Opioid abuse in a high-risk pregnancy clinic
We are conducting a short-term longitudinal study of mothers-to-be in a high-risk pregnancy clinic at the University of Tennessee Medical Center in Knoxville (UTMC). Some of the mothers are at risk due to opioid misuse, others due to non-drug-related factors. We are interested in relationships between opioid misuse, childhood maltreatment, borderline features, stress, social support, depression, and anxiety. We first interview mothers when they are pregnant. We then access information on birth outcomes from medical records and follow the mothers up when the infant is 6 months old. We will assess the relationship between opioid misuse and how the mother-infant relationship is developing, how mothers are coping with parenting stress, how satisfied they feel about their parenting, if they experience domestic violence, and whether they relapse with opioids.
We are interested in is reflective functioning (mentalization), which is the ability to make sense of one’s own and others’ mental and emotional states. Being able to understand one’s own and others’ feelings and motivations, engenders warm and close relationships and good emotion regulation. Poor reflective functioning is associated with a history of childhood trauma such as maltreatment and separation from, or loss of, a caregiver. Good reflective functioning in a mother is associated with the development of a secure attachment with her infant at 12 months.
We are also interested in comparing treatment options for pregnant women who misuse opioids in pregnancy. The standard of care is for women to maintain on low doses of opioids to minimize cravings and help prevent relapse. However, this does not take advantage of many women’s desire to stop using opioids completely prior to giving birth. Moreover, neonatal opioid withdrawal syndrome (NOWS; formerly termed neonatal abstinence syndrome, NAS) is a likely consequence for infants of women who maintain on prescribed opioids as it is for women who continue to misuse opioids during pregnancy. NOWS infants are born dependent on opioids and may have difficulty sleeping, eating, and being soothed. Physicians at UTMC are on the forefront of helping women withdraw from opioids during pregnancy in conjunction with an intensive behavioral intervention to reduce the likelihood of relapse.
Child development in the offspring of mothers with borderline personality disorder (BPD)
BPD symptoms include impulsive self-destructive behavior, difficulty dealing with anger, mood swings, frantic efforts to avoid abandonment, alternately idealizing and devaluing others, and instability in a sense of identity. In past studies we compared offspring whose mothers have BPD with offspring whose mothers do not. We remain interested in this area of research and include aspects in our current study. The data collected on the women who misuse opioids in pregnancy includes assessment of BPD in the form of self-reported borderline features. We are examining the relationship between borderline features, opioid misuse, reflective functioning, and infant outcomes.
A confusion in parent and child roles, e.g., when a mother looks to a child for care, or a father plays with his child as if he were another child rather than setting limits, hampers a child’s development of attachment, self, self-regulation, and peer relationships. We are currently developing a coding system to assess role confusion from videotaped problem-solving interactions between mothers and their adolescents in a sample of mothers who have BPD, and normative comparisons.