Prenatal yoga as adjunctive treatment for pregnant women with substance use disorders. Collaboration with Milagro, ASAP, and High Desert Yoga.

Prenatal alcohol and other substance use is an ongoing problem in the United States with long-term consequences for affected children and families. Approximately 5% of women entering treatment for an alcohol or substance use disorder (SUD) are pregnant.1 Pregnant women with SUD often have trouble engaging in treatment, and relapse rates during pregnancy are high - often around 50%.2,3 Many women with SUD use alcohol during pregnancy even if the primary substance for which they receive treatment is opioids (also about 50%).4 Thus, ancillary interventions to improve treatment engagement and reduce relapse for pregnant women are needed.

Several factors are associated with SUD in this population, and addressing these could help women abstain prenatally and after their babies are born. Posttraumatic stress disorder (PTSD) is associated with depression and relapse among pregnant women with SUD5 and poorer outcomes for pregnant women in general.6-9 There are uniquely high rates of trauma and PTSD in women with prenatal SUD.10,11 Another potential intervention target is antenatal bonding, i.e. the relationship and feelings pregnant women develop toward their fetuses, which is associated with alcohol12 and tobacco use13 during pregnancy, as well as fetal abuse,14 poor prenatal health practices,15 and postpartum depression.12 Poor psychological heath is associated with disruptions in prenatal bonding.16-18 Prenatal yoga, particularly when it integrates mindfulness training, has been shown to alleviate symptoms of depression and anxiety,19-21 and may be an especially attractive option to complement treatment programs for pregnant women in addiction recovery programs.

This program is a collaborative effort between four organizations in Albuquerque, NM. The Milagro Program at the University of New Mexico (UNM) Health Sciences Center is the primary addictions treatment program for pregnant women in New Mexico. The program provides alcohol and other SUD treatment in conjunction with prenatal and obstetric care to between 200-300 pregnant women yearly. Pilar Sanjuan, Ph.D. is a psychologist and research assistant professor at the Center on Alcoholism, Substance Abuse, and Addictions (CASAA) at UNM, who is currently conducting a study with Milagro to investigate factors, especially PTSD and prenatal bonding, associated with alcohol and other drug use during pregnancy. Hannah Watson, MD is a family practice physician and a fellow with the UNM Family and Community Medicine Department, which houses the Milagro Program. Larissa Maley, Ph.D. is a psychologist and the Chief of Clinical Programming at the UNM Addiction and Substance Abuse Program (ASAP), where many women in the Milagro program receive treatment. Mary Beth Sutter, MD is an assistant professor in the Department of Family Medicine and attending physician at Milagro, whose research focuses on group prenatal care for women with SUD. Heather Lee Farrell, DOM is a doctor of oriental medicine, an EYT500hr-RYT 500hr Yoga teacher with Perinatal certification, a doula, and Studio Director at High Desert Yoga (HDY).

Together we have identified prenatal yoga as a safe22 and promising intervention to address some of the problems facing these women. Via mindfulness training,23-28 exercise,29-31 and social support,32,33 group prenatal yoga has the potential to decrease pregnancy-related discomfort, PTSD, anxiety, depression, and alcohol and other substance use, and also to improve pregnancy outcome. Moreover, it may potentially increase fetal bonding17 through directed bonding exercises. Another benefit is that yoga exercises can help women have less physical discomfort during pregnancy26 and better experiences during labor. Additionally, it can be provided in a manner that it is accessible and desirable to these women34 who often have problems with homelessness, childcare, and transportation.

This is not a Medicaid-covered health expense and these women mostly have very limited financial means, thus we are working to develop a Prenatal Yoga program for these pregnant women with addiction that is initially (1) taught by volunteer expert prenatal yoga instructors, (2) based on empirical research, and (3) supplied by donations from the community. This way it can be provided at no cost to patients in the Milagro Program. Drs. Sanjuan, Watson, Maley, Sutter, and Farrell are providing coordination and expertise on a volunteer basis. Mandy Hartley, RN, charge nurse at the Milagro Clinic will provide key coordination between Milagro and ASAP. Preventfas.com and Jerome Romero, director of the NM Statewide Fetal Alcohol Syndrome Prevention Program, will assist in the acquisition of yoga equipment. The first step is to establish the feasibility of the program. Next, we plan to conduct scientific research evaluating the effectiveness of the intervention and also to establish funding for the program so instructors can be compensated. The hope is that this program can be developed into a long-term sustainable service for the women at Milagro.