The Effects of Centering Pregnancy on Attitudes towards Breastfeeding among Women with Opioid Use Disorder

Introduction: Breastfeeding has been found to decrease severity of neonatal abstinence syndrome (NAS), however, breastfeeding rates among women with opioid use disorder (OUD) are significantly lower than national averages. CenteringPregnancy, a group prenatal care model, increases exposure to education regarding breastfeeding, making it more likely that patients breastfeed in traditional populations. Objective: This project’s purpose was to identify and understand current infant feeding attitudes among mothers with OUD and explore whether participation in the CenteringPregnancy “Breastfeeding Session” positively impacted knowledge and attitudes towards breastfeeding. Methods: Data were collected from 12 women in treatment for OUD who participated in CenteringPregnancy. A survey was given prior to and after the CenteringPregnancy “Breastfeeding Session,” and after completion of CenteringPregnancy. Descriptive statistics, including means for continuous data and count and percent frequencies for categorical data used to describe data. Results: Concern for transmission of methadone and hepatitis C through breast milk, travel schedules to the OUD treatment center, and desire to smoke cigarettes were identified as barriers to breastfeeding. After the breastfeeding session, 58.3% of the women intended to breastfeed. Among those women, none indicated that they did not feel confident in their ability to breastfeed. Follow-up surveys revealed participants found the discussions surrounding breastfeeding helpful and played a role in their decision to breastfeed. Conclusion: Breastfeeding education programs, such as PregnancyCentering, are needed to address deficits in knowledge of and attitudinal barriers towards breastfeeding among women with OUD. Due to small study size, further studies are needed

The Effect of Perceived Physician Opinion on Breastfeeding in Women with Opioid Use Disorder Who Are Receiving Medication-Assisted Treatment

Women who receive medication-assisted treatment (MAT) for opioid use disorder (OUD) are less likely to breastfeed than the general population despite the many possible benefits to the newborn. The ongoing study examines the effect of perceived physician opinion on the outcome of breastfeeding in women receiving MAT for OUD. Women who were receiving MAT for OUD at Thomas Jefferson University’s Family Center were given a survey during their third trimester (n=45), and at 1 month postpartum (n=33) to gather information on the perceived opinion of their physicians on how they should feed their baby and the importance of those opinions. Information was also gathered on whether or not participants obtained information on breastfeeding from various healthcare professionals (doctor, nurse, or other). Descriptive statistics on our sample revealed that 48.5% of participants reported breastfeeding their child at some point. Results also showed that 73.3% reported obtaining information about breastfeeding from a health professional during their pregnancy. Additionally, 51.2% didn’t know or thought their OBGYN didn’t have an opinion on how their baby should be fed despite ­­­­­86.1% viewing their OBGYN’s opinion as somewhat or very important. For their child’s pediatrician, 42.8% didn’t know or thought the physician didn’t have an opinion with 86.5% viewing their opinion as somewhat or very important. Preliminary results of this ongoing study reveals that breastfeeding prevalence in women receiving MAT for OUD could be improved with increased intervention by physicians and improved perception of physicians’ opinions on how their infant should be fed

Perceptions of Centering Pregnancy at Jefferson’s Maternal Addiction Treatment, Education & Research (MATER) Program

Introduction: Opioid use and misuse, including during pregnancy, is prevalent across the United States. Many women with opioid use disorder (OUD) face multiple barriers to care, including prenatal care. Group prenatal care, as compared to individual prenatal care, may lead to beneficial outcomes such as reduced odds of preterm birth. Objective: This study aimed to assess the perceptions of Centering Pregnancy (CP), a group prenatal care program, among women in treatment for OUD. Methods: The target population included women who participated in the CP program at MATER. Participants (N=6) completed a survey after the last CP session. Survey questions assessed strengths and weaknesses of the program, as perceived by the participants. Likert scale responses were assigned a numerical value and analyzed individually and by theme (ex. knowledge, support, preparation). Results: Preliminary data suggests that the program was very well received, with mean and median responses being greater than 4 for each question and theme group, indicating high satisfaction with the program. All participants said they would recommend the program. Most participants provided constructive suggestions to improve the program, often expressing a desire for more information to prepare them for delivery. Conclusion: Group prenatal care classes are a promising alternative to traditional individual prenatal care, especially in populations who face barriers to healthcare such as women with OUD. Among this population of women in treatment for OUD, the CP program was well received, suggesting this may be an effective way to connect women being treated for OUD with helpful prenatal care

Maternal Stress and Breastfeeding Intention in Pregnant Women with Opioid Use Disorder

Introduction: Breastfeeding rates are low among women in treatment for opioid use disorder (OUD). Information on determinants of breastfeeding intention can help inform the design of breastfeeding promotion interventions for this population. The objective of the study was to examine associations between maternal characteristics, including stress, and breastfeeding intention among pregnant women in treatment for OUD. Methods: Fifty-six pregnant women who were receiving treatment for OUD at Thomas Jefferson University’s Maternal Addiction Treatment Education & Research (MATER) program completed a survey, which included questions on demographics, psychosocial characteristics, breastfeeding history, and breastfeeding intention. Maternal stress was measured using the Perceived Stress Scale-10 (PSS). Characteristics and PSS scores were compared between women who intended to breastfeed and women who did not. ­­­­ Results: The majority of the participants were white (63.2%), smoked (73.7%), in committed relationships (56.1%), and with at least one other child (70.2%). Total PSS scores were not significantly different between women with intention to breastfeed and women without (19.9 vs. 19.6, P=0.874). Breastfeeding intention was higher in women who had a history of breastfeeding (94.5% vs 61.9%, P=0.021). Women who smoked were less likely to report breastfeeding intention than women who did not smoke, though results were not statistically significant (74.4% vs 80%, P=0.739). Conclusion: Future studies with larger sample sizes would be useful to further evaluate the association between breastfeeding history and breastfeeding intention. If an association is found, future interventions promoting breastfeeding in women undergoing treatment for OUD could focus on women who have not previously breastfed

Menstrual management in adolescent transgender males

Introduction: Gender dysphoria is associated with increased rates of anxiety, depression, and suicidal ideation in adolescents. There is anecdotal evidence that menstruation increases the occurrence of gender dysphoria in adolescent transgender males. We hypothesize that menses are distressing to transgender males and this population would benefit from menstrual management. Methods: We conducted a retrospective chart review of all transgender male patients seen in the Nemours Gender Wellness Program (GWP) and limited our population to those who have reached menarche. Data was extracted from the encounters at the GWP clinic and recorded in REDCap. We compared self-reported symptoms of gender dysphoria at 3 months, 6 months, and one year following an individual’s baseline visit to the GWP. The incidence of gender dysphoria at subsequent visits will highlight the efficacy of treatment. Results: Preliminary results show that a majority of our population reported significant gender dysphoria related to menses. Of patients reporting gender dysphoria at the initial visit, 84% chose to use menstrual suppression. Patients who chose an IUD at the initial visit had a higher incidence of breakthrough bleeding and gender dysphoria at the first follow up visit compared to patients who chose other menstrual suppression methods. Conclusion: Menstruation is associated with increased gender dysphoria in transgender male adolescents. Menstrual suppression has the potential to be a transformative treatment for this population. Further research is necessary to determine whether the potential harm that could result from prolonging the distress associated with menses justifies the benefits of using an IUD

Ferumoxytol for the treatment of iron deficiency and iron-deficiency anemia of pregnancy.

Introduction: A litany of recent evidence supports the morbidity of intra-natal iron-deficiency anemia and its prodrome, iron deficiency. Oral iron administered during second and third trimesters does not get to the developing fetus if the mother is iron deficient. This is especially concerning as the rapidly developing fetal brain is in particular need of iron sufficiency. Intra-natal iron deficiency is associated with autism, schizophrenia and abnormal brain structure. The obstetrical literature reports an unacceptably high incidence of gastrointestinal adverse events with oral iron. The time iron honored standard in the United States for intravenous iron replenishment in gravidas is iron sucrose. While safe and effective, four to seven visits are required to accomplish what newer formulations can achieve with one. Methods: Ferumoxytol is a superparamagnetic iron oxide linked to polyglucose sorbitol carboxymethylether-binding elemental iron tightly allowing administration of complete replacement doses in 15-30 min. Herein, we report the results of 131 consecutive, non-selected, iron-deficient second- and third-trimester pregnant women who received either 510 mg of intravenous (IV) ferumoxytol twice or 1020 mg once. Results: Hemoglobin and iron parameter increments were highly statistically significant. No adverse events were reported. We report how a single infusion is safe and effective as the same dose over two visits, saving an unnecessary visit and IV placement, while reducing cost. Conclusion: Ferumoxytol represents an efficacious and safe method of administration of IV iron which improves convenience for patients and practitioners, and is cost saving due to fewer visits. Plain language summary: One or two infusions of intravenous iron for iron deficiency or iron-deficiency anemia of pregnancy simplifies careThis study was conducted to highlight the inconvenience of multiple doses of IV iron and how administering the same dose in one or two infusions simplifies care. We report how a single infusion is as safe and effective as the same dose over two visits, saving an unnecessary visit and IV placement, while reducing cost. This study supports a growing body of evidence, to date, unreported, with ferumoxytol in pregnancy, reporting improved convenience and decreased costs with higher doses of IV iron in one or two visits

Prevalence and Characterization of Adverse Childhood Experiences of Women in Substance Use Treatment

Rates of illicit drug use among women reproductive age significant national public health problem Adverse childhood experiences (ACE’s) associated with higher rates of prenatal depression and maternal childhood maltreatment Ace’s prevalent in those with Opioid Use Disorder (OUD) Aims of Study: Determine prevalence of ACE’s in a population of pregnant and parenting women in treatment for substance use disorder Characterize ACE’s Compare our sample to Behavioral Risk Factor Surveillance System (BRFSS) Pennsylvania datahttps://jdc.jefferson.edu/obgynposters/1007/thumbnail.jp