Improving Assessment, Treatment, and Understanding of Pregnant Women with Opioid Use Disorder: The Importance of Life Context - Preis, H. et al. Flashcards
Opioid Use Disorder
Refers to the nonmedical habitual use of opioids.
In the last decade, OUD in the US has increased dramatically, and the number of pregnant women with OUD has quadrupled between 1999 and 2014.
What are the consequences of OUD during pregnancy?
Adverse consequences including increased risk of stillbirth, preterm birth, low birth weight, and neonatal abstinence syndrome
Maternal mortality is also associated with OUD, and it, too, is on the rise
What factors prevent pregnant women with OUD from seeking help, which lead to OUD being undiagnosed and untreated?
Social consequences, such as exceptional stigma and shame brought on by social scrutiny, misconceptions about the safety of prescription opioids, and secrecy due to fear of the involvement of Child Protective Services. There’s cultural disapproval of pregnant substance users.
Also this group faces a multitude of interpersonal and strucutral barriers (e.g., poor access to care, inadequate insurance coverage)
Life Course Theory
Is a conceptual framework for understanding population health. It emphasizes the role of social, environmental, and financial determinants of health.
One of the core concepts of LCT that is relevant to perinatal health is a directive to view individuals and their bodily systems through a whole-system perspective.
Whole-System Perspective
Recognize how life context affects health. Life context is often overlooked both in clinical practice with pregnant women with OUD and in research on this population.
Life context includes women’s personal and medical history; their currently available mental, social, and physical resources; and their cultural and biomedical needs, all of which are pivotal to their health and well-being
Prenatal care
Is to ensure the healthy continuation of pregnancy and to provide the best possible outcomes for both mother and infant.
Medication-assisted treatment (MAT)
Involves methadone or buprenorphine. In woman-centered care, MAT dosage is adjusted to accommodate increasing metabolic demands as pregnancy progresses.
Although MAT does not eliminate the risk of neonatal abstinence syndrome, it is related to lower likelihood of preterm birth, higher birth weight, shorter hospital stays, and better infant health. MAT also reduces risk of relapse, overdose, and other deleterious circumstances (e.g., intravenous injections, the stress associated with having to obtain more drugs, etc)
Life-context factors
Includes stress, lack of social support, interpersonal violence, low income and education, psychiatric comorbidities, and membership in an underserved racial/ethnic group. All of which are associated with worse perinatal outcomes.
Women centered programs
Tailored to the needs of women and pregnancy, they address women’s life context, and provide social and psychological care.
Profile for Maternal Opioid Treatment Effectiveness (PROMOTE)
Is a brief, self-administered instrument that includes items based on psychological theories relevant to health (e.g., LCT), on empirical evidence from prenatal and OUD populations, and on clinical best practice.
