Approximately 15% of women aged 15 to 44 years use drugs at some point during their pregnancy.1 Substance-abusing women face a multitude of challenges that interfere with successful recovery and obtaining prenatal care, including financial stability, housing, poor interpersonal relationships, domestic abuse, depression, anxiety, poor self-esteem, poorly developed coping patterns, difficulty trusting, and unrealistic expectations of self and infant.2 Women are most often identified as the primary caregiver of their children; thus, maternal psychopathology can directly influence the perinatal time period.2
Although prenatal care settings face numerous challenges to meet clinical needs in fast-paced, high-demand environments, they offer a crucial opportunity to engage substance-abusing women in physical and mental healthcare needs. Comprehensive assessment and treatment may improve long-term recovery outcomes for the mother-infant dyad. Thus, understanding the risks of perinatal substance abuse and the need for assessment and treatment is critical.
Articles in this issue focus on the risks of perinatal substance abuse, the importance of screening and detection, and treatment needs. In the first article, Worley writes about the significant mounting problem of prescription drug abuse and the risk to pregnancy. Prescription drug abuse occurs upward toward 20% among pregnant women.3 Prescription drugs used to treat pain and psychiatric disorders are most commonly misused. Identifying abuse among perinatal women requires not only routine screening but also healthcare settings that demonstrate trust and nonjudgment. Pregnant women commonly will hesitate to report such abuse due to feelings of shame, guilt, and fear of involvement of child services. Worley discusses perinatal risks, assessment, and treatment recommendations related to prescription drug abuse.
The second article focuses on an emerging treatment option for opioid dependence. Historically, methadone maintenance treatment was most commonly heard of pregnant women with opioid dependence. Mittal discusses the use of buprenorphine as a maintenance treatment option in place of methadone maintenance and other medication-assisted withdrawal. Perinatal women receiving substance abuse treatment are already seen as a challenging population to treat obstetrically. Ideally, collaborative care models combining obstetric and psychiatric care would likely result in improved treatment outcomes; however, more research is needed to support this as an evidence-based practice. Nevertheless, buprenorphine is demonstrating promising benefits to both mother and fetus.
Identifying risks and screening and assessment of substance abuse in pregnant woman are essential improved physical and mental outcomes of mother and fetus. Furthermore, ensuring ongoing recovery and prevention of long-term risks, understanding and access to treatment modalities are required. The final 2 articles focus on treatment modalities. In the first of the two, Brandon reviews current literature discussing various types of psychosocial and behavioral interventions addressing perinatal substance abuse. In the last article, Bittner et al report on an intervention study evaluating the effectiveness of a cognitive-behavioral group program among pregnant women suffering from anxiety and depression.
Although pregnancy is generally a time of overall reduced substance use, abuse of illicit and licit drugs continues to occur in women of childbearing age. Perinatal substance abuse poses physical and psychological risks to both mother and fetus. Understanding the risks posed is crucial to provide comprehensive prenatal care, which will reduce the likelihood of short- and long-term consequences to the health and well-being of the mother-infant dyad.
Neonatal abstinence syndrome (NAS) has resurged in the United States, leading to renewed focus on implications and challenges for neonatal intensive care practices. Neonatal nurses caring for infants with NAS must have knowledge, skills, and competencies, as well as supportive systems of care, to meet the challenges of this population. Dr Karen D'Apolito, a member of the Neonatal Editorial Board for The Journal of Perinatal & Neonatal Nursing (JPNN), served as the guest editor for this issue. The neonatal articles for this issue all focus on NAS and will provide helpful evidence-based knowledge, clinical tools, and discussion of the assessment of NAS in newborn infants and their families.
Assessing signs of withdrawal in infants is important for determining care needs of infants with NAS. Neonatal nurses need to have knowledge and standardized training for conducting and scoring infants for signs of drug withdrawal. Dr Susan Orlando, in her article "An Overview of Clinical Tools Used to Assess Neonatal Abstinence Syndrome," reviews the published assessment tools developed to quantify and score the severity of clinical signs seen in these infants.
Dr Denise Maguire's article, titled, "Care of the Infant With Neonatal Abstinence Syndrome: Strength of the Evidence," provides a review of the evidence for pharmacologic and nonpharmacologic interventions for NAS and is the CE article for the neonatal section. Dr Maguire seeks to provide an update for neonatal nurses on current and best evidence to guide nursing care interventions for infants with NAS.
Carla Saunders and her coauthors of "Neonatal Abstinence Syndrome: Evaluating the Effectiveness of an Evidence-Based Multidisciplinary Care Approach" present an overview and initial results of a multidisciplinary quality improvement project to address the pharmacologic and other treatment strategies for infants with NAS and their families. Their article offers a guide to using a comprehensive and inclusive process and quality improvement principles to address the complex care challenges presented by this infant population.
Dr Karen D'Apolito discusses the importance of establishing reliability among staff nurses who use the Finnegan Scoring Tool to assess NAS in infants. The scoring tool, like most clinical assessment tools, tends to be subjective. Dr D'Apolito strives to help staff nurses who use the Finnegan Scoring Tool improve their reliability by providing item definitions and a strategy to ensure that staff attain and maintain reliability when assessing NAS in infants using the Finnegan Scoring Tool.
Our column editors, Drs Susan Blackburn, Katherine Gregory, and Terese Verklan, once again provide relevant and important information and perspectives for your reading and learning pleasure.
Dr Linda Samson offers a review of the neonatal textbook, Comprehensive Neonatal Nursing Care: A Physiologic Perspective, Fifth Edition, by Carole Kenner PhD, RNC-NIC, NNP, FAAN, and Judy Lott, DSN, RN, BC-NNP, FAAN. This is Dr Samson's final contribution as a long-standing member of the JPNN Neonatal Editorial Board, because she is stepping away from this professional role. Over the years, she has served as an author and expert reviewer and we were fortunate to have had her many years of committed service.
-Rebecca Christophersen, BSN, MSN, PMHNP-BC
Perinatal Guest Editor
Rush University Community
Systems & Mental Health Nursing College of Nursing
Chicago, Illinois
-Karen D'Apolito, PhD, RN, NNP, FAAN
Neonatal Guest Editor
Vanderbilt University School of Nursing
Program Director
Neonatal Nurse Practitioner Specialty
Nashville, Tennessee
-Susan Bakewell-Sachs, PhD, RN, PNP-BC, FAAN
Neonatal Editor
References