One in five pregnant substance users reported using more than one substance during pregnancy
Among US pregnant women who used any substance, nearly 20% reported polysubstance use, with cannabis at 4.3% prevalence and screening rates for cannabis lagging behind alcohol and tobacco.
Quick Facts
What This Study Found
In a nationally representative US sample, cigarettes (8.1%), alcohol (7.4%), and cannabis (4.3%) were the most commonly reported substances during pregnancy. Among those using any substance, nearly one in five used at least one additional substance. While prenatal screening for alcohol and cigarettes reached ~95%, only 82.1% were screened for cannabis or illicit substances.
Key Numbers
Cigarettes: 8.1% (95% CI 7.6-8.7%); alcohol: 7.4% (95% CI 6.7-8.1%); cannabis: 4.3% (95% CI 3.9-4.7%); illicit drugs: 0.5% (95% CI 0.4-0.7%); cannabis screening: 82.1%; alcohol/tobacco screening: ~95%
How They Did This
Analysis of 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 25 US jurisdictions. Weighted prevalence estimates calculated for substance use, polysubstance use, and screening rates during pregnancy.
Why This Research Matters
The gap between high screening rates for alcohol/tobacco and lower rates for cannabis suggests clinicians may be missing a meaningful proportion of prenatal substance exposure, particularly given rising cannabis legalization.
The Bigger Picture
As cannabis use during pregnancy increases alongside legalization, the 13-percentage-point gap in screening rates compared to alcohol and tobacco represents a growing blind spot in prenatal care.
What This Study Doesn't Tell Us
Self-reported substance use likely underestimates true prevalence. PRAMS data from 25 jurisdictions may not represent all US states. Different assessment windows for different substances complicate direct comparisons.
Questions This Raises
- ?Would universal cannabis screening during pregnancy improve detection and intervention rates?
- ?How does polysubstance use affect neonatal outcomes compared to single-substance exposure?
Trust & Context
- Key Stat:
- 82% screened for cannabis vs. 95% for alcohol and tobacco
- Evidence Grade:
- Nationally representative surveillance data from 25 US jurisdictions with weighted estimates, though self-reported substance use likely underestimates prevalence.
- Study Age:
- Published 2023 using 2019 data
- Original Title:
- Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective.
- Published In:
- Drug and alcohol dependence, 247, 109872 (2023)
- Authors:
- Board, Amy(2), D'Angelo, Denise V, Salvesen von Essen, Beatriz, Denny, Clark H, Miele, Kathryn, Dunkley, Janae, Baillieu, Robert, Kim, Shin Y
- Database ID:
- RTHC-04421
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
How common is cannabis use during pregnancy in the US?
According to this nationally representative survey, 4.3% of pregnant women reported cannabis use, making it the third most common substance after cigarettes (8.1%) and alcohol (7.4%).
Are pregnant women screened for cannabis use?
About 82% of pregnant women reported being screened for cannabis or illicit substances, compared to approximately 95% being screened for alcohol and cigarettes.
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Cite This Study
https://rethinkthc.com/research/RTHC-04421APA
Board, Amy; D'Angelo, Denise V; Salvesen von Essen, Beatriz; Denny, Clark H; Miele, Kathryn; Dunkley, Janae; Baillieu, Robert; Kim, Shin Y. (2023). Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective.. Drug and alcohol dependence, 247, 109872. https://doi.org/10.1016/j.drugalcdep.2023.109872
MLA
Board, Amy, et al. "Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective.." Drug and alcohol dependence, 2023. https://doi.org/10.1016/j.drugalcdep.2023.109872
RethinkTHC
RethinkTHC Research Database. "Polysubstance use during pregnancy: The importance of screen..." RTHC-04421. Retrieved from https://rethinkthc.com/research/board-2023-polysubstance-use-during-pregnancy
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.