Pilar Margaret Sanjuan

Introduction: In the past decade, hepatitis C virus (HCV) infections among pregnant women increased dramatically in the United States, rising in parallel with the opioid crisis and increasing the number of children at risk for HCV. People with HCV infection that remains untreated are also at increased risk of cirrhosis, liver cancer, and death. Objective: To describe timing of HCV testing during pregnancy and postpartum HCV treatment among women with opioid use disorder (OUD). Methods: This analysis draws from the MATernaL and Infant clinical NetworK (MAT‐LINK) surveillance system's cohort of women with OUD during pregnancy, which is collected from electronic health records of seven healthcare systems. Women were included if they had OUD during pregnancy and a known pregnancy outcome during January 1, 2014–August 31, 2021. Antenatal HCV testing was examined by characteristics of pregnant women (including age, race, ethnicity, insurance, urbanicity, parity, and medication for OUD) using multinomial regression. Hepatitis C diagnosis (positive antibody or nucleic acid test or diagnostic code) and postpartum treatment were also examined. Results: Among the 5533 pregnancies in this cohort, 1506 (27.2%) had no testing or diagnostic code for hepatitis C including 1296 who received prenatal care. Among 910 pregnancies with no prenatal care, 700 (76.9%) had HCV testing or diagnostic codes. Among pregnancies with HCV testing or diagnostic codes, 55.8% had a hepatitis C diagnosis. Women were more likely to have HCV testing if they were White or Hispanic, had government‐funded insurance, or received medication for OUD during the pregnancy. From five clinical sites with prescription information available, 9.7% ( n = 81/836) of those with a detectable viral load had a direct‐acting antiviral prescription in the first year postpartum. Conclusion: Women with OUD during pregnancy have a high burden of hepatitis C. Despite national recommendations, gaps remain in HCV testing during pregnancy and HCV treatment postpartum. HCV testing among women with no prenatal care indicates that testing is occurring outside of traditional prenatal care settings. Receiving medication for OUD was associated with being tested for HCV during pregnancy. Improved HCV testing, treatment, and management for pregnant women with OUD represent opportunities for improving overall health and eliminating HCV infection.

A transition in care (TIC) is a significant change in the primary adults who provide care for a child, involving a move to informal or formal non‐parental care, including kinship and foster care. In this paper, we address three issues: (1) the theoretical and empirical reasons for retaining infants and children who experience TIC in longitudinal studies of child health and development; (2) the import of retaining infants and children who experience TIC in studies focusing on parental substance use; and (3) methodological strategies for following children with TIC. We discuss the HEALthy Brain and Child Development (HBCD) study as an example of how a large prospective longitudinal cohort study can retain children who experience TIC, describing strategies such as: (1) documenting the frequency and contexts of these transitions and their associations with child health, mental health, and neurodevelopment; (2) attending to consent and mandated reporting requirements; (3) being sensitive to state child welfare policies and practices; (4) addressing retention challenges; (5) focusing on issues related to diversity, equity, and inclusion; and (6) establishing methods that document transitions and flexibly follow children as they grow older.

Current research on the effects of childhood trauma largely focuses on maltreatment. In the current study, we used diffusion tensor imaging (DTI) to determine the association between potentially traumatic exposures not related to maltreatment and fractional anisotropy (FA) in 184 youth aged 9–14 years. The Trauma History Profile was used to determine how many traumatic events in different categories were experienced and create low- and high-trauma groups. FA values were compared between groups in twelve a priori chosen regions of interest (ROIs). Five of the twelve regions showed significantly lower FA in the high-trauma groups when compared to the low-trauma groups, including the body of the corpus callosum, the total corpus callosum, bilateral posterior thalamic radiation, and the left cingulate gyrus projection of the cingulum bundle. Group differences were also observed across a range of behaviors. However, FA was not associated with posttraumatic stress symptomology. The results support the hypothesis that the high-trauma group had lower FA compared to the low-trauma group. The significant ROIs represent a subset of regions identified in studies of adults exposed to traumatic childhood events or children with a history of maltreatment. These results, obtained from typically developing youth, underline the importance of examining childhood trauma exposure in future developmental studies.

Pregnant women with substance use disorder (SUD) comprise an underserved population with complex treatment needs, including complications from trauma histories and comorbid psychological disorders. Using ecological momentary assessment, we examined momentary fluctuations in posttraumatic stress disorder (PTSD) symptoms, prenatal bonding, and substance craving, among pregnant women in SUD treatment who had a history of trauma. We hypothesized that (a) PTSD symptoms and prenatal bonding would each be associated with substance craving and (b) PTSD symptoms would be negatively associated with prenatal bonding, and this would at least partially account for the association between PTSD symptoms and substance craving (i.e., indirect effect). Participants (n = 32) were on average 27.1 weeks pregnant (SD = 5.27), 27.8 years old (SD = 4.54), and predominantly Hispanic/Latina (66%). At the within subjects level, higher momentary ratings of PTSD symptoms were associated with lower quality (but not intensity of preoccupation) of prenatal bonding, which in turn was associated with greater craving. Lower quality of prenatal bonding partially mediated the positive association between PTSD symptoms and craving, which remained strong after accounting for prenatal bonding. Our results provide some preliminary support for considering interventions aimed at stabilizing or decreasing PTSD symptoms and stabilizing or increasing prenatal bonding to reduce substance craving and, thus, the risk of perinatal substance use among women with SUD and trauma histories. (PsycINFO Database Record (c) 2020 APA, all rights reserved).