Methadone Maintenance Therapy: a Breastfeeding Intervention for Pregnant Women

美沙酮维持治疗：针对孕妇的母乳喂养干预措施

• 批准号: 7675458
• 负责人: DEBRA L BOGEN
• 金额: $ 20.81万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-15 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7675458
• 关键词: Academy; Addictive Behavior; African American; Alcohol or Other Drugs use; Alcohols; American; Attitude; Baltimore; Behavior; Behavior Therapy; Behavioral; Breast Feeding; Cocaine Dependence; Communication; Communities; Data; Development; Drug usage; Educational process of instructing; Emotional; Expert Opinion; Face; Focus Groups; Future; General Population; Goals; Grant; Guilt; Health; Health Benefit; Healthy People 2010; Human Milk; Infant; Infant Development; Infant Health; Intention; Intervention; Knowledge; Lactation; Length; Length of Stay; Link; Low income; Maintenance Therapy; Measures; Medical Records; Mental Health; Methadone; Methods; Mothers; NIH Program Announcements; National Institute of Drug Abuse; Neonatal Abstinence Syndrome; Opiates; Outcome; Patient Self-Report; Pediatrics; Pharmaceutical Preparations; Phase; Pilot Projects; Policies; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Program Effectiveness; Psychiatric Diagnosis; Randomized; Randomized Controlled Trials; Reporting; Research; Research Design; Review Literature; Role; Sample Size; Series; Serum; Severities; Site; Social support; Substance Use Disorder; Symptoms; System; Testing; Time; Toxicology; Urine; Woman; addiction; clinical research site; cohort; comparison group; design; emotion regulation; feeding; follow up assessment; high risk; improved; infant nutrition; infant outcome; interest; methadone maintenance; mindfulness; peer; post intervention; pregnant; programs; public health priorities; skills; social; statistics; success; successful intervention; treatment center; willingness

DESCRIPTION (provided by applicant): Background: Pregnancy offers a special opportunity for women with substance use disorders (SUDs) to change the trajectory of their addictive behavior. Unfortunately, return to unhealthful behaviors is often rapid after delivery1. The physical link between mother and infant during pregnancy that motivates many women to reduce or eliminate substance use1, 2 can be extended with breastfeeding. Breastfeeding promotes the health of the mother and infant and mother-infant attachment2, 3. We hypothesize that the physical and emotional commitment to breastfeeding will serve to motivate women with SUDs to decrease substance use and improve maternal role functioning and infant health outcomes. This R21 will develop a psycho-educational breastfeeding intervention with the goal of increasing the proportion of women who breastfeed and length of time women breastfeed and then pilot test the program's effectiveness. The long-term goal is to evaluate the impact of breastfeeding on substance use and health outcomes for methadone-exposed mother-infant dyads. Specific aims: Aim 1: Develop a psycho-educational breastfeeding intervention for women on methadone maintenance therapy (MMT) and refine measures of change in breastfeeding knowledge and attitudes. Aim 2: Pilot the intervention to: a) Compare rates of breastfeeding initiation and duration among women in one methadone treatment center before, during and after the availability of the intervention; b) Use the information obtained about differences in breastfeeding rates, maternal substance use, gratification with mothering role and severity of neonatal abstinence syndrome to estimate the sample sizes needed to design a larger randomized control trial of the intervention. Methods: The breastfeeding intervention will be developed through focus groups, ongoing research, literature review and expert opinion and will include group sessions to increase knowledge and skill 6months 12 months 6months building, one-on-one lactation support and peer-support. Specific behavioral skills from dialectical behavioral therapy will be adapted for use in the intervention. For the intervention pilot, will use a three-phase time series study design with non- randomly chosen comparison groups selected by interest in breastfeeding and willingness to participate in an intervention. Baseline assessments will include breastfeeding intention, attitude and knowledge, psychiatric diagnoses and social support. Follow-up assessments completed at one month postpartum will include infant feeding outcomes, self-reported substance use and maternal role functioning. Medical record review data will be used to assess neonatal abstinence syndrome severity and maternal substance use three months postpartum. Future Direction: These data will support a multi-site R01 grant where sites that serve pregnant women on MMT can be randomly assigned to receive (or not receive) the breastfeeding intervention. Outcomes will be compared between breastfed and formula fed methadone-exposed mother-infant dyads. Successful interventions will be adapted for women with other SUDs.Project Narrative Mothers and babies exposed to opiates during pregnancy are at high risk for adverse outcomes. Encouraging and supporting breastfeeding could motivate women on methadone to remain in treatment and off of other drugs and improve health outcomes for both mother and baby. In the proposed study, we will develop and evaluate a breastfeeding program in which women on methadone are taught about breastfeeding and skills to overcome social, personal and systems level barriers to breastfeeding.

描述（由申请人提供）： 背景：怀孕为患有物质使用障碍（SUD）的女性提供了改变其成瘾行为轨迹的特殊机会。不幸的是，产后通常很快就会恢复不健康的行为1。怀孕期间母亲和婴儿之间的身体联系促使许多妇女减少或消除药物使用1, 2，母乳喂养可以延长这种联系。母乳喂养促进母亲和婴儿的健康以及母婴依恋2, 3。我们假设，对母乳喂养的身体和情感承诺将有助于激励患有 SUD 的女性减少药物使用并改善母亲角色功能和婴儿健康结果。 R21 将制定母乳喂养心理教育干预措施，目标是增加母乳喂养女性的比例和女性母乳喂养的时间长度，然后试点测试该计划的有效性。长期目标是评估母乳喂养对暴露于美沙酮的母婴二人的物质使用和健康结果的影响。具体目标： 目标 1：为接受美沙酮维持治疗 (MMT) 的女性制定母乳喂养心理教育干预措施，并完善母乳喂养知识和态度改变的措施。目标 2：试点干预措施，以： a) 比较一个美沙酮治疗中心妇女在干预措施实施之前、期间和之后开始母乳喂养的比率和持续时间； b) 使用获得的关于母乳喂养率、母亲物质使用、对母亲角色的满意度以及新生儿戒断综合症严重程度的差异的信息来估计设计更大的干预随机对照试验所需的样本量。方法：母乳喂养干预措施将通过焦点小组、正在进行的研究、文献综述和专家意见来制定，并将包括增加知识和技能的小组会议 6 个月 12 个月 6 个月建设、一对一哺乳支持和同伴支持。辩证行为疗法中的具体行为技能将适用于干预。对于干预试点，将使用三阶段时间序列研究设计，根据对母乳喂养的兴趣和参与干预的意愿选择非随机选择的对照组。基线评估将包括母乳喂养意愿、态度和知识、精神病诊断和社会支持。产后一个月完成的后续评估将包括婴儿喂养结果、自我报告的药物使用和母亲角色功能。医疗记录审查数据将用于评估新生儿戒断综合症的严重程度和产后三个月母亲的物质使用情况。未来方向：这些数据将支持多地点 R01 拨款，其中为接受 MMT 的孕妇提供服务的地点可以被随机分配接受（或不接受）母乳喂养干预。将比较母乳喂养和配方奶喂养的美沙酮暴露母婴二人组的结果。成功的干预措施将适用于患有其他 SUD 的女性。项目叙述 怀孕期间接触阿片类药物的母亲和婴儿出现不良后果的风险很高。鼓励和支持母乳喂养可以激励服用美沙酮的妇女继续接受治疗并停止使用其他药物，并改善母亲和婴儿的健康状况。在拟议的研究中，我们将制定并评估一项母乳喂养计划，向服用美沙酮的妇女传授母乳喂养知识以及克服社会、个人和系统层面母乳喂养障碍的技能。