Mindful Moms in Recovery: Yoga-based mindfulness relapse prevention for pregnant women with opioid disorder

项目摘要/摘要 新罕布夏州的人均阿片类药物使用障碍率(OUD)位居第二，也是最高的 估计10%的分娩受到围产期OUD的影响，而新的 汉普郡每年预计会有多达1000名出生时接触阿片类药物的婴儿。粗略地 最近，在NH，40%的阿片类药物过量死亡是女性，21%的与妊娠有关的死亡 2013-2015年间被归因于服药过量。美国妇产科医师学会， 美国儿科学会和美国成瘾医学会呼吁采用护理 促进早期识别和治疗患有脐带血的孕妇和育儿妇女的模型。 药物辅助治疗(MAT)是建议患有OUD的孕妇的最佳实践。 即使在MAT开始时，停止治疗和复发率也很高，特别是在早期 产后期。留住的障碍包括高抑郁、焦虑和创伤后应激 混乱和不利的社会条件(例如，住房和经济不安全、人际关系 暴力)。疼痛管理对于患有先天性巨结肠的孕妇来说也是复杂的，而且管理不善 疼痛是复发的强烈风险因素。冥想，如瑜伽和正念，可能会降低罹患癌症的风险 OUD孕妇和育儿妇女的复发。建设提供MAT和协作性的能力 在产科环境中照顾患有产科疾病的孕妇和育儿妇女是新罕布夏州的优先事项 国家对阿片类药物危机的有针对性的反应。该项目代表了与NH的合作伙伴关系 利益攸关方通过开发和试点评估创伤信息系统来加强这一STR倡议 瑜伽和正念预防复发干预(康复中的正念妈妈：更多)。R21 阶段有三个具体目标：1)确定创伤知识瑜伽的需求和适应领域，以及 通过与怀孕和育儿的形成性工作，基于正念的复发预防方案 女性，2)制定综合的10个疗程的干预方案，并从客户那里反复反馈 利益相关者，以及3)在试点前评估MMORE的可行性、可接受性和疗效趋势 怀孕的女人。展示的里程碑将为R33奠定基础，有三个具体目标： 1)在一项以孕妇为对象的小型随机对照研究中评估Mmore，作为对 产科实践中的协作性MAT护理对MAT治疗保留、复发和风险的影响 指标(抑郁、焦虑、压力、疼痛管理)，2)检查治疗效果的机制 产后纵向评估结果，3)评估翻译障碍和促进者， 可持续地为接受MAT的妇女实施MORE，作为产科护理的一部分。如果成功， Mmore将提供一种非药物替代方案来支持康复和改善孕妇的生活 以及养育有乌德和她们婴儿的妇女。

Project Summary/Abstract New Hampshire has second the highest per capita rate of opioid use disorders (OUD) and the highest rate of fentanyl overdose in the U.S. An estimated 10% of deliveries are affected by perinatal OUD, and New Hampshire can anticipate as many as 1,000 infants born with prenatal opioid exposure each year. Roughly 40% of recent opioid overdose deaths in NH were women, and 21% of pregnancy-associated deaths between 2013-2015 were attributed to overdose. The American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and American Society for Addiction Medicine call for adoption of care models that promote early identification and treatment for pregnant and parenting women with OUD. Medication-assisted treatment (MAT) is the recommended best practice for pregnant women with OUD. Even when MAT is initiated, rates of treatment discontinuation and relapse are high, particularly in the early postpartum period. Barriers to retention include high rates of depression, anxiety, and posttraumatic stress disorder, and adverse social conditions (e.g., housing and economic insecurity, interpersonal relationship violence). Pain management is also complicated for pregnant women with OUD, and under-management of pain is a strong risk factor for relapse. Contemplative, such as yoga and mindfulness, may reduce risks for relapse for pregnant and parenting women with OUD. Building capacity for providing MAT and collaborative care to pregnant and parenting women with OUD in obstetric settings is a priority of the New Hampshire State Targeted Response (STR) to the Opioid Crisis. This project represents a partnership with NH stakeholders to augment this STR initiative through development and pilot evaluation of a trauma-informed yoga and mindfulness relapse prevention intervention (Mindful Moms in Recovery: MMORE). The R21 phase has three specific aims: 1) Identify needs and areas of adaptation of trauma-informed yoga and mindfulness-based relapse prevention protocols through formative work with pregnant and parenting woman, 2) Develop an integrated10-session intervention protocol with iterative feedback from client stakeholders, and 3) Evaluate feasibility, acceptability and efficacy trends of MMORE in a pre-post pilot with pregnant women. Demonstrated milestones will provide the foundation for the R33, with three specific aims: 1) Evaluate MMORE in a small randomized controlled study with pregnant women as an augment to collaborative MAT care in obstetric practices for impact on MAT treatment retention, relapse, and risk indicators (depression, anxiety, stress, pain management), 2) Examine mechanisms of treatment effects on outcomes assessed longitudinally into postpartum, 3) Evaluate barriers and facilitators to translation and sustainable implementation of MMORE for women receiving MAT as part of obstetric care. If successful, MMORE will offer a non-pharmacological alternative to support recovery and improve the lives of pregnant and parenting women with OUD and their infant children.