Abstract
Purpose
Given the health consequences, perinatal substance use is a significant public health concern, especially as substance use rates increase among women; ongoing data regarding the rates of substance use across trimesters of pregnancy is needed.
Methods
The present study utilized cross-sectional population-based data from the National Survey of Drug Use and Health (NSDUH) between 2009 and 2019. We aimed to explore both licit and illicit substance use assessed within each trimester among women endorsing past-year substance use. The NSDUH sample included 8,530 pregnant women.
Results
Perinatal substance use was less prevalent among women in later trimesters; however, past-month substance use was observed for all substances across trimesters. The prevalence of past-month licit substance use among pregnant women ranged from 5.77 to 22.50% and past-month illicit substance use ranged from 4.67 to 14.81%. In the second trimester, lower odds of past-month substance use were observed across tobacco, alcohol, and marijuana (odds ratios [ORs] ranging from 0.29 to 0.47), when compared to the first trimester. A similar lower rate of past-month substance use was observed in the third trimester compared to the first trimester, across tobacco, alcohol, and marijuana use, as well as cocaine, prescription pain medication, and tranquilizer use (ORs ranging from 0.02 to 0.42). The likelihood of polysubstance use was lower among women in the second and third trimesters compared to the first trimester (ORs ranging from 0.09 to 0.46).
Conclusion
Findings indicate that a minority of women continue to use substances across all trimesters. This is especially true among women using licit substances and marijuana. These results highlight the need for improved interventions and improved access to treatment for these women.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adams ZM, Ginapp CM, Price CR, Qin Y, Madden LM, Yonkers K, Meyer JP (2021) “A good mother”: impact of motherhood identity on women’s substance use and engagement in treatment across the lifespan. J Subst Abuse Treat 130:108474
Addis A, Moretti ME, Ahmed Syed F, Einarson TR, Koren G (2001) Fetal effects of cocaine: an updated meta-analysis. Reprod Toxicol 15(4):341–369. https://doi.org/10.1016/S0890-6238(01)00136-8
Ali MM, Nye E, West K (2022) Substance use disorder treatment, perceived need for treatment, and barriers to treatment among parenting women with substance use disorder in us rural counties. J Rural Health 38:70–76. https://doi.org/10.1111/jrh.12488
Alshaarawy O, Anthony JC (2019) Cannabis use among women of reproductive age in the United States: 2002–2017. Addict Behav 99:106082. https://doi.org/10.1016/j.addbeh.2019.106082
Azagba S, Manzione L, Shan L, King J (2020) Trends in smoking during pregnancy by socioeconomic characteristics in the United States, 2010–2017. BMC Pregnancy Childbirth 20(1):52. https://doi.org/10.1186/s12884-020-2748-y
Berenson AB, Wilkinson GS, Lopez LA (1995) Substance use during pregnancy and peripartum complications in a triethnic population. Int J Addict 30(2):135–145
Best D, Segal J, Day E (2009) Changing patterns of heroin and crack use during pregnancy and beyond. J Subst Use 14(2):124–132. https://doi.org/10.1080/14659890802658962
Centers for Disease Control and Prevention (2019) Pregnancy-related deaths. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm
Chapman SLC, Wu L-T (2013) Postpartum substance use and depressive symptoms: a review. Women Health 53(5):479–503. https://doi.org/10.1080/03630242.2013.804025
Coleman-Cowger VH, Schauer GL, Peters EN (2017) Marijuana and tobacco co-use among a nationally representative sample of US pregnant and non-pregnant women: 2005–2014 National Survey on Drug Use and Health findings. Drug Alcohol Depend 177:130–135. https://doi.org/10.1016/j.drugalcdep.2017.03.025
Ebrahim SH, Gfroerer J (2003) Pregnancy-related substance use in the United States during 1996–1998. Obstet Gynecol 101(2):347–349
Forray A (2016) Substance use during pregnancy. F1000Research, 5, F1000 Faculty Rev-1887. https://doi.org/10.12688/f1000research.7645.1
Forray A, Gilstad-Hayden K, Suppies C, Bogen D, Sofuoglu M, Yonkers KA (2017) Progesterone for smoking relapse prevention following delivery: a pilot, randomized, double-blind study. Psychoneuroendocrinology 86:96–103. https://doi.org/10.1016/j.psyneuen.2017.09.012
Forray A, Merry B, Lin H, Ruger JP, Yonkers KA (2015) Perinatal substance use: a prospective evaluation of abstinence and relapse. Drug Alcohol Depend 150:147–155. https://doi.org/10.1016/j.drugalcdep.2015.02.027
Goldman-Mellor S, Margerison CE (2019) Maternal drug-related death and suicide are leading causes of postpartum death in California. Am J Obstet Gynecol 221(5):489.e1-489.e9. https://doi.org/10.1016/j.ajog.2019.05.045
Gorman MC, Orme KS, Nguyen NT, Kent EJ, Caughey AB (2014) Outcomes in pregnancies complicated by methamphetamine use. Am J Obstet Gynecol 211(4):429.e421-429.e427. https://doi.org/10.1016/j.ajog.2014.06.005
Grant BF, Chou SP, Saha TD, Pickering RP, … Hasin DS (2017) Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiat, 74(9):911–923. https://doi.org/10.1001/jamapsychiatry.2017.2161
Grant BF, Saha TD, Ruan WJ, Goldstein RB, Chou SP, Jung J, . . . Hasin DS (2016) Epidemiology of DSM-5 drug use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions–III. JAMA Psychiat, 73(1), 39-47. https://doi.org/10.1001/jamapsychiatry.2015.2132
Hawkins SS, Hacker MR (2022) Trends in use of conventional cigarettes, e-cigarettes, and marijuana in pregnancy and impact of health policy. Clin Obstet Gynecol 65(2):305–318. https://doi.org/10.1097/GRF.0000000000000690
Howard LM, Chandra P, Hanlon C, Fisher J, Gregoire A, Herrman H, Honikman, Simone S, Kulkarni J, Milgrom J, Rahman A, Rondon MB, Wisner K (2017) Perinatal mental health: position statement. World Psychiatric Assoc
Hudak ML, Tan RC (2012) Neonatal drug withdrawal. Pediatrics 129(2):e540–e560. https://doi.org/10.1542/peds.2011-3212
Hymowitz N, Schwab M, McNerney C, Schwab J, Eckholdt H, Haddock K (2003) Postpartum relapse to cigarette smoking in inner city women. J Natl 95(6):461–474
Jones HE, Kraft WK (2019) Analgesia, opioids, and other drug use during pregnancy and neonatal abstinence syndrome. Clin Perinatol 46(2):349–366. https://doi.org/10.1016/j.clp.2019.02.013
Kozhimannil KB, Graves AJ, Levy R, Patrick SW (2017) Nonmedical use of prescription opioids among pregnant U.S. women. Women’s Health Issues 27(3):308–315. https://doi.org/10.1016/j.whi.2017.03.001
Kurti AN, Nighbor TD, Tang K, Bolívar HA, Evemy CG, Skelly J, Higgins ST (2022) Effect of smartphone-based financial incentives on peripartum smoking among pregnant individuals: a randomized clinical trial. JAMA Netw Open 5(5):e2211889–e2211889
Latuskie KA, Leibson T, Andrews NCZ, Motz M, Pepler DJ, Shinya I (2019) Substance use in pregnancy among vulnerable women seeking addiction and parenting support. Int J Ment Health Addiction 17:137–150. https://doi.org/10.1007/s11469-018-0005-7
Lester BM, Andreozzi L, Appiah L (2004) Substance use during pregnancy: time for policy to catch up with research. Harm Reduct J 1:5–5. https://doi.org/10.1186/1477-7517-1-5
Levine MD, Cheng Y, Marcus MD, Kalarchian MA, Emery RL (2016) Preventing postpartum smoking relapse: a randomized clinical trial. JAMA Intern Med 176(4):443–452. https://doi.org/10.1001/jamainternmed.2016.0248
MacDorman MF, Declercq E, Cabral H, Morton C (2016) Recent increases in the U.S. maternal mortality rate: disentangling trends from measurement issues. Obstet Gynecol 128(3):447–455. https://doi.org/10.1097/aog.0000000000001556
Mangla K, Hoffman MC, Trumpff C, O’Grady S, Monk C (2019) Maternal self-harm deaths: an unrecognized and preventable outcome. Am J Obstet Gynecol 221(4):295–303. https://doi.org/10.1016/j.ajog.2019.02.056
Massey SH, Lieberman DZ, Reiss D, Leve LD, Shaw DS, Neiderhiser JM (2011) Association of clinical characteristics and cessation of tobacco, alcohol and illicit drug use during pregnancy. Am J Addict 20(2):143–150. https://doi.org/10.1111/j.1521-0391.2010.00110.x
McHugh RK, Wigderson S, Greenfield SF (2014) Epidemiology of substance use in reproductive-age women. Obstet Gynecol Clin North Am 41(2):177–189. https://doi.org/10.1016/j.ogc.2014.02.001
Minozzi S, Amato L, Bellisario C, Ferri M, Davoli M (2013) Maintenance agonist treatments for opiate-dependent pregnant women. Cochrane Database Syst Rev (12). https://doi.org/10.1002/14651858.CD006318.pub3
Moore DG, Turner JD, Parrott AC, Goodwin JE, Fulton SE, Min MO, . . . Singer LT (2010) During pregnancy, recreational drug-using women stop taking ecstasy (3,4-methylenedioxy-N-methylamphetamine) and reduce alcohol consumption, but continue to smoke tobacco and cannabis: initial findings from the development and infancy study. J Psychopharmacol 24(9), 1403-1410. https://doi.org/10.1177/0269881109348165
O’Connor MJ, Whaley SE (2003) Alcohol use in pregnant low-income women. J Stud Alcohol 64(6):773–783. https://doi.org/10.15288/jsa.2003.64.773
Oh S, Reingle Gonzalez JM, Salas-Wright CP, Vaughn MG, DiNitto DM (2017) Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: evidence from the NSDUH 2005–2014. Prev Med 97:93–99. https://doi.org/10.1016/j.ypmed.2017.01.006
Pineles BL, Park E, Samet JM (2014) Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol 179(7):807–823. https://doi.org/10.1093/aje/kwt334
Qato DM, Zhang C, Gandhi AB, Simoni-Wastila L, Coleman-Cowger VH (2020) Co-use of alcohol, tobacco, and licit and illicit controlled substances among pregnant and non-pregnant women in the United States: findings from 2006 to 2014 National Survey on Drug Use and Health (NSDUH) data. Drug Alcohol Depend 206:107729. https://doi.org/10.1016/j.drugalcdep.2019.107729
Salihu HM, Wilson RE (2007) Epidemiology of prenatal smoking and perinatal outcomes. Early Hum Dev 83(11):713–720. https://doi.org/10.1016/j.earlhumdev.2007.08.002
Singh GK (2021) Trends and social inequalities in maternal mortality in the United States, 1969–2018. Int J MCH AIDS 10(1):29–42. https://doi.org/10.21106/ijma.444
Shmulewitz D, Hasin DS (2019) Risk factors for alcohol use among pregnant women, ages 15–44, in the United States, 2002 to 2017. Prev Med 124:75–83. https://doi.org/10.1016/j.ypmed.2019.04.027
Soneji S, Beltrán-Sánchez H (2019) Association of maternal cigarette smoking and smoking cessation with preterm birth. JAMA Netw Open 2(4):e192514. https://doi.org/10.1001/jamanetworkopen.2019.2514
Substance Abuse and Mental Health Services Administration [SAMSHA]. (2015). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables.
Substance Abuse and Mental Health Services Administration [SAMSHA]. (2016, 01/14/2016). About Popuatlion Data/ NSDUH. Retrieved 01/22, 2017
Substance Abuse and Mental Health Services Administration [SAMSHA]. (2018). 2015 NATIONAL SURVEY ON DRUG USE AND HEALTH PUBLIC USE FILE CODEBOOK. 2021, from https://www.datafiles.samhsa.gov/sites/default/files/field-uploads-protected/studies/NSDUH-2015/NSDUH-2015-datasets/NSDUH-2015-DS0001/NSDUH-2015-DS0001-info/NSDUH-2015-DS0001-info-codebook.pdf
Sokol RJ, Delaney-Black V, Nordstrom B (2003) Fetal alcohol spectrum disorder. JAMA 290(22):2996–2999. https://doi.org/10.1001/jama.290.22.2996
Stone R (2015) Pregnant women and substance use: fear, stigma, and barriers to care. Health & Justice 3(1):2. https://doi.org/10.1186/s40352-015-0015-5
Terplan M, McNamara EJ, Chisolm MS (2012) Pregnant and non-pregnant women with substance use disorders: the gap between treatment need and receipt. J Addict Dis 31(4):342–349. https://doi.org/10.1080/10550887.2012.735566
Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rössler A, Soyka M, Yonkers K (2019) WFSBP and IAWMH Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 20(1):17–50. https://doi.org/10.1080/15622975.2018.1510185
Tong VT, Dietz PM, Farr SL, D’Angelo DV, England LJ (2013) Estimates of smoking before and during pregnancy, and smoking cessation during pregnancy: comparing two population-based data sources. Public Health Rep 128(3):179–188
Tong VT, England LJ, Dietz PM, Asare LA (2008) Smoking patterns and use of cessation interventions during pregnancy. Am J Prev Med 35(4):327–333. https://doi.org/10.1016/j.amepre.2008.06.033
Trost SL, Beauregard JL, Smoots AN, Ko JY, Haight SC, Moore Simas TA, . . . Goodman D (2021) Preventing pregnancy-related mental health deaths: insights from 14 US maternal mortality review committees, 2008–17. Health Aff., 40(10), 1551-1559. https://doi.org/10.1377/hlthaff.2021.00615
Tsuda-McCaie F, Kotera Y (2022) A qualitative meta-synthesis of pregnant women’s experiences of accessing and receiving treatment for opioid use disorder. Drug Alcohol Rev 41:851–862. https://doi.org/10.1111/dar.13421
Wang GS, Buttorff C, Wilks A, Schwam D, Metz TD, Tung G, Pacula RL (2022) Cannabis legalization and cannabis-involved pregnancy hospitalizations in Colorado. Prev Med 156:106993
Yonkers KA, Forray A, Nich C, Carroll KM, Hine C, Merry BC, . . . Sofuoglu M (2014) Progesterone for the reduction of cocaine use in post-partum women with a cocaine use disorder: a randomised, double-blind, placebo-controlled, pilot study. Lancet Psychiat 1(5), 360-367. https://doi.org/10.1016/S2215-0366(14)70333-5
Young-Wolff KC, Tucker L, Alexeeff S et al (2017) Trends in self-reported and biochemically tested marijuana use among pregnant females in California from 2009–2016. JAMA 318(24):2490–2491. https://doi.org/10.1001/jama.2017.17225
Funding
This work was supported by National Institute of Health grants U54AA027989 (SAM), P50DA033945 (SAM), K01AA025670 (TLV), R03AA028361 (TLV), K23AA02689 (WR), and T32DA007238 (MRP). The funding agency had no involvement in the study design, interpretation of data, writing of the report or the decision to submit the article for publication.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MacKenzie Peltier, PhD, and Walter Roberts, PhD. The first draft of the manuscript was written by MacKenzie Peltier, PhD, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval
This is an observational study, which utilizes publicly available, de-identified data.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Peltier, M.R., Roberts, W., Verplaetse, T.L. et al. Licit and illicit drug use across trimesters in pregnant women endorsing past-year substance use: Results from National Survey on Drug Use and Health (2009–2019). Arch Womens Ment Health 25, 819–827 (2022). https://doi.org/10.1007/s00737-022-01244-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-022-01244-6