A comparative analysis of risks associated with tobacco, alcohol and illicit drug use during pregnancy in a population of African American mothers in the District of Columbia

The use of substances during pregnancy continues to represent a significant challenge to health providers caring for high risk populations. More information is needed on the comparison of risk exposure to tobacco, alcohol and illicit drugs. Such information would be useful to health providers and can be used to educate pregnant women receiving care. We followed 1,044 African American women during pregnancy if they were >18 years, spoke English, <28 weeks pregnant and screened positively for smoking, environmental tobacco smoke, depression or intimate partner violence. Of mothers with known pregnancy outcomes (n=909), 18.3% smoked during pregnancy, 21.9% admitted to consuming alcohol during pregnancy and 12.2% admitted to illicit drug use during pregnancy. Compared to US African American rates for 2003, the women in this study who smoked tobacco had strikingly high rates of neonatal death (1.8% vs. 0.9%), of perinatal death (3.6% vs. 1.2%) and low birth weight (17.9% vs. 13.4%). For women using illicit drugs during pregnancy, low birth weight was 20.4% vs. 13.4% for the US African Americans in 2003. Health providers need to screen pregnant women for tobacco smoking and illicit drug use.