A Preconception Health Intervention to Reduce Substance Exposed Pregnancies among Incarcerated Women

PROJECT SUMMARY
The devastating effects of illicit substance use during pregnancy on mothers and children is widespread,
affecting more than 500,000 births between 2017 and 2018. Adverse birth outcomes can include fetal growth
restriction, neonatal abstinence syndrome, prematurity, and death. Illicit drug use during pregnancy puts
women at risk of activities that expose them to sexually transmitted infections and legal consequences
including loss of child custody and incarceration. Long-term negative consequences for children exposed to
substances in-utero range from growing up in an environment where one or both parents have substance use
disorders (SUD) to increased risk of depression, developing SUD themselves, and suffering from abuse.
While the American Society of Addiction Medicine recommends reproductive planning education be
incorporated into SUD treatment programs, interventions have primarily focused on increasing access to birth
control and treatment strategies for women already pregnant. A proactive approach to address substance use
prior to pregnancy, in the preconception period, is needed. Preconception interventions that address alcohol
and tobacco cessation have been found effective. However, to our knowledge, there are no interventions to
address preconception illicit substance use. The prevalence of SUD among women in jail is as high as 63%
and this population is at risk of both drug relapse and pregnancy after release. There is an optimal period of
time (prior to release) when preconception SUD interventions are feasible and ideal for this population. Using a
proactive approach for women in jail and before pregnancy will reduce the risk of substance exposed
pregnancies (SEPs) and mitigate the numerous negative consequences for mothers, newborns, and families.
The proposed study will be the first to adapt an evidence-based preconception intervention, CHOICES, for
use among incarcerated women with illicit SUD. CHOICES was developed to reduce the risk of alcohol-
exposed pregnancies by targeting both risky drinking and effective contraceptive use.1 The proposed study will
adapt CHOICES for use among incarcerated women with illicit SUD who are at risk for an SEP when they are
released. The specific aims of this project are to: (1) adapt CHOICES for use among incarcerated women with
illicit drug-related SUD to create a manualized intervention, CHOICES-PLEAS (Pregnancy Liberated from
Exposure to Alcohol and Substances) and (2) evaluate the feasibility, acceptability, and efficacy of CHOICES-
PLEAS at reducing the risk of SEPs (continued drug abstinence and/or reduction in risky sexual behavior)
among women in a court-mandated SUD treatment program.
Through completion of these aims and additional training in behavioral intervention design, advanced
statistical methods, and SUD treatment for reproductive-age women, the trainee, Dr. Bello, will gain the
expertise necessary to be an independent investigator. Her long-term goal is to establish herself as an
independent investigator with expertise in addressing the reproductive health needs of women with SUD.

Grant Number: 5K23DA053433-04
NIH Institute/Center: NIH
Principal Investigator: Jennifer Bello Kottenstette