During the COVID-19 pandemic, the odds of pregnancy-related emergency department visits involving cannabis increased 10% and alcohol by 16%, with Medicaid-insured and uninsured patients showing consistently elevated odds across substance types.
Obstetric emergency physicians, public health officials, and policymakers planning for health system responses during societal crises.
What the researchers found
Pandemic period showed increased odds of ED visits involving alcohol (aOR=1.16, 95% CI: 1.05-1.27) and cannabis (aOR=1.10, 95% CI: 1.01-1.20). African American individuals had prepandemic higher odds of cannabis use. Disparities in cannabis use narrowed for Hispanic and Native American individuals relative to White individuals during the pandemic.
Why it matters
The pandemic exacerbated substance use during pregnancy, a period when both mother and fetus are vulnerable. The finding that cannabis-related visits increased suggests pandemic stressors may have driven increased use among pregnant individuals.
The numbers in context
Cannabis ED visits: 10% increase during pandemic (aOR=1.10). Alcohol: 16% increase (aOR=1.16). Medicaid and uninsured: consistently elevated odds for opioid, cannabis, and nicotine use. Cannabis disparities narrowed for Hispanic and Native American vs White.
How the study worked
Difference-in-differences analysis of 2019-2021 Nationwide Emergency Department Sample data examining ED visits among pregnant individuals with documented substance use. Disparities assessed by race/ethnicity and insurance status.
What this study cannot tell us
ED visits represent the most acute cases, not total prenatal substance use. Difference-in-differences cannot fully control for secular trends. Substance documentation in ED records may be inconsistent.
How to read the evidence
National ED database with difference-in-differences methodology provides strong epidemiological evidence, though limited to the most acute presentations.
When this study was published
2025 publication with 2019-2021 data.
The bigger picture
Societal disruptions appear to increase prenatal substance use, particularly among already-vulnerable populations. The narrowing of racial disparities in cannabis use during the pandemic suggests the stressor equally affected groups that previously had lower use rates.
Questions still open
- Did the pandemic-related increase in prenatal cannabis use persist after COVID restrictions eased?
- Would proactive outreach during societal crises reduce prenatal substance use?
Common questions
Why did prenatal substance use increase during the pandemic?
Which populations were most affected?
Read the original research
Socioeconomic Disparities in Perinatal Substance Use Emergency Department Visits Before and During COVID-19.
Journal of women's health (2002), 34(12), 1548-1557
Citation
González-Alvarez, Ana Daniela; Kapukotuwa, Sidath; Hurst, Larry; Owusu-Ansah, Abena Gyawu; Guo, Ying; Vaderlaan, Jennifer; Shen, Jay J. (2025). Socioeconomic Disparities in Perinatal Substance Use Emergency Department Visits Before and During COVID-19.. Journal of women's health (2002), 34(12), 1548-1557. https://doi.org/10.1177/15409996251370887
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