Doctoral Programme of Clinical Investigation, Department of Child Psychiatry, University of Turku, 20014, Turku, Finland.
Department of Child Psychiatry, Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521, Turku, Finland.
Matern Child Health J. 2020 Jan;24(1):90-100. doi: 10.1007/s10995-019-02773-w.
The aim of the study was to explore the effect of a new prenatal intervention on participation in obstetric care, fetal drug exposure, and perinatal outcomes among substance using pregnant women in Finland.
The participants were 90 women referred to a hospital obstetric outpatient clinic due to current or recent substance use. The intervention group (n = 46) was offered three interactive ultrasounds at 24, 30 and 34 gestational weeks and a pregnancy diary accompanied by three prenatal infant mental health consultations. The intervention elements were designed to enhance parental mentalization and prenatal attachment. A randomized control group (n = 44) design was used. All participants were offered treatment-as-usual in the obstetric tertiary setting. Medical record data and meconium toxicology were analyzed.
The retention rate in the whole sample was 89%. Retention was higher in the intervention group (96% vs. 82%, p < 0.05), of which 74% attended all three ultrasound sessions. However, the pregnant women in the intervention group participated less often in all the scheduled obstetric standard care visits (59% vs. 83%, p = 0.02). Fetal drug exposure and perinatal outcomes were similar in both groups. Within the whole sample, 13% of the neonates were preterm, 12% small for gestational age and 7% had exposure to drugs.
Retention in the intervention was very good. Watching the fetus with parenting focus seemed to motivate these high-risk women. Interestingly, the pregnant women in the intervention group tended to prefer the intervention sessions to the routine care. Clinical implications of this finding are discussed.
The trial registration number in ClinicalTrials.gov: NCT03413631.
本研究旨在探讨芬兰一项新的产前干预措施对有物质使用问题的孕妇参与产科护理、胎儿药物暴露和围产儿结局的影响。
研究对象为 90 名因当前或近期物质使用而被转介至医院产科门诊的孕妇。干预组（n=46）接受了 3 次 24、30 和 34 孕周的互动式超声检查，以及妊娠日记和 3 次产前婴儿心理健康咨询。干预元素旨在增强父母的心理化和产前依恋。采用随机对照设计。所有参与者均在产科三级环境中接受常规治疗。分析了病历数据和胎粪毒理学结果。
全样本的保留率为 89%。干预组的保留率更高（96%比 82%，p<0.05），其中 74%的孕妇参加了所有 3 次超声检查。然而，干预组的孕妇参加所有计划的产科标准护理就诊的频率较低（59%比 83%，p=0.02）。两组胎儿药物暴露和围产儿结局相似。在全样本中，13%的新生儿早产，12%的新生儿小于胎龄，7%的新生儿有药物暴露。
干预措施的保留率非常高。关注胎儿的养育焦点似乎激发了这些高风险孕妇的积极性。有趣的是，干预组的孕妇似乎更倾向于接受干预措施而非常规护理。对这一发现的临床意义进行了讨论。
ClinicalTrials.gov 注册号：NCT03413631。
