ST. LOUIS – Jennifer Bello-Kottenstette, M.D., an assistant professor in the department of family and community medicine at Saint Louis University School of Medicine, has been awarded a K23 grant through the National Institute on Drug Abuse to study the effectiveness of a motivational interviewing intervention to address substance use prior to pregnancy.

The five-year grant totals $866,710 and will fund Bello-Kottenstette to adapt and test the evidence-based pre-pregnancy intervention, CHOICES, for use among incarcerated women with illicit polysubstance use. The pilot study will take place at the St. Louis County Jail with women of childbearing age in a 90-day substance use disorder (SUD) treatment program. 

Bello-Kottenstette works with patients with SUD, some in the criminal justice system and others in an outpatient addiction medicine clinic. She says an evidence-based approach has been found to reduce the risk of alcohol- and tobacco-exposed pregnancies, and she is hoping to expand it to those who use illicit substances - especially those who may want to become pregnant.

“We know the devastating effects of illicit substance use during pregnancy for both mothers and children,” she said. “If we can reach women who have used illicit substances before they become pregnant, we hope to see improved outcomes for women and their children.”

Many of the women who have been incarcerated due to charges related to substance use have children or may want to have children, Bello-Kottenstette said. Working directly in a motivational interviewing counseling session can help women self-identify goals for changing substance use, risky sexual behaviors, or both.

Substance use during pregnancy can lead to adverse birth outcomes including fetal growth restriction, neonatal abstinence syndrome, prematurity, and death. Illicit drug use during pregnancy puts women at risk of activities that expose them to sexually transmitted infections and legal consequences including loss of child custody and incarceration. 

The long-term negative consequences for children exposed to substances in-utero range from growing up in an environment where one or both parents have SUD, to increased risk of depression, developing SUD themselves, and suffering from abuse. 

“There are no interventions to address pre-pregnancy illicit substance use,” Bello-Kottenstette said. “The prevalence of substance use among women in jail is as high as 63% and this population has a high rate of both drug relapse and pregnancy after release.”

She noted there is an optimal period (prior to release) when pre-pregnancy interventions are feasible and may be ideal for this population. Bello-Kottenstette will adapt an existing program, CHOICES, first developed to address alcohol use prior to pregnancy. 

The proposed study will adapt CHOICES for use among incarcerated women with illicit polysubstance use. Bello-Kottenstette aims to adapt the intervention and evaluate the feasibility, acceptability, and efficacy of the program in reducing the risk of continued drug abstinence and/or reduction in risky sexual behaviors among women in a court-mandated treatment program. 

“Many women want to change. Many of them already have children and they want to be there for them,” Bello-Kottenstette said. 

Women enrolled in the pilot study will participate in three or four one-on-one motivational interviewing sessions. These sessions will take place first while the woman is in a jail setting and then post-release.

K23 awards from the National Institutes for Health support the career development of those with clinical doctoral degrees, who have the potential to develop into productive, clinical investigators, and who have made a commitment to focus their research endeavors on patient-oriented research. The K23 provides support and protected time for patient-oriented research and training.

K23 awardees are encouraged to take advantage of mentors at their institutions. Bello-Kottenstette is being mentored by Jeremiah Weinstock, Ph.D., professor of psychology at Saint Louis University, and Richard Grucza, Ph.D., professor of family and community medicine at SLU and a core faculty member in SLU’s AHEAD Institute.

Bello-Kottenstette participated in the Washington University Institute of Clinical and Translational Science (ICTS) NIH Mock Study Sections. SLU is a part of the Washington University-led research consortium.

The mock study program is designed to simulate an actual NIH study section for clinical and translational R, K, and F series grant applications. The purpose of the program is to increase the likelihood of grant funding success by providing comprehensive, study section-like feedback to applicants on their complete grant application prior to grant submission.

This study is supported by the National Institute on Drug Abuse, 1K23DA053433-01A1.

Saint Louis University School of Medicine

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious diseases.