Maternal Mental health and substance use:An examination of their role in pregnancy health behaviors and birth outcomes.

Abstract

Objective: To characterize maternal mental health from a surveillance perspective and to specifically focus on maternal mental health and its potential relationship with prenatal substance use by: describing the co-occurrence of maternal mood and prenatal substance use; exploring the independent and interactive associations of maternal mood and prenatal substance use with infant health outcomes; and examining the relationship between maternal mood, stressful life events and prenatal tobacco cessation and maternal mood, stressful life events, postpartum depression and postpartum tobacco relapse. A qualitative study of methamphetamine use during pregnancy was designed to describe the experiences of pregnant women who had used methamphetamine immediately prior to or during pregnancy, with a specific focus on their mental health history. Methods: Surveillance data from the Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS), an on-going written/telephone survey of women who recently delivered live births in Minnesota linked to birth certificate data, comprised the dataset used to examine substance use, maternal mental health and infant health outcomes, as well as the tobacco cessation/relapse analyses. It is considered representative of Minnesota's recent mothers and infants. The Maternal Methamphetamine Study evolved from a community-based, participatory research model. Primary data collection and analysis focused on a small sample of women located in urban and rural settings in Minnesota. Qualitative methods were used to describe a population of women in out-patient therapy for methamphetamine use through county-based treatment programs. Data collection tools were designed in collaboration with researchers from the Minnesota Department of Health (MDH), Children's Hospitals and Clinics and Hennepin County Medical Center (HCMC). Qualitative data were obtained through in-person or telephone interviews and quantitative data through self-administered, written questionnaires. The University of Minnesota Institutional Review Board (IRB) reviewed both studies. The PRAMS questionnaire has been previously reviewed and approved by the Centers for Disease Control and Prevention (CDC) and MDH IRBs. The secondary analyses of PRAMS data qualified for IRB exemption, as it uses existing data and does not contain personal identifiers. The methamphetamine project was approved by the University of Minnesota IRB. Conclusions: Low maternal mood co-occurred with substance use during pregnancy, which has profound implications for the health of women and their infants. Low maternal mood during pregnancy and tobacco use were interactively associated with a two-fold higher risk of low birthweight births. Women who reported low mood during pregnancy and who abstained from alcohol use during the third trimester of pregnancy were twice as likely to have a preterm delivery compared to women who reported higher mood levels. Low mood levels and stress were associated with decreased likelihood of tobacco cessation during pregnancy. Women with a history of methamphetamine addiction reported personal and familial histories of psychological problems. In addition, methamphetamine was described as a remedy for low energy, low self-esteem, depression and anxiety. Women stated they could accomplish more while on methamphetamine and it helped them cope with the demands of daily life. Thus, mental health problems and substance use co-occurred, which may have potential adverse consequences for pregnant women. More study of this complex relationship, and the resulting effects on women and their children, is important for long-term maternal and child health. Limitations: The two data sources define depressive symptoms differently, with different data collection methods. Thus, comparability between the study populations is difficult. This further reflects the lack of a gold standard measure for prenatal depression and depressive symptoms and the difficulty of measuring such symptoms during pregnancy. The question related to maternal mood during pregnancy from PRAMS is not considered a standard screening question and requires caution when interpreting results. Additionally, the women participating in the methamphetamine study are a select group of women who were identified through drug treatment programs. Public Health Implications: This proposal suggests that mental health may be important over the course of a pregnancy and during the postpartum. The innovative nature of this project relates to its exploration of maternal mental health and substance use concurrently, and their potential joint contributions to adverse maternal and infant health outcomes. In addition, it is one of the first studies to describe pregnant women in recovery from methamphetamine addiction. The results from these manuscripts provide information for local, state and federal public health agencies for program development and research allocation, and could influence their confidence in surveillance data designed to track maternal mental health.