An ecological momentary assessment study examining posttraumatic stress disorder symptoms, prenatal bonding, and substance use among pregnant women

• Published in: Drug and alcohol dependence Vol. 195; pp. 33 - 39
• Main Authors: Sanjuan, Pilar M., Pearson, Matthew R., Poremba, Carly, Amaro, Hortensia de Los Angeles, Leeman, Lawrence
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2019; Elsevier Science Ltd
• Subjects: Adult; Alcohol; Alcohol use; Alcoholic beverages; Attachment; Bonding; Cannabis; Compliance; Data processing; Drug abuse; Drug use; Ecological Momentary Assessment; Ecological risk assessment; Female; Fetuses; Heroin; Humans; Marijuana; Medical treatment; Narcotics; Object Attachment; Pilot Projects; Post traumatic stress disorder; Posttraumatic stress disorder; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - epidemiology; Pregnancy Complications - psychology; Prenatal; Prenatal care; Prenatal experience; Prenatal Exposure Delayed Effects - diagnosis; Prenatal Exposure Delayed Effects - epidemiology; Prenatal Exposure Delayed Effects - psychology; Prenatal fetal; Prospective Studies; Protective factors; Risk analysis; Risk assessment; Risk Factors; Severity; Signs and symptoms; Smartphone; Smartphones; Stability; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - psychology; Substance use; Substance use disorder; Substance-Related Disorders - diagnosis; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Tobacco; Trauma; Young Adult; Prenatal; Substance use; Ecological momentary assessment; Posttraumatic stress disorder; Prenatal fetal; Bonding
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2018.11.019

•Peak post-traumatic stress disorder (PTSD) symptoms may put women at risk for same day prenatal substance use.•Facets of prenatal bonding may protect against same day alcohol use.•Women reported prenatal substance use/trauma via ecological momentary assessment.•Ecological momentary assessment can be used with pregnant women using substances.•Retention rates were similar to studies with lower-risk populations. Substance use disorder (SUD) during pregnancy requires efficacious interventions based on understanding the ebb and flow of risk and protective factors for substance use across time. To assess how these fluctuations are associated temporally with substance use, we used ecological momentary assessment (EMA) to evaluate substance use risk (posttraumatic stress disorder [PTSD] symptoms) and protective (prenatal fetal bonding) factors and their associations with prenatal substance use recorded in real time. Pregnant women in SUD treatment (N = 33) with prior trauma exposure received smartphones with an EMA application that queried them thrice daily for 28 days about PTSD symptoms, prenatal bonding, and substance use. Nearly all (N = 32) provided EMA data resulting in 2049 EMA reports (74% compliance). Most participants reported tobacco (72%), alcohol (22%), heroin (41%), and/or other illicit drug (6%–31%) use at least once via EMA. There were moderate associations (average β = 0.23) between greater daily peak PTSD symptoms and substance use with significant effects on illicit drug (β = 0.37), cannabis (β = 0.35) and cigarette use (β = 0.24). Prenatal bonding subscales were modestly associated with substance use, with daily intensity of attachment low point associated with lower heroin (β=-0.34), but higher alcohol (β = 0.24) use. Quality of attachment low point was associated with higher cigarette use (β = 0.06). Despite the SUD severity and social instability of this sample, we observed high rates of compliance. We found preliminary support suggesting daily PTSD symptoms as a risk factor and less consistent support for prenatal bonding as a protective factor for prenatal substance use.