Challenges and opportunities during the COVID-19 pandemic: Treating patients for substance use disorders during the perinatal period.

The coronavirus disease 2019 (COVID-19) pandemic exacerbated the opioid use disorder epidemic and accelerated alcohol and other substance use disorders. Sudden health care service delivery changes during the COVID-19 pandemic created both challenges and opportunities for all patients with substance use disorders including the use of virtual or telemedicine visits, medication access issues and ensuring access to naloxone when supplies cannot be handed out. Unique challenges for pregnant and post-partum patients with substance use disorders includes some evidence of reduced access to medication to treat opioid use disorders and changes in delivery protocols that isolate birthing people from supports. Opportunities for all patients with substance use disorders include virtual platforms presenting positive opportunities for treatment. They are time efficient, eliminate transportation barriers, and potentially reduce childcare barriers. For pregnant and post-partum patients with substance use disorders, hybrid models of telemedicine and in-person visits reduced no-show visit rates and increased flexibility in medication dosing regimens. Thus, there is a unique opportunity to study the success of different virtual care models given the variety of implemented strategies. The COVID-19 pandemic provides an unprecedented opportunity to dramatically transform standard care approaches to help optimize care for all patients, including pregnant and post-partum people.

Motherhood and the hormones of pregnancy modify concentrations of hippocampal neuronal dendritic spines.

Short-term fluctuations in steroid hormones such as estradiol (E2) and progesterone (P) can affect the concentration of hippocampal dendritic spines in adult, cycling nulliparous female rats. Pregnancy is characterized by a significantly longer duration of substantially elevated E2 and P compared to the estrous cycle. Thus, even greater changes than those reported during estrus may be evident. In two experiments, we examined the extent to which reproductive and hormonal state altered the concentration of apical neuronal dendritic spines of the CA1 region of the hippocampus in the following age-matched groups (N's = 7-10/group) of rats: in Exp. 1., CA1 dendritic spine density was examined in nulliparous diestrus (DES), proestrus (PRO), and estrus (ES) females, and late-pregnant (LP) (day 21) and lactating (day 5-6; LACT) females. In Exp. 2, the effects on spine density of a regimen mimicking pregnancy (and that stimulates maternal behavior) were examined, using ovariectomized, no hormone-exposed (OVX-minus) vs. sequential P&E(2)-treated (OVX + P&E2) groups. For both experiments, brains were removed, Golgi-Cox-stained and the most lateral tertiary branches of the apical dendrite of completely-stained hippocampal CA1 pyramidal neurons were traced with oil-immersion at x 1600 and dendritic spine density (# spines/10 micro dendritic segment) recorded. In Exp. 1, spine density was increased in LP and LACT females (which were not different) compared to the other virgin groups, including PRO females, who had more spines than DES and ES. In Exp. 2, OVX + P&E2 displayed significantly more dendritic spines per 10 micro than OVX-minus females (and had numbers that were similar to those of LP and LACT from Exp. 1). Pregnancy and its attendant hormonal fluctuations, therefore, may alter hippocampal neurons that regulate some non-pup-directed components of maternal behavior (e.g., nest building) or behaviors that support maternal behavior (e.g., foraging, associative memory).