A brief psychosocial screener used at the first prenatal visit found that being unpartnered tripled the odds of prenatal cannabis use, while past-year substance use predicted use of all substances during pregnancy.
Prenatal care providers, public health researchers, anyone interested in prenatal substance use screening
3.37x higher odds of prenatal cannabis use for unpartnered patients
What the researchers found
Among 1,842 pregnant patients screened with the PROMOTE instrument, 2.7% used cannabis prenatally. Being unpartnered was uniquely associated with prenatal cannabis use (AOR=3.37), while past-year tobacco and illegal drug use predicted all three substances (tobacco, cannabis, alcohol).
Why it matters
Identifying prenatal substance use early allows for earlier intervention. This study shows that a brief, routine screening tool can flag specific psychosocial risk factors unique to each substance.
The numbers in context
10.2% (188) used at least one substance prenatally. Tobacco: 7.2%, cannabis: 2.7%, alcohol: 2.4%. Being unpartnered: AOR 3.37 for cannabis. Low education: AOR 2.74 for tobacco. Major life events: AOR 3.25 for alcohol.
How the study worked
Retrospective chart review of 1,842 patients who completed the PROMOTE psychosocial screening instrument at their first prenatal visit to New York State outpatient clinics from June 2019 to November 2020. Substance use was identified from medical records including clinical notes, self-report, and urine toxicology.
What this study cannot tell us
Single health system in New York. Retrospective design may miss unreported use. Small number of cannabis users (n=50) limits statistical power. Study period overlapped with COVID-19 pandemic.
How to read the evidence
Moderate: structured screening data from a real clinical setting, but small cannabis user sample and single health system
When this study was published
Published in 2025 using 2019-2020 data
The bigger picture
Universal psychosocial screening at prenatal visits could improve identification of at-risk individuals. Different substances have different risk profiles, suggesting targeted rather than one-size-fits-all approaches.
Questions still open
- Would the PROMOTE screener perform similarly in other settings? How do these risk factors interact with each other?
Common questions
What is the PROMOTE screener?
Why was being unpartnered specifically linked to cannabis?
Read the original research
Using the PROMOTE Screener to Identify Psychosocial Risk Factors for Prenatal Substance Use.
Journal of addiction medicine, 19(2), 216-222
Citation
Azeem, Ayesha; Lobel, Marci; Heiselman, Cassandra; Preis, Heidi. (2025). Using the PROMOTE Screener to Identify Psychosocial Risk Factors for Prenatal Substance Use.. Journal of addiction medicine, 19(2), 216-222. https://doi.org/10.1097/ADM.0000000000001427
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