Salud mental, abuso de sustancias y trastornos duales en el embarazo: Tasas de prevalencia y tratamiento en un país desarrollado

Rodrigo Carmona Camacho, Nayara López Carpintero, María Luisa Barrigón, Cristina Ruiz Nogales, Inés Menéndez, Montserrat Sánchez Alonso, Irene Caro Cañizares, Juan José Hernández Aguado, Benjamin Le Cook, Margarita Alegría, Ricardo Saviron Cornudella, Javier Plaza, Enrique Baca-García

Resumen


El tabaquismo y el consumo de sustancias durante el embarazo son importantes causas prevenibles de morbimortalidad, teniendo una relación bidireccional y deletérea con la salud mental de la madre y el niño. 

Como parte de la iniciativa WOMAP (Woman Mental Health and Addictions on Pregnancy), se estudiaron 2,014 embarazadas buscando describir la prevalencia de trastornos mentales y por uso de sustancias concurrentes, las tasas de tratamiento y los diagnósticos y la gravedad. Las participantes fueron evaluadas con la escala AC-OK y se les preguntó sobre sus hábitos tabáquicos y uso de servicios de salud mental/sustancias. De las participantes, 170 mujeres resultaron positivas para un trastorno mental y por uso de sustancias concurrentes (≥ 2 positivos a la subescala AC-OK-Salud Mental, ≥ 1 positivos a la subescala AC-OK-Sustancias y/o fumar más de una vez al mes y no estar en tratamiento) y fueron evaluadas en profundidad mediante una batería de escalas (Patient Health Questionnaire [PHQ-9], General Anxiety Disorder [GAD-7], Post-traumatic stress disorder Checklist [PCL-5], Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST] y Fagerström).

En el último año, 614 mujeres (30,5%) fumaron tabaco (42,5% diariamente) y el 9,8% fueron positivas para problemas por uso de sustancias y salud mental según la AC-OK. Solo el 11,1% había recibido tratamiento en los tres meses previos y solo un 13,6% tenía una cita en el siguiente mes. De las 170 pacientes evaluadas secundariamente, 62(36,5%) presentaron al menos depresión moderada, 35(20,6%) al menos ansiedad moderada, 32(18,8%) fueron positivas a la PCL-5, y 37 de las 88 que reconocieron uso de alcohol puntuaron por encima del umbral en AUDIT (≥ 3). 

En conclusión, la combinación de una prevalencia significativa junto con bajas tasas de tratamiento, remarcan la necesidad de mecanismos de detección efectivos en la atención habitual, permitiendo una intervención temprana.


Palabras clave


Atención perinatal; salud mental perinatal; patología dual; tabaquismo; consumo de drogas; cribado.

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Referencias


ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. (2012). Obstet Gynecol, 119, 1070-1076. doi:10.1097/AOG.0b0­13e318256496e.

Austin, M. P., Priest, S. R. & Sullivan, E. A. (2008). Antenatal psychosocial assessment for reducing perinatal mental health morbidity. Cochrane Database Systematic Revision, 4, CD005124. doi:10.1002/14651858.CD005124.pub2.

Barrigon, M. L., Berrouiguet, S., Carballo, J. J., Bonal-Gimenez, C., Fernandez-Navarro, P., Pfang, B.,… Baca-Garcia, E. (2017). User profiles of an electronic mental health tool for ecological momentary assessment: MEmind. International Journal of Methods in Psychiatric Research, 26, e1554. doi:10.1002/mpr.1554.

Bayrampour, H., Hapsari, A. P. & Pavlovic, J. (2018). Barriers to addressing perinatal mental health issues in midwifery settings. Midwifery, 59, 47-58. doi:10.1016/j.midw.2017.12.020.

Blanchard, E. B., Jones-Alexander, J., Buckley, T. C. & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669-673.

Blasco-Alonso, M., Gonzalez-Mesa, E., Galvez Montes, M., Lozano Bravo, I., Merino Galdon, F., Cuenca Campos, F.,… Bellido Estevez, I. (2015). Exposure to tobacco, alcohol and drugs of abuse during pregnancy. A study of prevalence among pregnant women in Malaga (Spain). Adicciones, 27, 99-108.

Blatt, K., Moore, E., Chen, A., Van Hook, J. & DeFranco, E. A. (2015). Association of reported trimester-specific smoking cessation with fetal growth restriction. Obstetrics & Gynecology, 125, 1452-1459. doi:10.1097/aog.0000000000000679.

Bohn, M. J., Babor, T. F. & Kranzler, H. R. (1995). The Alcohol Use Disorders Identification Test (AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol, 56, 423-432. doi:10.15288/jsa.1995.56.423.

Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Reserach, 6 (Suppl. 2), S125-140. doi:10.1080/14622200410001669187.

Cook, J. L., Green, C. R., de la Ronde, S., Dell, C. A., Graves, L., Ordean, A.,… Wong, S. (2017). Epidemiology and effects of substance use in pregnancy. Journal of Obstetrics and Gynaecology Canada, 39, 906-915. doi:10.1016/j.jogc.2017.07.005.

Chang, G., Orav, E. J., Jones, J. A., Buynitsky, T., Gonzalez, S. & Wilkins-Haug, L. (2011). Self-reported alcohol and drug use in pregnant young women: A pilot study of associated factors and identification. Journal of Addiction Medicine, 5, 221-226. doi:10.1097/ADM.0b0­13e318214360b

Chavez, L. M., Shrout, P. E., Wang, Y., Collazos, F., Carmona, R. & Alegria, M. (2017). Evaluation of the AC-OK mental health and substance abuse screening measure in an international sample of Latino immigrants. Drug and Alcohol Dependence, 180, 121-128. doi:10.1016/j.drugalcdep.2017.07.042.

Cherry, A. L. & Dillon, M. E. (2013). The AC-OK cooccurring screen: Reliability, convergent validity, sensitivity, and specificity. Journal of Addiction, 2013, 573906. doi:10.1155/2013/573906.

Dahlin, S., Gunnerbeck, A., Wikstrom, A. K., Cnattingius, S. & Edstedt Bonamy, A. K. (2016). Maternal tobacco use and extremely premature birth - a population-based cohort study. British Journal of Obstetrics and Gynaecology, 123, 1938-1946. doi:10.1111/1471-0528.14213.

Donald, K. A., Eastman, E., Howells, F. M., Adnams, C., Riley, E. P., Woods, R. P.,… Stein, D. J. (2015). Neuroimaging effects of prenatal alcohol exposure on the developing human brain: A magnetic resonance imaging review. Acta Neuropsychiatrica, 27, 251-269. doi:10.1017/neu.2015.12.

Ebrahim, S. H. & Gfroerer, J. (2003). Pregnancy-related substance use in the United States during 1996-1998. Obstetrics & Gynecology, 101, 374-379.

Ekblad, M., Gissler, M., Lehtonen, L. & Korkeila, J. (2010). Prenatal smoking exposure and the risk of psychiatric morbidity into young adulthood. Archives of General Psychiatry, 67, 841-849. doi:10.1001/archgenpsychiatry.2010.92.

England, M. C., Benjamin, A. & Abenhaim, H. A. (2013). Increased risk of preterm premature rupture of membranes at early gestational ages among maternal cigarette smokers. American Journal of Perinatology, 30, 821-826. doi:10.1055/s-0032-1333408.

Fairbrother, N., Janssen, P., Antony, M. M., Tucker, E. & Young, A. H. (2016). Perinatal anxiety disorder prevalence and incidence. Journal of Affective Disorders, 200, 148-155. doi:10.1016/j.jad.2015.12.082.

Forray, A. & Foster, D. (2015). Substance use in the perinatal period. Current Psychiatry Reports, 17, 91. doi:10.1007/s11920-015-0626-5.

Garg, M., Garrison, L., Leeman, L., Hamidovic, A., Borrego, M., Rayburn, W. F. & Bakhireva, L. (2016). Validity of self-reported drug use information among pregnant women. Maternal and Child Health Journal, 20, 41-47. doi:10.1007/s10995-015-1799-6.

Gauthier, T. W., Guidot, D. M., Kelleman, M. S., McCracken, C. E. & Brown, L. A. (2016). Maternal alcohol use during pregnancy and associated morbidities in very low birth weight newborns. American Journal of the Medical Sciences, 352, 368-375. doi:10.1016/j.amjms.2016.06.019.

Gouin, K., Murphy, K. & Shah, P. S. (2011). Effects of cocaine use during pregnancy on low birthweight and preterm birth: Systematic review and metaanalyses. American Journal of Obstetrics & Gynecology, 204, 340 e341-312. doi:10.1016/j.ajog.2010.11.013.

Hankin, J., McCaul, M. E. & Heussner, J. (2000). Pregnant, alcohol-abusing women. Alcoholism: Clinical and Experimental Research, 24, 1276-1286.

Heatherton, T. F., Kozlowski, L. T., Frecker, R. C. & Fagerstrom, K. O. (1991). The Fagerstrom test for nicotine dependence: A revision of the Fagerstrom tolerance questionnaire. British Journal of Addiction, 86, 1119-1127.

Holbrook, B. D. & Rayburn, W. F. (2014). Teratogenic risks from exposure to illicit drugs. Obstetrics and Gynecology Clinics of North America, 41, 229-239. doi:10.1016/j.ogc.2014.02.008.

Howard, L. M., Piot, P. & Stein, A. (2014). No health without perinatal mental health. Lancet, 384, 1723-1724. doi:10.1016/s0140-6736(14)62040-7.

Kingston, D., Tough, S. & Whitfield, H. (2012). Prenatal and postpartum maternal psychological distress and infant development: A systematic review. Child Psychiatry & Human Development, 43, 683-714. doi:10.1007/s10578-012-0291-4.

Ko, T. J., Tsai, L. Y., Chu, L. C., Yeh, S. J., Leung, C., Chen, C. Y.,… Hsieh, W. S. (2014). Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: A birth cohort study. Pediatrics and Neonatology, 55, 20-27. doi:10.1016/j.pedneo.2013.05.005.

Kramer, M. S., Lydon, J., Seguin, L., Goulet, L., Kahn, S. R., McNamara, H.,… Platt, R. W. (2009). Stress pathways to spontaneous preterm birth: The role of stressors, psychological distress, and stress hormones. American Journal of Epidemiology, 169, 1319-1326. doi:10.1093/aje/kwp061.

Kroenke, K., Spitzer, R. L. & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606-613.

Lange, S., Probst, C., Rehm, J. & Popova, S. (2018). National, regional, and global prevalence of smoking during pregnancy in the general population: A systematic review and meta-analysis. Lancet Global Health, 6, e769-e776. doi:10.1016/s2214-109x(18)30223-7.

Martinez-Paredes, J. F. & Jacome-Perez, N. (2019). Depression in pregnancy. Revista Colombiana de Psiquiatría, 48, 58-65. doi:10.1016/j.rcp.2017.07.003.

Paykel, E. S., Myers, J. K., Lindenthal, J. J. & Tanner, J. (1974). Suicidal feelings in the general population: A prevalence study. British Journal of Psychiatry, 124, 460-469.

Pereira, P. P., Da Mata, F. A., Figueiredo, A. C., de Andrade, K. R. & Pereira, M. G. (2017). Maternal active smoking during pregnancy and low birth weight in the americas: A systematic review and meta-analysis. Nicotine & Tobacco Research, 19, 497-505. doi:10.1093/ntr/ntw228.

Pineles, B. L., Hsu, S., Park, E. & Samet, J. M. (2016). Systematic review and meta-analyses of perinatal death and maternal exposure to tobacco smoke during pregnancy. American Journal of Epidemiology, 184, 87-97. doi:10.1093/aje/kwv301.

Sarman, I. (2018). Review shows that early foetal alcohol exposure may cause adverse effects even when the mother consumes low levels. Acta Paediatrica, 107, 938-941. doi:10.1111/apa.14221.

Siu, A. L. (2015). Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. preventive services Task Force Recommendation Statement. Annals of Internal Medicine, 163, 622-634. doi:10.7326/m15-2023.

Spanish Government. Ley Orgánica 3/2018 de Protección de Datos Personales y garantía de los derechos digitales. (2018). Madrid, Spain: Retrieved at https://www.boe.es/eli/es/lo/2018/12/05/3/dof/spa/pdf.

Spitzer, R. L., Kroenke, K., Williams, J. B. & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092-1097. doi:10.1001/archinte.166.10.1092.

Tiesler, C. M. & Heinrich, J. (2014). Prenatal nicotine exposure and child behavioural problems. European Child & Adolescent Psychiatry, 23, 913-929. doi:10.1007/s00787-014-0615-y.

Woody, C. A., Ferrari, A. J., Siskind, D. J., Whiteford, H. A. & Harris, M. G. (2017). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 219, 86-92. doi:10.1016/j.jad.2017.05.003.

Yudko, E., Lozhkina, O. & Fouts, A. (2007). A comprehensive review of the psychometric properties of the Drug Abuse Screening Test. Journal of Substance Abuse Treatment, 32, 189-198. doi:10.1016/j.jsat.2006.08.002.




DOI: https://doi.org/10.20882/adicciones.1568

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