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

项目总结/摘要 新罕布什尔州的阿片类药物使用障碍（OUD）人均发病率第二高， 估计有10%的分娩受到围产期OUD的影响，新的 汉普郡预计每年有多达1,000名婴儿出生前接触阿片类药物。大致 NH最近阿片类药物过量死亡的40%是女性，21%是妊娠相关死亡 2013年至2015年期间，因服用过量而死亡。美国妇产科学院， 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OUD的孕妇和育儿妇女的模式。 药物辅助治疗（MAT）是推荐的OUD孕妇的最佳实践。 即使开始MAT，治疗中断和复发率也很高，特别是在早期 产后时期保持记忆的障碍包括抑郁、焦虑和创伤后压力的高发生率 紊乱，和不利的社会条件（例如，住房和经济无保障，人际关系 暴力）。对于患有OUD的孕妇来说，疼痛管理也很复杂， 疼痛是复发的一个重要危险因素。冥想，如瑜伽和正念，可以降低风险， 妊娠和养育OUD女性的复发。建设提供MAT和协作的能力 在产科环境中护理患有OUD的孕妇和育儿妇女是新罕布什尔州的优先事项 国家有针对性的反应（STR）阿片类药物危机。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知情的 瑜伽和正念复发预防干预（恢复中的正念妈妈：MMORE）。R21 阶段有三个具体目标：1）确定创伤知情瑜伽的需求和适应领域， 正念为基础的复发预防协议，通过形成工作与怀孕和养育 2）制定一个综合的10次干预方案，并从客户那里获得反复反馈 利益相关者，以及3）在前后试点中评估MMORE的可行性、可接受性和有效性趋势， 孕妇示范里程碑将为R33提供基础，有三个具体目标： 1)在一项小型随机对照研究中评价MMORE，该研究以妊娠女性作为补充， 产科实践中协作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）评估翻译的障碍和促进因素， 可持续地实施MMORE计划，使接受MAT的妇女成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，以支持恢复并改善孕妇的生活。 和养育患有OUD的妇女及其婴儿。

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.