Psychosocial Res. to Improve Drug Treatment in Pregnancy

描述(由申请人提供)： 孕妇滥用非法和合法药物是很常见的，可能会对母亲及其子女造成一些有害影响。例如，母亲和婴儿感染艾滋病毒的风险都增加了，婴儿更容易受到结构缺陷和神经发育障碍的影响。不仅怀孕期间使用有害物质往往未被发现，而且滥用药物和依赖的妇女经常得不到药物使用的治疗，产前护理的数量也低于最佳水平。行为治疗，包括激励性访谈和预防药物滥用的复发，对其他药物滥用人群有效，包括初级保健患者。然而，它们还没有在使用可卡因、大麻或甲基苯丙胺的孕妇身上进行系统的测试。行为疗法是怀孕患者使用的理想选择，因为它们消除了对本身存在毒性风险的药物干预的需要。此外，她们还可以利用经常伴随着怀孕的健康行为的建设性变化。由患者的产科提供者提供的行为治疗构成了一种综合方法，加强了药物滥用治疗和产前护理。在这项应用中，我们提出了一项随机对照试验，以评估对使用危险物质的孕妇的联合动机和认知行为干预。这项试验利用了一名妇女与其临床医生反复进行的产前检查，并提供了一个独特的机会来提供与围产期护理完全结合的药物滥用治疗。这将构成第一项系统、随机和受控的预防复发研究，以解决孕妇中的可卡因、大麻和其他非法药物滥用问题。我们建议：1)在康涅狄格州的两家公共资助的围产期诊所，耶鲁大学纽黑文医院妇女中心和布里奇波特医院产前护理诊所进行筛查；2)招募260名妇女；3)在产前就诊期间同时举行咨询会议；以及4)对主要滥用物质(大麻、可卡因或酒精)进行分层。这项研究的结果是母亲使用任何物质的天数百分比(主要)、艾滋病毒危险行为的减少(次要)和对胎儿结局的评估(次要)。

DESCRIPTION (provided by applicant): Illicit and licit substance abuse by pregnant women is common and can lead to a number of deleterious effects in mother and her offspring. For example, risks of HIV for both mother and baby are elevated and the infant is more vulnerable to both structural defects and impaired neurodevelopment. Not only is hazardous substance use in pregnancy often undetected, but women with substance abuse and dependence frequently receive no treatment for their substance use and less than optimal amounts of prenatal care. Behavioral treatments, including motivational interviewing and relapse prevention for substance abuse, are effective for other substance abuse populations, including primary care patients. However, they have not been systematically tested in pregnant women who use cocaine, marijuana or methamphetamines. Behavioral treatments are ideal candidates to use in pregnant patients since they obviate the need for pharmacological interventions that carry their own risks of toxicity. Moreover, they can capitalize on constructive changes in health behaviors that often accompany pregnancy. Behavioral treatments delivered by the patient's obstetrical providers constitute an integrated approach that strengthens substance abuse treatment and prenatal care. In this application, we propose a randomized, controlled trial to evaluate a combined motivational and cognitive behavioral intervention for pregnant women with hazardous substance use. This trial takes advantage of the repeated prenatal visits a woman has with her clinician and provides a unique opportunity to deliver substance abuse treatment that is fully integrated with perinatal care. This would constitute the first systematic, randomized and controlled relapse prevention study to address cocaine, marijuana and other illicit substance abuse in pregnant women. We propose to: 1) conduct screening at two publicly funded perinatal clinics in Connecticut, the Yale New Haven Hospital Women's Center and the Bridgeport Hospital Prenatal Care Clinic; 2) enroll 260 women; 3) hold counseling sessions conjoint within prenatal visits; and 4) stratify for primary substance of abuse (marijuana, cocaine or alcohol). Outcomes for this study are the percentage of days the mother used any substances (primary), reduction in the HIV risk behaviors, (secondary) and assessment of fetal outcomes (secondary).