One in five pregnant substance users reported using more than one substance during pregnancy | Research

The takeaway

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.

Prenatal care providers, public health officials, substance use screening researchers

82% screened for cannabis vs. 95% for alcohol and tobacco

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Nationally representative surveillance data from 25 US jurisdictions with weighted estimates, though self-reported substance use likely underestimates prevalence.

When this study was published

Published 2023 using 2019 data

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.

Questions still open

Would universal cannabis screening during pregnancy improve detection and intervention rates? How does polysubstance use affect neonatal outcomes compared to single-substance exposure?

Common 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.

Read the original research

Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective.

Drug and alcohol dependence, 247, 109872

View on PubMed ↗Publisher’s paper ↗

Citation

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