Understanding Pregnancy’s Protective Effect on Drug Use Within a Developmental Framework
2018; American Psychiatric Association; Volume: 175; Issue: 3 Linguagem: Inglês
10.1176/appi.ajp.2017.17101099
ISSN1535-7228
AutoresSuena H. Massey, Katherine L. Wisner,
Tópico(s)Birth, Development, and Health
ResumoBack to table of contents Previous article Next article Letters to the EditorFull AccessUnderstanding Pregnancy's Protective Effect on Drug Use Within a Developmental FrameworkSuena H. Massey, M.D., Katherine L. Wisner, M.D., M.S.Suena H. Massey, M.D., Katherine L. Wisner, M.D., M.S.Published Online:1 Mar 2018https://doi.org/10.1176/appi.ajp.2017.17101099AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In the article by Kendler et al. (1), published in the October 2017 issue of the Journal, the authors analyzed Sweden's national health registry data on nearly 150,000 women to examine pregnancy status in relation to drug use patterns, accounting for demographic, heritable, partner-related, and unmeasured individual-level confounding effects. Viewed as a natural intervention, the impact of pregnancy on drug use rivaled the effects of financial incentive–based (contingency management) interventions. Strikingly, this impact was equal, if not greater, in women with higher baseline risk factors for prenatal drug use (as shown in Table 2 in the article). The authors describe the mothers' intrinsic motivation to protect their developing children by suspending drug use as evidence for the limitations of an exclusively brain-based view of drug abuse.We present an expanded interpretation of the findings—one that incorporates brain-based models of addiction. Health-related behaviors of pregnant women can also be understood developmentally within a caregiving framework (2, 3). Maternal motivation to protect the fetus against drug exposure could be facilitated by highly evolutionarily conserved processes first described in mammalian species and increasingly characterized in human parental and nonparental contexts (4). These neurobiological models could be highly relevant for understanding why pregnancy confers a protective effect.The study by Kendler and colleagues also has broader implications beyond the perinatal context. The ways that drug use and associated neuroadaptations may interrupt social and interpersonal processes have received significant attention (5). The findings from this study, together with prospective investigations that employ biomarker-verified reports of cessation during pregnancy (6, 7), now provide compelling evidence that social processes related to maternal caregiving can also interrupt addictive processes. In this way, the protective effect of pregnancy on drug use convincingly demonstrated in this study is a unique paradigm of how social and interpersonal processes can positively and powerfully influence addictive behaviors. This is encouraging because more effective and durable solutions to the treatment of substance use disorders are sorely needed.From the Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago.Address correspondence to Dr. Massey ([email protected]).Supported by NIDA grant K23 DA037913 to Dr. Massey.The content of this letter is solely the responsibility of the authors and does not necessarily represent the official views of NIDA or NIH.The Department of Psychiatry and Behavioral Sciences at Northwestern University received contractual fees for Dr. Wisner's consultation to Quinn Emanuel Urquhart & Sullivan, LLP (New York City), which represents Pfizer. Dr. Massey reports no financial relationships with commercial interests.References1 Kendler KS, Ohlsson H, Svikis DS, et al.: The protective effect of pregnancy on risk for drug abuse: a population, co-relative, co-spouse, and within-individual analysis. Am J Psychiatry 2017; 174:954–962Link, Google Scholar2 Massey SH, Decety J, Wisner KL, et al.: Specification of change mechanisms in pregnant smokers for malleable target identification: a novel approach to a tenacious public health problem. Front Public Health 2017; 5:239Crossref, Medline, Google Scholar3 Feldman R: The neurobiology of mammalian parenting and the biosocial context of human caregiving. Horm Behav 2016; 77:3–17Crossref, Medline, Google Scholar4 Massey SH, Neiderhiser JM, Shaw DS, et al.: Maternal self concept as a provider and cessation of substance use during pregnancy. Addict Behav 2012; 37:956–961Crossref, Medline, Google Scholar5 Volkow ND, Baler RD, Goldstein RZ: Addiction: pulling at the neural threads of social behaviors. Neuron 2011; 69:599–602Crossref, Medline, Google Scholar6 Massey SH, Estabrook R, O'Brien TC, et al.: Preliminary evidence for the interaction of the oxytocin receptor gene (OXTR) and face processing in differentiating prenatal smoking patterns. Neurosci Lett 2015; 584:259–264Crossref, Medline, Google Scholar7 Massey SH, Bublitz MH, Magee SR, et al.: Maternal-fetal attachment differentiates patterns of prenatal smoking and exposure. Addict Behav 2015; 45:51–56Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byWithin‐person decline in pregnancy smoking is observable prior to pregnancy awareness: Evidence across two independent observational cohorts17 October 2022 | Addiction Biology, Vol. 27, No. 6Are empathic processes mechanisms of pregnancy's protective effect on smoking? Identification of a novel target for preventive interventionSocial Science & Medicine, Vol. 305Impact of prenatal exposure characterization on early risk detection: Methodologic insights for the HEALthy Brain and Child Development (HBCD) studyNeurotoxicology and Teratology, Vol. 88Severe Mental Illness and Reproductive Health21 March 2020Obstetric patients' perspectives on functional magnetic neuroimaging research in pregnant women23 April 2018 | Archives of Women's Mental Health, Vol. 22, No. 1Neurotoxicology and Teratology, Vol. 67 Volume 175Issue 3 March 01, 2018Pages 286-287 Metrics KeywordsWomenPsychoactive Substance Use DisorderOther Areas Of NeuroscienceEpidemiologyPDF download History Accepted 1 December 2017 Published online 1 March 2018 Published in print 1 March 2018
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