregnant women. Maternal and Child Health Journal, 20, 41-47. doi:10.1007/s10995-015-1799-6.
  • Gauthier, T. W., Guidot, D. M., Kelleman, M. S., McCracken, C. E. & Brown, L. A. (2016). Maternal alcohol use during pregnancy and associated morbidities in very low birth weight newborns. American Journal of the Medical Sciences, 352, 368-375. doi:10.1016/j.amjms.2016.06.019.
  • Gouin, K., Murphy, K. & Shah, P. S. (2011). Effects of cocaine use during pregnancy on low birthweight and preterm birth: Systematic review and metaanalyses. American Journal of Obstetrics & Gynecology, 204, 340 e341-312. doi:10.1016/j.ajog.2010.11.013.
  • Hankin, J., McCaul, M. E. & Heussner, J. (2000). Pregnant, alcohol-abusing women. Alcoholism: Clinical and Experimental Research, 24, 1276-1286.
  • Heatherton, T. F., Kozlowski, L. T., Frecker, R. C. & Fagerstrom, K. O. (1991). The Fagerstrom test for nicotine dependence: A revision of the Fagerstrom tolerance questionnaire. British Journal of Addiction, 86, 1119-1127.
  • Holbrook, B. D. & Rayburn, W. F. (2014). Teratogenic risks from exposure to illicit drugs. Obstetrics and Gynecology Clinics of North America, 41, 229-239. doi:10.1016/j.ogc.2014.02.008.
  • Howard, L. M., Piot, P. & Stein, A. (2014). No health without perinatal mental health. Lancet, 384, 1723-1724. doi:10.1016/s0140-6736(14)62040-7.
  • Kingston, D., Tough, S. & Whitfield, H. (2012). Prenatal and postpartum maternal psychological distress and infant development: A systematic review. Child Psychiatry & Human Development, 43, 683-714. doi:10.1007/s10578-012-0291-4.
  • Ko, T. J., Tsai, L. Y., Chu, L. C., Yeh, S. J., Leung, C., Chen, C. Y.,… Hsieh, W. S. (2014). Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: A birth cohort study. Pediatrics and Neonatology, 55, 20-27. doi:10.1016/j.pedneo.2013.05.005.
  • Kramer, M. S., Lydon, J., Seguin, L., Goulet, L., Kahn, S. R., McNamara, H.,… Platt, R. W. (2009). Stress pathways to spontaneous preterm birth: The role of stressors, psychological distress, and stress hormones. American Journal of Epidemiology, 169, 1319-1326. doi:10.1093/aje/kwp061.
  • Kroenke, K., Spitzer, R. L. & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606-613.
  • Lange, S., Probst, C., Rehm, J. & Popova, S. (2018). National, regional, and global prevalence of smoking during pregnancy in the general population: A systematic review and meta-analysis. Lancet Global Health, 6, e769-e776. doi:10.1016/s2214-109x(18)30223-7.
  • Martinez-Paredes, J. F. & Jacome-Perez, N. (2019). Depression in pregnancy. Revista Colombiana de Psiquiatría, 48, 58-65. doi:10.1016/j.rcp.2017.07.003.
  • Paykel, E. S., Myers, J. K., Lindenthal, J. J. & Tanner, J. (1974). Suicidal feelings in the general population: A prevalence study. British Journal of Psychiatry, 124, 460-469.
  • Pereira, P. P., Da Mata, F. A., Figueiredo, A. C., de Andrade, K. R. & Pereira, M. G. (2017). Maternal active smoking during pregnancy and low birth weight in the americas: A systematic review and meta-analysis. Nicotine & Tobacco Research, 19, 497-505. doi:10.1093/ntr/ntw228.
  • Pineles, B. L., Hsu, S., Park, E. & Samet, J. M. (2016). Systematic review and meta-analyses of perinatal death and maternal exposure to tobacco smoke during pregnancy. American Journal of Epidemiology, 184, 87-97. doi:10.1093/aje/kwv301.
  • Sarman, I. (2018). Review shows that early foetal alcohol exposure may cause adverse effects even when the mother consumes low levels. Acta Paediatrica, 107, 938-941. doi:10.1111/apa.14221.
  • Siu, A. L. (2015). Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. preventive services Task Force Recommendation Statement. Annals of Internal Medicine, 163, 622-634. doi:10.7326/m15-2023.
  • Spanish Government. Ley Orgánica 3/2018 de Protección de Datos Personales y garantía de los derechos digitales. (2018). Madrid, Spain: Retrieved at https://www.boe.es/eli/es/lo/2018/12/05/3/dof/spa/pdf.
  • Spitzer, R. L., Kroenke, K., Williams, J. B. & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092-1097. doi:10.1001/archinte.166.10.1092.
  • Tiesler, C. M. & Heinrich, J. (2014). Prenatal nicotine exposure and child behavioural problems. European Child & Adolescent Psychiatry, 23, 913-929. doi:10.1007/s00787-014-0615-y.
  • Woody, C. A., Ferrari, A. J., Siskind, D. J., Whiteford, H. A. & Harris, M. G. (2017). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 219, 86-92. doi:10.1016/j.jad.2017.05.003.
  • Yudko, E., Lozhkina, O. & Fouts, A. (2007). A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. Journal of Substance Abuse Treatment, 32, 189-198. doi:10.1016/j.jsat.2006.08.002.
Data source: Dialnet