Using a Multidisciplinary Approach for Pregnant Women With Nicotine Dependence and Co-occurring Disorders

Abstract

Smoking during pregnancy increases the risk of complications during pregnancy, including low birth weight and prematurity. While smoking prevalence among pregnant women has been declining, pregnant women with co-occurring disorders struggle with smoking cessation not only because they are managing their psychiatric and substance-related conditions but also because they are at greater risk for a number of psychosocial stressors, such as poverty, domestic violence, and limited support. In addition, obstetric, substance abuse, and psychiatric treatment for pregnant women is often fragmented and uncoordinated, resulting in poor health outcomes for mother and baby. The goal of this clinical forum is to demonstrate the potential for multidisciplinary treatment providers and community members to work together toward successfully meeting the complex needs of pregnant women with co-occurring disorders. Following the case presentation, we outline the ways in which patients and their obstetric, psychiatric, and substance abuse treatment providers can work together as a team, often incorporating members of the broader community. In this context, we provide brief overviews of effective pharmacotherapy approaches, psychosocial interventions, as well as community-based interventions for tobacco cessation among pregnant women with co-occurring disorders. In addition, we outline an organizational change model to systematically address tobacco use in clinical settings that serve these patients. We demonstrate that even small efforts to coordinate care can have large payoffs in terms of outcomes for mothers and their babies.

Keywords:

• pregnancy
• tobacco
• co-occurring disorders
• multidisciplinary treatment
• relapse prevention
• smoking cessation

ACKNOWLEDGMENTS

All contributors to this article are authors. This forum was written without grant or other financial support. Drs. Lundquist and Kolodziej and Mr. Seward presented portions of this paper at a workshop during a conference on Women and Co-Occurring Disorders organized by Spectrum Health Systems Inc. and held in Westborough, Massachusetts, in May 2010.