Behavioral, psychosocial, and environmental risk factors associated with substance use during pregnancy: Comparisons of substance-using and non-using pregnant women

Behavioral, psychosocial, and environmental factors have independently been associated with use of alcohol, tobacco, and/or other drugs (ATOD) during pregnancy. However, few studies have assessed the constellation of risk factors that substance-using pregnant women exhibit.

In 2007, the Orange County Health Care Agency, using a multi-method approach, investigated risk factors associated with ATOD use during pregnancy. Nearly 2,600 pregnant women participated in an anonymous assessment, which included urinalysis and chart review of women giving birth at participating hospitals, and self-report assessments of women presenting at prenatal care providers.

Risk factor profiles of women who used substances while pregnant were compared to profiles of non-using women. Compared with non-users, women who used ATOD while pregnant were more likely to have initiated prenatal care later or not receive prenatal care (χ²=48.83, p<.01), have a close family member with a substance problem (OR=3.18; CI 1.93, 5.22), be exposed to second-hand smoke (OR=7.56; CI 4.47, 12.79) and experience high stress (OR=2.09; CI 0.73, 6.03) during pregnancy. Moreover, substance-users were more likely to have babies born prematurely (OR=4.67; CI 2.73, 8.00) and with lower birth weight (OR=3.98; CI 2.07, 7.63).

Findings suggest that women who use ATOD during pregnancy may face a variety of additional behavioral, psychosocial, and environmental risk factors while pregnant, many of which could compound the deleterious effects on the unborn child. Early identification and amelioration of these risk factors is critical to improving birth outcomes.