O'Brien, Margaret L. (2014). Influence of Early Substance Use and Stress on Alcohol and Marijuana Use During Pregnancy.
Alcohol and marijuana use during pregnancy persist, despite clear guidance cautioning against such use. Little is known about the effect that early substance use patterns may have on drinking or marijuana use while pregnant, nor about the effects of stressors experienced during pregnancy or different patterns of stress response. This study investigated these questions to ascertain ways that prevention and treatment might be enhanced. Two samples from the National Longitudinal Study of Adolescent Health (Add Health) were used. The first included 5,101 women who experienced their first pregnancy after the baseline interview. The second was a subset of the first and included 357 women pregnant during an interview. The Add Health study was conducted in four waves and included a nationally representative sample of Americans, interviewed beginning in middle school, continuing into adulthood. This study employed a two-level generalized approach and path analyses, with chained multiple imputation to address missing data. Outcomes considered were drinking or marijuana use during pregnancy, and periconceptional alcohol use. Use patterns considered included early initiation (before 12 (tobacco) or 15 (alcohol, marijuana/other illicit drugs)), regular or heavy use before age 15, and dependence before pregnancy. Stress responses included deliberative, avoidant and emotionally reactive. Periconceptional stressors included experiences such as community violence and financial problems. Early initiation and dependence prior to pregnancy were associated with drinking during pregnancy, while heavy alcohol use and polysubstance use were associated with marijuana use during pregnancy. Community violence and an emotionally reactive stress response were associated with increased periconceptional alcohol use and marijuana use during pregnancy, while a deliberative stress response was associated with drinking during pregnancy. This study provides support for screening by pediatricians to identify and facilitate treatment of adolescents who initiate substance use early. Timely and appropriate screening of women of reproductive age that considers effects of early use, life stressors and stress response would permit targeted intervention. Further, substance use disorder treatment that considers the relationship between pre-pregnancy dependence and drinking during pregnancy may prove a valuable opportunity to prevent substance-exposed pregnancies.
Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014
O'Brien, Margaret L.
Garnick, Deborah W.
Brandeis University, The Heller School for Social Policy and Management
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