PRIDE in Pregnancy

Purpose:

The specific aims of PRIDE were:

  1. To assess whether a behavioral treatment combining motivational enhancement and cognitive skills training (MET-CBT) is more effective than brief advice in decreasing use of a full range of psychoactive substances in pregnant substance-using women.
  2. To assess whether MET-CBT decreases HIV risk behavior, when compared to brief advice.
  3. To evaluate whether pregnant substance using women who receive MET-CBT have longer gestation and infants that are greater birth weight compared to those who receive brief advice.

Results:

PRIDE in Pregnancy established a truly integrated substance abuse treatment program within two inner-city prenatal clinics, provided ongoing in-service education to the prenatal healthcare providers, and quality care improvements to nearly 200 pregnant women working to stay clean and sober.

In total, 2684 pregnant patients were screened and evaluated for eligibility for the study. 169 pregnant women enrolled in the treatment and completed the study. 86 were randomized to receive Brief Advice (BA) intervention, while 83 were randomized to receive MI-enhance Cognitive Behavioral Therapy (MI-CBT) from a nurse employed by the study and housed within the clinic. BA subjects received an average of 7 sessions of advice and medical education; MI-CBT subjects received an average of 5 sessions of skills counseling. All study-related services were provided in an integrated fashion with prenatal care.

All study-related self-report subject questionnaires were computerized in an audio-assisted computer-assisted self-interview (ACASI) program and administered in either English or Spanish to study subjects. Four study staff members were fully bilingual, including the PI, Project Director and two Research Assistants.

Plans:

A colleague in the Yale School of Epidemiology and Public Health was funded to conduct an economic analysis on this intervention. R01-DA025555 will extend through December 31, 2012, and has added 1 and 2-year postpartum follow-up interviews. All PRIDE subjects are offered these interviews, although no further intervention is conducted at those timepoints.

Publications:

Yonkers, KA, Howell HB, Allen AE, Ball SA, Pantalon MV, Rounsaville BJ. A treatment for substance abusing pregnant women. Archives of Women’s Mental Health, 2009, 12(4): 221-227. PMID: 19350369

Yonkers KA, Gotman, N, Kershaw, T, Forray, A, Howell, HB, Rounsaville, BJ. Screening for Prenatal Substance Use: Development of the Substance Use Risk Profile-Pregnancy Scale. Obstetrics & Gynecology, 2010 Oct; 116(4): 827-33. PMID: 20859145 

Yonkers, KA, Howell, HB, Gotman, N, Rounsaville, BJ. Self-report of illicit substance use versus urine toxicology results from at-risk pregnant women. Journal of Substance Use, 2011 Oct 1;16(5):372-389. PMID: 23956685

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