The effect of the COVID-19 pandemic on substance use patterns and physiological dysregulation in pregnant and postpartum women

Sharon Ruyak; Melissa H Roberts; Stephanie Chambers; Xingya Ma; Jared DiDomenico; Richard De La Garza 2nd; Ludmila N Bakhireva

doi:10.1111/acer.15077

The effect of the COVID-19 pandemic on substance use patterns and physiological dysregulation in pregnant and postpartum women

Alcohol Clin Exp Res (Hoboken). 2023 Jun;47(6):1088-1099. doi: 10.1111/acer.15077. Epub 2023 Jun 11.

Authors

Sharon Ruyak¹, Melissa H Roberts², Stephanie Chambers³, Xingya Ma², Jared DiDomenico², Richard De La Garza 2nd⁴, Ludmila N Bakhireva²

Affiliations

¹ College of Nursing, University of New Mexico, Albuquerque, New Mexico, USA.
² Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA.
³ Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
⁴ Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

PMID: 37526587
PMCID: PMC10394275 (available on 2024-06-11)
DOI: 10.1111/acer.15077

Abstract

Background: The SARS-CoV-2/COVID-19 pandemic has been associated with increased stress levels and higher alcohol use, including in pregnant and postpartum women. In the general population, alcohol use is associated with dysregulation in the autonomic nervous system (ANS), which is indexed by heart rate variability (HRV). The objectives of this study were to: (1) characterize changes in substance use during the SARS-CoV-2/COVID-19 pandemic via a baseline self-report survey followed by mobile ecological momentary assessment (mEMA) of substance use; and (2) examine the associations between momentary substance use and ambulatory HRV measures in pregnant and postpartum women.

Methods: Pregnant and postpartum women were identified from the ENRICH-2 prospective cohort study. Participants were administered a baseline structured phone interview that included the Coronavirus Perinatal Experiences (COPE) survey and ascertained the prevalence of substance use. Over a 14-day period, momentary substance use was assessed three times daily, and HRV measurements were captured via wearable electronics. Associations between momentary substance use and HRV measures (root mean square of successive differences [RMSSD] and low frequency/high frequency [LF/HF] ratio) were examined using a mixed effects model that included within-subject (WS) and between-subject (BS) effects and adjusted for pregnancy status and participant age.

Results: The sample included 49 pregnant and 22 postpartum women. From a combination of a baseline and 14-day mEMA surveys, 21.2% reported alcohol use, 16.9% reported marijuana use, and 8.5% reported nicotine use. WS effects for momentary alcohol use were associated with the RMSSD (β = -0.14; p = 0.005) and LF/HF ratio (β = 0.14; p = 0.01) when controlling for pregnancy status and maternal age. No significant associations were observed between HRV measures and instances of marijuana or nicotine use.

Conclusions: These findings highlight the negative effect of the SARS-CoV-2/COVID-19 pandemic on the psychological health of pregnant and postpartum women associated with substance use, and in turn, ANS dysregulation, which potentially puts some women at risk of developing a substance use disorder.

Keywords: COVID‐19; alcohol use; ecological momentary assessment; heart rate variability; pregnancy.

Grants and funding

R01 AA021771/AA/NIAAA NIH HHS/United States