Alcohol and Tobacco Use Among Pregnant Women in the United States: Evidence from a National Sample

Background/Purpose:Alcohol and tobacco use during pregnancy are considered to be the strongest and most preventable risk factors of adverse neonatal health outcomes. And yet, it is estimated that 10-15% of American women use these substances during the critical period of fetal gestation. Although much has been learned regarding alcohol and tobacco use during pregnancy, few population-based studies of this phenomenon have been conducted. The present study addresses this important gap by examining the prevalence and psychosocial correlates (i.e., mental health, criminal justice involvement, and pregnancy-related factors) of alcohol and tobacco use among pregnant women using a nationally representative sample. Given the potential differences in alcohol and tobacco use between adolescent and adult women, analyses were conducted separately for adolescents aged 12-17 and adults aged 18-44.

Method: Data were derived from a population-based study (National Survey on Drug Use and Health) of adolescent (ages 12-17; n = 80,498) and adult women (ages 18-44; n = 152,043) in the United States between 2005 and 2014. At the time of interview, 529 adolescent and 7,911 adult respondents reported being pregnant. Measures of alcohol and tobacco use were based on past-month self-reports (no = 0, yes = 1). Additionally, we examined past-12 month major depressive episode (based on DSM criteria), past-12 month criminal justice involvement, and pregnancy trimester. Demographic variables included age, race/ethnicity, employment, and household income for both age groups and marital status and educational level for the adult group only.

Results: Our study yielded a number of salient results. First, we identified disconcerting levels of past-month alcohol (adolescents = 11.5%, adults = 8.7%) and tobacco (adolescents = 23.0%, adults = 14.9%) among pregnant women in the United States. Second, we found that pregnant adolescents were less likely to report past-30day use of alcohol (AOR = .521, 95% CI = .357 - .760), but far more likely to report use of tobacco (AOR = 2.203, 95% CI = 1.528 – 3.176) compared to their non-pregnant counterparts. On the other hand, adults were less likely to report alcohol (AOR = .061, 95% CI = .053 - .070) and tobacco (AOR = .470, 95% CI = .428 - .516) use during pregnancy. Third, we found that both adolescents and adults who used alcohol and tobacco during pregnancy were substantially more likely to report recent criminal justice involvement. Finally, we found that adult women reporting tobacco use during pregnancy were substantially more likely than non-smokers to have met criteria for major depressive disorder (AOR = 2.39, 95% CI = 1.73-3.28).

Conclusions and Implications: Given the deleterious consequences of alcohol and tobacco use during pregnancy, increased attention to reducing the use of these substances during pregnancy is critical. Our findings suggest that tobacco use appears to be especially problematic among adult women and is strongly linked with depression and criminal justice involvement. Our study testifies to the need to pay attention to not only the health-risk behaviors among pregnant women, but also their mental health needs and factors that lead to contact with the criminal justice system.