A Preconception Health Intervention to Reduce Substance Exposed Pregnancies among Incarcerated Women

项目总结 怀孕期间使用非法药物对母亲和儿童的破坏性影响普遍存在， 2017年至2018年期间，影响了50多万名新生儿。不良的分娩结局可能包括胎儿发育。 限制、新生儿禁欲综合症、早产和死亡。怀孕期间使用非法药物使 面临暴露于性传播感染和法律后果活动风险的妇女 包括失去儿童监护权和监禁。暴露在空气中的儿童的长期负面后果 宫内物质的范围从在父母一方或双方都有药物使用的环境中长大 精神障碍(SUD)会增加患抑郁症的风险，发展为SUD本身，并遭受虐待。 而美国成瘾医学会建议生育计划教育应 纳入sud治疗计划的干预措施主要集中在增加分娩机会上。 已怀孕妇女的控制和治疗策略。积极主动地解决物质使用问题 在怀孕前，在未孕期，是需要的。解决酒精问题的先入为主的干预 戒烟已被证明是有效的。然而，据我们所知，没有干预措施来 解决先入为主的非法物质使用问题。在监狱中的女性中，sud的患病率高达63%。 这一人群在获释后既面临药物复发的风险，也面临怀孕的风险。存在一个最佳时期 (在释放之前)先入为主的SUD干预对这一人群是可行和理想的时间。使用 对监狱中和怀孕前的妇女采取积极主动的做法将降低接触物质的风险 减少怀孕(SEP)，减轻对母亲、新生儿和家庭的众多负面后果。 这项拟议的研究将是第一次采用基于证据的前概念干预，选择，用于 在患有非法尿毒症的被监禁妇女中使用。选择是为了减少饮酒的风险-- 通过针对危险饮酒和有效避孕措施来暴露怀孕。1拟议的研究将 在患有非法性侵的被监禁妇女中调整使用的选择，当她们处于 释放了。该项目的具体目标是：(1)调整选择，以供被监禁妇女使用 与非法药物有关的SUD将创建一种手动干预、选择-恳求(将怀孕从 接触酒精和物质)和(2)评估选择的可行性、可接受性和有效性- 呼吁降低SEP的风险(持续戒毒和/或减少危险的性行为) 在参加法院规定的SUD治疗计划的女性中。 通过完成这些目标和行为干预设计方面的额外培训，高级 统计方法，以及育龄妇女的sud治疗，实习生贝洛博士将获得 成为一名独立调查员所需的专业知识。她的长期目标是使自己成为一名 独立调查员，在解决患有自闭症妇女的生殖健康需求方面具有专业知识。

PROJECT SUMMARY The devastating effects of illicit substance use during pregnancy on mothers and children is widespread, affecting more than 500,000 births between 2017 and 2018. Adverse birth outcomes can include fetal growth restriction, neonatal abstinence syndrome, prematurity, and death. Illicit drug use during pregnancy puts women at risk of activities that expose them to sexually transmitted infections and legal consequences including loss of child custody and incarceration. Long-term negative consequences for children exposed to substances in-utero range from growing up in an environment where one or both parents have substance use disorders (SUD) to increased risk of depression, developing SUD themselves, and suffering from abuse. While the American Society of Addiction Medicine recommends reproductive planning education be incorporated into SUD treatment programs, interventions have primarily focused on increasing access to birth control and treatment strategies for women already pregnant. A proactive approach to address substance use prior to pregnancy, in the preconception period, is needed. Preconception interventions that address alcohol and tobacco cessation have been found effective. However, to our knowledge, there are no interventions to address preconception illicit substance use. The prevalence of SUD among women in jail is as high as 63% and this population is at risk of both drug relapse and pregnancy after release. There is an optimal period of time (prior to release) when preconception SUD interventions are feasible and ideal for this population. Using a proactive approach for women in jail and before pregnancy will reduce the risk of substance exposed pregnancies (SEPs) and mitigate the numerous negative consequences for mothers, newborns, and families. The proposed study will be the first to adapt an evidence-based preconception intervention, CHOICES, for use among incarcerated women with illicit SUD. CHOICES was developed to reduce the risk of alcohol- exposed pregnancies by targeting both risky drinking and effective contraceptive use.1 The proposed study will adapt CHOICES for use among incarcerated women with illicit SUD who are at risk for an SEP when they are released. The specific aims of this project are to: (1) adapt CHOICES for use among incarcerated women with illicit drug-related SUD to create a manualized intervention, CHOICES-PLEAS (Pregnancy Liberated from Exposure to Alcohol and Substances) and (2) evaluate the feasibility, acceptability, and efficacy of CHOICES- PLEAS at reducing the risk of SEPs (continued drug abstinence and/or reduction in risky sexual behavior) among women in a court-mandated SUD treatment program. Through completion of these aims and additional training in behavioral intervention design, advanced statistical methods, and SUD treatment for reproductive-age women, the trainee, Dr. Bello, will gain the expertise necessary to be an independent investigator. Her long-term goal is to establish herself as an independent investigator with expertise in addressing the reproductive health needs of women with SUD.