Seven Distinct Patterns of Substance Use Found Among Pregnant Women in the U.S.

Seven latent classes of maternal substance use were identified: minimal users (70.7%), pre-pregnancy cigarette users (10.5%), persistent cigarette users (6.8%), pre-pregnancy cannabis users (5.5%), broad polysubstance users (3.6%), opioid-only users (1.9%), and persistent cigarette/opioid co-users (1.0%). Groups differed significantly by age, income, race/ethnicity, and pre-pregnancy alcohol use.

Analysis of 15,429 PRAMS postpartum survey participants (2016-2018) from seven U.S. states, representing 384,918 live singleton births. Latent class analysis identified patterns of substance use before and during pregnancy. State-level survey weights applied.

Identifying distinct substance use patterns rather than treating all prenatal substance exposure as equivalent can help target interventions more effectively and understand different risk profiles for perinatal outcomes.

The pre-pregnancy cannabis user class (5.5%) is notable because these women largely stopped cannabis use during pregnancy, distinguishing them from persistent substance users. This suggests cannabis-using women may be responsive to pregnancy-motivated cessation.

Self-reported substance use likely underestimates prevalence. Only seven states included, limiting national representativeness. Cannot determine substance quantities or frequency within classes. 73.3% non-Hispanic White limits racial/ethnic diversity.