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

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

MYCOPLASMA GENITALIUM: CLINICAL CHARACTERISTICS, RISK FACTORS AND ADVERSE PREGNANCY OUTCOME

Mycoplasma genitalium (Mg), a sexually transmitted bacterium, may cause female reproductive morbidities, including pelvic inflammatory disease (PID). As the clinical and risk profile of women with Mg is not well understood, we examined the characteristics of Mg among women. Data from 586 women with clinically suspected PID enrolled in the PID Evaluation and Clinical Health Study were analyzed. Clinical, demographic, sexual and behavioral characteristics were compared between women positive and negative for Mg in the cervix and/or endometrium by polymerase chain reaction (PCR), and between Mg positive and Chlamydia trachomatis (Ct) and/or Neisseria gonorrhoeae (Gc) (Ct/Gc) positive women. Mg positive women had similar clinical characteristics as women without Mg and as women with Ct. Compared to women with Gc, women with Mg had lower pelvic pain scores (p=0.01), and were less likely to have cervicitis (p=0.001), erythrocyte sedimentation rate >15mm/hr (p=0.002), white blood cell count >10,000mm3 (p=0.02), and oral temperature >38.3°C (p=0.08). Age <25 years (AOR 2.7, 95% CI 1.5-5.2), douching (AOR 2.3, 95% CI 1.3-4.1), and smoking (AOR 1.8, 95% CI 1.0-3.2) were associated with Mg. The demographic, sexual and behavioral characteristics were similar between Mg positive women and Ct/Gc positive women.Since Mg is associated with PID, Mg may affect pregnancy, yet the consequences of prenatal Mg are unknown. Therefore, we next conducted a nested case-control study to examine the relationship between Mg and spontaneous abortion (SAB) among women enrolled in the Early Pregnancy Study, a study of violence and SAB among pregnant women presenting at an Emergency Department. Mg was measured by PCR in urine from 82 women who experienced a SAB and 134 control women. Characteristics of cases and controls were compared and the relationship between Mg and SAB was evaluated. Mg was not associated with SAB but was associated with nulliparity (AOR 3.4, 95% CI, 1.0-11.6), self-reported difficulty conceiving (AOR 4.8, 95% CI 0.9-25.7), and history of PID (AOR 3.9, 95% CI 0.9-16.1) and Ct (AOR 3.0, 95% CI 0.8-10.5).This dissertation yields significant public health findings by describing the clinical picture of Mg-PID, identifying women at risk, and examining the consequences of prenatal Mg

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

Decreasing prevalence of no known major risk factors for cardiovascular disease among Mississippi adults, Mississippi Behavioral Risk Factor Surveillance System, 2001 and 2009

Abstract Background Cardiovascular disease (CVD) is the leading cause of death in Mississippi. However, the prevalence of no known CVD risk factors among Mississippi adults and the change of prevalence in the past 9 years have not been described. We assess changes in prevalence of no known CVD risk factors during 2001 and 2009. Methods Prevalence of high blood pressure, high cholesterol, diabetes, physical inactivity, smoking, and obesity were investigated. Survey respondents who reported having none of these factors were defined as having no known CVD risk factors. Differences in prevalence and 95% confidence intervals were determined using t-test analysis. Results Overall, age-standardized prevalence of having no known CVD risk factors significantly decreased from 17.3% in 2001 to 14.5% in 2009 (p = 0.0091). The age-standardized prevalence of no known CVD risk factors were significantly lower in 2009 than in 2001 among blacks (8.9% vs. 13.2%, p = 0.008); males (13.5% vs. 17.9%, p = 0.0073); individuals with a college degree (25.2%, vs. 30.8%, p = 0.0483); and those with an annual household income of $20,000–$34,999 (11.6% vs. 16.9%, p = 0.0147); and $35,000–$49,999 (15.2% vs. 23.3%, p = 0.0135). Conclusion The prevalence of no known CVD risk factors among Mississippi adults significantly decreased from 2001 to 2009 with observed differences by race, age group, sex, and annual household income

Pediatric Group Well Care within the Maternal Treatment Education & Research (MATER) Program

Introduction: This project aims to develop and implement group well care for mothers and infants receiving care for opioid use disorder (OUD). Groups would be composed of 5-7 mothers and infants of similar age with extension of sessions to allow group activities and parenting discussions. To evaluate acceptability and feasibility of this care model, we sought to examine attitudes and beliefs from these mothers, in particular the impacts of the COVID-19 pandemic. Methods: A qualitative interview study of women receiving treatment for OUD at Maternal Addiction Treatment Education and Research at Thomas Jefferson University from October – December 2020 was conducted. Participants were eligible if they had a child \u3c 2 years of age. Study procedures including recruitment, consent, and data collection were conducted by telephone. Participants were administered a 24-item survey to asses demographic and clinical information. This was followed by a semi-structured, open-ended interview to collect information on (1) priorities for pediatric care (2) attitudes toward a group care, and (3) potential barriers– including COVID-19. Percentages from survey items were calculated. Thematic analysis is planned to identify meaningful patterns in interview responses. Results: Among the 22 participants with completed data collection, 40.9% were “very likely” and 18.2% “likely” to bring their child to participate. Themes describing mother’s feelings towards group-care during the COVID-19 pandemic will be identified upon study completion. Conclusion: In a sample of mothers in treatment for OUD, interest in group well care was identified. Further thematic analysis will assess attitudes and beliefs towards the intervention related to COVID-19

Treatments for opioid use disorder among pregnant and reproductive-aged women.

The increased prevalence of opioid use disorder and access to medical insurance is subsequently increasing the likelihood that medical professionals will encounter individuals with opioid use disorder. Sharp increases in opioid use disorder among women mean that obstetricians, gynecologists, and other reproductive medicine providers may be especially likely to encounter such patients. Medical professionals\u27 understanding of treatment for opioid use disorder and their roles in their patients\u27 treatment may increase referrals to treatment, reduce stigma, and improve the quality of medical care. Treatment for opioid use disorder falls into four overlapping domains: medication management, medical care, behavioral/mental health care, and psychosocial support. In this review, we discuss these domains with an emphasis on pregnant women and women of reproductive age. Treatment for opioid use disorder is most effective when all providers coordinate care in an informed, nonjudgmental, patient-centered approach

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

Mycoplasma genitalium among Young, Urban Pregnant Women

Objective. As the consequences of Mycoplasma genitalium in pregnant women are unknown, we examined the relationship between prenatal M. genitalium infection and SAB. Methods. The presence of M. genitalium was determined by PCR in urine from 82 women who subsequently experienced a SAB and 134 women who maintained their pregnancies past 22 weeks gestation. The relationships between M. genitalium and subsequent SAB, demographic, current pregnancy, and reproductive health history characteristics were evaluated. Results. Compared to women without M. genitalium, women with M. genitalium were more likely to report nulliparity (41.7% versus 17.4%, P = .04), history of pelvic inflammatory disease (27.3% versus 8.8%, P = .08), prior C. trachomatis infection (63.6% versus 36.9%, P = .11,) and problems getting pregnant (18.2% versus 4.4%, P = .10). M. genitalium was not associated with SAB (AOR 0.9, 95% CI 0.2–3.8). Conclusions. Pregnant women who test positive for M. genitalium do not have an increased risk of SAB but report a history of reproductive morbidities

Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: a cross-sectional feasibility study

Background: Growing prevalence of atrial fibrillation (AF) in the ageing population, and its associated life-changing health and resource implications, have led to a need to improve its early detection. Primary care is an ideal place to screen for AF, however this is limited by shortages in general practitioner (GP) resources. Recent increases in the number of clinical pharmacists within primary care, makes them ideally placed to conduct AF screening. This study aimed to determine the feasibility of GP practice-based clinical pharmacists to screen the over 65s for AF, using digital technology and pulse palpation during the influenza vaccination season. Methods and Findings: Screening was conducted over two influenza vaccination seasons, 2017-2018 and 2018-2019 in four GP practices in Kent, UK. Pharmacists were trained by a cardiologist to pulse palpate, record and interpret a single-lead ECG (SLECG). Eligible persons aged ≥65 years, attending an influenza vaccination clinic were offered a free heart rhythm check. 604 participants were screened (median age 73 years, 42.7% male). Total prevalence of AF was 4.3%. All participants with AF qualified for anticoagulation and were more likely to be male (57.7%); older; have an increased BMI and have a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75, Diabetes, previous Stroke, Age 65-74 years, Sex category) score ≥ 3. The sensitivity and specificity of clinical pharmacists diagnosing AF using pulse palpation was 76.9% [95% CI: 56.4-91.0] and 92.2% [89.7-94.3], respectively. This rose to 88.5% (69.9-97.6) and 97.2% [95.5-98.4] with a SLECG. At follow-up, four participants (0.7%) were diagnosed with new AF and 3 (0.5%) were initiated on anticoagulation. Screening with SLECG also helped identify new non-AF cardiovascular diagnoses, such as left ventricular hypertrophy, in 28 participants (4.6%). The screening strategy was cost-effective in 71.8% and 64.3% of the estimates for SLECG or pulse palpation, respectively. Feedback from participants (422/604) was generally positive. Key limitations of the study were that the intervention did not reach individuals who did not attend the practice for an influenza vaccination and there was a limited representation of UK ethnic minority groups in the study cohort. Conclusions: This study demonstrates that AF screening performed by GP practice-based pharmacists was feasible, economically viable and positively endorsed by participants. Furthermore, diagnosis of AF by the clinical pharmacist using a SLECG was more sensitive and more specific than the use of pulse palpation alone. Future research should explore the key barriers preventing the adoption of national screening programmes