Background: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population.

Objectives: To investigate the length of stay for observation and treatment of neonatal abstinence syndrome (NAS), as well as the hospital costs associated with the medical care of affected newborns. Methods: A retrospective chart review was conducted at Shands Hospital at the University of Florida, Gainesville, Florida. Data were collected for newborns diagnosed with NAS, including their hospital length of stay and the associated hospital charges, from December 1, 2008, to November 30, 2011. Results: One hundred-sixty eligible newborns were included in the study. During the 3-year study period, hospital charges related to the diagnosis and treatment of NAS increased from $1.1 million per year to $1.8 million per year. Compared with the cost of caring for newborns without the risk of NAS, an additional $4.1 million was spent in the medical care of these newborns. Conclusions: The costs associated with treating newborns with NAS are exponentially higher than the costs associated with newborns not affected with NAS. The societal costs associated with treatment of newborns with NAS, as well as infant symptomatology experienced with NAS, can be reduced by encouraging physicians to be proactive in screening for drug use, urging women who use chronic opioids to actively engage in family planning and contraception, and encouraging pregnant women who use opioids to seek substance treatment.

Introduction: The American College of Obstetrics and Gynecology advises against cannabis and cannabidiol (CBD) product use during pregnancy; despite this, recent studies suggest cannabis and CBD use is increasing during pregnancy. The objective of this study is to assess risk perceptions of cannabis and CBD use during pregnancy among pregnant and non-pregnant patients. Methods: The study design is multi-method; a cross-sectional survey assessing use behaviors and risk perceptions is supplemented with qualitative focus group discussions (FGDs). Recruitment for surveys was from outpatient obstetrics clinics and recruitment for FGDs was from the same clinics and a substance-use treatment clinic, from October 2022 to February 2023. The survey instrument was developed via combining question items from validated instruments that assess cannabis and CBD use and risk perceptions. Comparisons of response frequency distributions for pregnant versus non-pregnant participants were calculated with chi-square analysis for individual risk perception question items. Data from the FGDs were coded and analyzed via a deductive content analysis approach. Results: There were 261 survey respondents and 5 FGDs (n = 17). Of the surveys, 198 (75.9%) were currently pregnant, 55 (21.1%) were not pregnant, and 8 (3.1%) did not disclose pregnancy status. Approximately 5.0% (n = 13) reported currently breastfeeding. For the question, “How risky is it to use marijuana [cannabis] once or twice a week during pregnancy?”, pregnant versus non-pregnant participants responded most frequently with “great risk” (29.2% vs. 27.3%) and “not sure” (40.0% vs. 34.5%), where p = 0.88 (not significant) between pregnant vs. non-pregnant response distribution. For the question, “How risky is it to use CBD once or twice a week during pregnancy?” pregnant vs. non-pregnant participants responded most frequently with: “great risk” (22.1% vs. 20.0%), and “not sure” (52.3% vs. 41.8%), where p = 0.12 (not significant). Ever use of cannabis and CBD differed in pregnant versus non-pregnant patients (cannabis 36.0% pregnant vs. 65.5% non-pregnant; CBD 19.9% pregnant vs. 38.2% non-pregnant). Qualitative findings indicated that participants perceived that legalization of marijuana has resulted in reduction of stigma against users, but participants expressed mixed feelings toward the perception of marijuana safety due to legalization, though several participants described perceived benefits of marijuana use more generally. Conclusion: Findings indicate uncertainty of risk related to cannabis and CBD use during pregnancy regardless of current pregnancy or lactation status, despite prevalent ever use of cannabis and CBD in those who were pregnant. This suggests an urgent need for clearer risk communication about cannabis and CBD use in pregnancy.