Depression and prenatal substance use: Evidence of the need for coordinated screening and care

Background: This study explores depression as a predictor of prenatal substance use. Methods: The 2008 National Survey on Drug Use and Health is used, with a sample size of 973 pregnant women. Dependent variables assess past-month use of tobacco, alcohol, binge drinking, and illicit drugs. The explanatory variable measures whether the woman experienced past-year depression. Logistic regressions modeled the effect of depression on substance use, controlling for age, race/ethnicity, poverty level and trimester. Results: Depression was associated with tobacco (OR: 2.21, p<0.01), and with illicit drug use, both including (OR: 2.80, p<0.01) and excluding marijuana (OR: 3.36, p<0.05). Depressed teens (OR: 13.78, p<0.001) and young adults (OR: 5.76, p<0.01) were more likely to use illicit drugs than were those over 25. Depressed teens were more likely to use illicit drugs excluding marijuana (OR: 8.19, p<0.05) than were those over 25. African-Americans (OR: 0.33, p<0.001) and Latinas with depression (OR: 0.12, p<0.001) had reduced likelihood of smoking, and Latinas had lower odds of illicit drug use (OR: 0.30, p<0.05) than did depressed whites. Those who were poor and near poor (OR: 3.28-4.40, p<0.001) were more likely to smoke, and the near poor had greater odds of binge drinking (OR: 2.63, p<0.05). Poverty had no relationship to prenatal use of any other substance. Conclusion: This study confirms that depression is a predictor of substance use in pregnancy, in particular tobacco and illicit drug use. Greater emphasis must be placed on screening and intervention for both depression and substance use among pregnant women.