Association of Prepregnancy Substance Use and Substance Use Disorders with Pregnancy Timing and Intention

Abstract

Background: Limited research exists on the association between substance use disorders (SUDs) and dimensions of pregnancy intention. This study sought to examine the independent relationships between prepregnancy substance use and SUDs with pregnancy timing and intentions. Materials and Methods: Secondary analysis of data from three prenatal care sites in Connecticut, Massachusetts, and Michigan, 2016-2017. Associations were estimated using modified Poisson regression with robust error variance to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), controlling for relevant covariates. Results: The total sample size was 1115 women. Respectively, 61.1% and 15.5% of women used any substance in the 30 days prepregnancy or had any SUD in the past 12 months. After adjustment, any prepregnancy substance use was associated with a reduced likelihood of a well-timed (aPR 0.85; 95% CI: 0.77-0.93) and intended (aPR 0.80; 95% CI: 0.72-0.89) pregnancy; similarly, any SUD was associated with a reduced likelihood of a well-timed (aPR 0.66; 95% CI: 0.55-0.80) and intended (aPR 0.79; 95% CI: 0.67-0.93) pregnancy. Conclusions: Women with prepregnancy substance use or SUD have decreased prevalence of well-timed and intended pregnancies. Greater efforts are needed to address substance use and family planning in routine, well-woman, prenatal, and postpartum care.

Keywords: pregnancy intention; pregnancy timing; substance use disorders.

FIG. 1.

Prevalences of prepregnancy substance use and substance use disorders in the past 12 months in participants from three prenatal care sites, 2016–2017 (n = 1115). Any substance use includes either self-report of use in the month before pregnancy or positive urine drug test at the prenatal visit of study enrollment of alcohol, marijuana, prescription drug misuse, and stimulant and/or heroin (includes amphetamines, cocaine, and heroin or opioids).

FIG. 2.

Prevalences of self-reported prepregnancy substance use adjusted with positive urine drug screens in participants from three prenatal care sites, 2016–2017 (n = 1115). *Includes amphetamines, barbiturates, cocaine, and opioids. Opioid use was measured by self-report of misuse of prescription opioids or evidence of opioid use in the urine drug screen.