Polysubstance Use in Pregnancy: Surveillance, Interventions, and Next Steps.

Substance use during pregnancy increases risk for a wide range of adverse maternal and neonatal health outcomes. Polysubstance use is common among people who use substances during pregnancy; however, the risks of combined substance exposures during pregnancy are poorly understood. In this report, we provide an overview of the activities of the Centers for Disease Control and Prevention (CDC) and partners and identified gaps related to (1) surveillance, (2) routine screening, and (3) prevention of polysubstance use during pregnancy. Efforts by CDC and other partners to reduce polysubstance use during pregnancy can improve the health of pregnant people and their infants and children.

National Partnership for Maternal Safety: Consensus Bundle on Obstetric Care for Women With Opioid Use Disorder.

The opioid epidemic is a public health crisis, and pregnancy-associated morbidity and mortality due to substance use highlights the need to prioritize substance use as a major patient safety issue. To assist health care providers with this process and mitigate the effect of substance use on maternal and fetal safety, the National Partnership for Maternal Safety within the Council on Patient Safety in Women's Health Care has created a patient safety bundle to reduce adverse maternal and neonatal health outcomes associated with substance use. The Consensus Bundle on Obstetric Care for Women with Opioid Use Disorder provides a series of evidence-based recommendations to standardize and improve the quality of health care services for pregnant and postpartum women with opioid use disorder, which should be implemented in every maternity care setting. A series of implementation resources have been created to help providers, hospitals, and health systems translate guidelines into clinical practice, and multiple state-level Perinatal Quality Collaboratives are developing quality improvement initiatives to facilitate the bundle-adoption process. Structure, process, and outcome metrics have also been developed to monitor the adoption of evidence-based practices and ensure consistency in clinical care.

The contributions of Dr. Kathleen K. Sulik to fetal alcohol spectrum disorders research and prevention.

Dr. Kathleen Sulik (Kathy) has spent 35 years studying fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD). Beginning with her landmark 1981 Science paper describing the early gestational window when alcohol can cause the craniofacial malformations characteristic of FAS, Kathy has contributed a vast amount of research furthering our knowledge of FASD. After her seminal work that definitively demonstrated that alcohol is the causative factor in FAS, she and her lab went on to explore and define the stage-dependent effects of early gestational alcohol exposure on the face and brain in numerous different ways throughout her career. She explored and discovered numerous mechanisms of alcohol's effects on the embryo, as well as describing several genetic factors that can modify susceptibility to developmental alcohol exposure. She did not restrict her research to the face and brain; her lab described in intricate detail the effects of developmental alcohol exposure on many different organs, including the heart, ears, kidneys, and limbs. In addition to her research, and in conjunction with NIAAA and the National Organization on Fetal Alcohol Syndrome (NOFAS), Kathy developed several FASD prevention curricula that are still in use today. Finally, as part of her drive to eradicate FAS and FASD, Kathy labored tirelessly with public policy makers to change how FASD is viewed by the public, how FASD is identified in affected individuals, and how FASD is studied by researchers. While no article could fully cover Kathy's contributions to FASD research and prevention, or her other contributions to embryology and teratology, this review will attempt to illustrate some of the highlights of Kathy's remarkable career.

Addressing the public health concerns of Fetal Alcohol Spectrum Disorder: Impact of stigma and health literacy.

BACKGROUND: Fetal alcohol spectrum disorders (FASD) are a group of developmental disabilities that may result from the mother's consumption of alcohol during pregnancy. The present study examined the effects of health literacy and stigma on the public health agenda for preventing FASD. METHODS: Three hundred and forty-one participants were sampled to ascertain levels of endorsement of the public health priorities of FASD, and FASD health literacy. Stigma towards women who consume alcohol during pregnancy, and towards biological mothers of children with FASD were operationalized using ratings of difference and disdain. RESULTS: Public stigma towards women who consume alcohol during pregnancy was greater than stigma towards biological mothers of children with FASD. Research participants with higher FASD literacy were more likely to endorse the prevention priorities of FASD, but also more likely to endorse greater stigma towards biological mothers of children with FASD. Interestingly, those who endorsed greater stigma supported the public health priorities of FASD more strongly. Female research participants more strongly supported the prevention priorities of FASD than male participants. Male participants were more likely to endorse stigma than female participants. CONCLUSIONS: Stigma experienced by biological mothers of children with FASD generalizes to women who consume alcohol while pregnant. Some results were contrary to expectations: stigma was positively associated with health literacy and endorsement of prevention priorities of FASD. Reasons for these findings are speculated and should be tested in future research.

The Public Stigma of Birth Mothers of Children with Fetal Alcohol Spectrum Disorders.

BACKGROUND: Stigma affects not only the person with a stigmatizing condition such as fetal alcohol spectrum disorders (FASD), but also their family members. This study examined whether there are stigmatizing attitudes about biological mothers of children with FASD in a crowdsourced sample. METHODS: Three hundred and eighty-nine participants were asked to rate levels of difference, disdain, and responsibility on 4 conditions: serious mental illness (MI), substance use disorder (SUD), jail experience, and FASD. A budget allocation task was administered as a proxy of discrimination. Prior experience with each of the 4 conditions was noted to assess familiarity. RESULTS: Research participants viewed mothers of children with FASD as more different, disdained, and responsible than women with serious MI, SUD, and jail experience. Budget allocation toward FASD service programs was significantly lower than that toward all other human service programs. Familiarity with the 3 comparison conditions moderated most of the stigma ratings, but this effect was not seen in the FASD condition. CONCLUSIONS: Results supported the notion that mothers of children with FASD are highly stigmatized for their past behavior. The data also suggested that the public might discriminate against this population. Stigma reduction interventions should focus on contact-based strategies, rather than education-based strategies.

Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo.

BACKGROUND: Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP). METHODS: Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. RESULTS: None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. CONCLUSIONS: Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection prevention; 4) improving referral systems to the hospitals; 5) advocating for changes in national RH policies and protocols; and 6) providing technical assistance for monitoring and evaluation of key RH indicators. Together, these initiatives will improve the quality and accessibility of RH services in the DRC - services which are urgently needed and to which Congolese women are entitled by international human rights law.