The Impact of Stress and Craving on Return to Postpartum Cannabis Use

项目摘要/摘要 妇女的大麻使用量正在增加，但使用模式往往在怀孕期间中断。很多女人 (73-78%)经常使用大麻先入为主的人在怀孕期间戒除或减少大麻的使用。 然而，几乎80%的妇女在产后4-5个月内重新开始使用大麻，尽管有可能 新生儿和产妇的健康状况不佳。压力和黄体酮可能在回归到 妇女产后吸食大麻。女性很容易受到与压力相关的物质使用复发的影响。压力， 焦虑、抑郁和睡眠不足在围产期很常见，并与 药物使用和复发。超过80%的围产期妇女报告压力和焦虑的缓解是最常见的 产后服用大麻的原因。黄体酮可能会减弱药物奖励和药物寻找行为， 有令人鼓舞的试验数据表明，黄体酮可能有助于防止产后复发 烟草和可卡因，但孕酮和产后大麻使用之间的关系尚未得到证实 学习。鉴于孕酮在出生后迅速下降，以及产后的压力性质， 需要进行纵向研究来检验应激、孕酮和 产后妇女恢复使用大麻。这项工作的长期目标是开发针对性别的、 有针对性的干预措施，防止产后重新使用大麻。这项研究的短期目标是 利用产后期可预测的、现实世界的自然主义压力源，结合日常日记 和生态瞬时评估(EMA)来阐明压力、 黄体酮和产后恢复使用大麻。在拟议的研究中，我们将使用每日生态 瞬间评估(EMA)，以确定压力、渴望、焦虑、情绪和睡眠的变化模式 可能与产后12周期间重新使用大麻有关。我们 假设增加了对主观压力、焦虑和渴望的测量，同时降低了情绪 和睡眠质量，将与重新使用大麻有关。我们还将测量唾液孕酮以 确定唾液孕酮水平与产后重新吸食大麻之间的关系。我们 假设对于个体参与者，孕酮水平降低将与恢复到 产后吸食大麻。我们将探索EMA指标中受试者内部变化的相关性， 孕酮与产后重新吸食大麻及假说：1)会有负相关 黄体酮的变化与主观压力等级之间的关系；2)黄体酮与 大麻的使用将通过主观压力等级的变化来调节。这些数据与通知 制定针对性的治疗和预防干预措施，以减少产后大麻的使用 提高妇女健康水平。

PROJECT SUMMARY/ABSTRACT Cannabis use in women is increasing, but patterns of use are often interrupted during pregnancy. Many women (73-78%) who regularly use cannabis preconception quit or cut down their use of cannabis during pregnancy. However, almost 80% of women return to cannabis use within 4-5 months postpartum despite the potential for poor newborn and maternal health outcomes. Stress and progesterone may play important roles in the return to postpartum cannabis use for women. Women are vulnerable to stress-related relapse to substance use. Stress, anxiety, depression, and sleep deficiencies are common in the perinatal period and have been linked to substance use and relapse. Over 80% of perinatal women report stress and anxiety relief as the most common reason for using cannabis postpartum. Progesterone may attenuate drug reward and drug seeking behavior, and there is encouraging pilot data suggesting that progesterone may help to prevent postpartum relapse to tobacco and cocaine, but the relationship between progesterone and postpartum cannabis use has yet to be studied. Given the rapid decline in progesterone following birth and the stressful nature of the postpartum period, longitudinal investigations are needed to examine the temporal relationships between stress, progesterone and return to cannabis use in postpartum women. The long-term goal of this work is to develop gender-specific, targeted interventions that prevent postpartum return to cannabis use. The short-term goal of this study is to leverage the predictable, real-world naturalistic stressor of the postpartum period, combined with daily diaries and Ecological Momentary Assessment (EMA) to elucidate the proximal relationships between stress, progesterone and return to postpartum cannabis use. In the proposed study we will use daily Ecological Momentary Assessment (EMA) to determine patterns of change in stress, craving, anxiety, mood, and sleep that may be associated with return to postpartum cannabis use during the 12-week postpartum period. We hypothesize that increased measures of subjective stress, anxiety and craving, along with reductions in mood and sleep quality, will be associated with return to cannabis use. We will also measure salivary progesterone to determine the association between salivary progesterone levels and return to postpartum cannabis use. We hypothesize that for individual participants, decreased levels of progesterone will be associated with return to postpartum cannabis use. We will explore the correlation of within-subject changes in EMA measures, progesterone and return to postpartum cannabis use and hypothesize that: 1) there will be a negative correlation between changes in progesterone and subjective stress ratings; and 2) the relationship between progesterone and cannabis use will be mediated by changes in subjective stress ratings. These data with inform the development of targeted sex-specific treatment and prevention interventions to reduce postpartum cannabis use and improve women’s health.