Substance Use and Pregnancy Intentions: A Complex Relationship

A recent study published in Addiction sheds light on the intricate ways substance use, notably alcohol and cannabis, intersects with women’s intentions regarding pregnancy. The research, which tracked women over time, found that certain patterns of substance use were associated with different pregnancy outcomes, depending on a woman’s desire to avoid pregnancy.

Key Findings on Substance Use and Pregnancy Intentions

The study analyzed data from nearly 2,000 women, assessing their past-month alcohol, cannabis, and other drug use at the outset. Participants were then followed quarterly, with their pregnancy preferences measured using the Desire to avoid Pregnancy scale. The analysis employed mixed-effects linear regression models and Cox proportional hazard models to explore these associations.

Baseline Substance Use Patterns

At the start of the study, a notable portion of participants reported substance use:

Heavy Drinking: 40% (795/1968) of participants reported heavy alcohol consumption. Cannabis Use: 16% (308/1968) reported using cannabis.
Other Drug Use: 3% (53/1968) reported using other drugs.

Heavy Drinking and High Desire to Avoid Pregnancy: Women who reported heavy drinking and had a high desire to avoid pregnancy were more likely to become pregnant. The adjusted hazard ratio (AHR) was 1.51 (95% CI, 1.12-2.04; P < .01), indicating a statistically significant increased risk of pregnancy in this group. Cannabis Use and Low Desire to Avoid Pregnancy: Less than daily cannabis use was associated with pregnancy among women with low Desire to Avoid Pregnancy scores. This group had an AHR of 1.64 (95% CI, 1.13-2.38; P < .01), suggesting that cannabis use in this context was linked to a higher likelihood of conception. Heavy Drinking and Mid-Range Desire to Avoid Pregnancy: Interestingly, among women with mid-range Desire to Avoid Pregnancy scores, heavy drinking was inversely associated with pregnancy. The AHR was 0.62 (95% CI, 0.42-0.90; P = .01), implying that heavy drinking in this group was linked to a lower likelihood of becoming pregnant.

understanding the Context: “In Practice”

The authors of the study noted the societal context surrounding substance use and pregnancy. “Alcohol use among nonpregnant women of reproductive age is common, legal, and accepted in the United States,” they stated. “Most people reduce alcohol use when they become pregnant, but fewer modify drinking before becoming pregnant even if they intend to become pregnant.” They highlighted the difficulty in sustaining behavior changes in advance of a potential pregnancy, especially when pregnancies are not explicitly planned.

In contrast,the authors pointed out the historical stigma and punitive measures associated with cannabis and other drug use,particularly during pregnancy. This is partly attributed to the legal status of these substances and the broader “war on drugs.”

study Limitations and Funding

The researchers acknowledged several limitations in their study. Substance use was only measured at baseline, preventing an analysis of how use might fluctuate over time or at the point of conception. There was also a possibility of underreporting of alcohol and drug use, although the nonpregnant status at baseline was thought to reduce differential reporting bias related to pregnancy preferences or status. Moreover, the findings may not be generalizable beyond women seeking primary and reproductive healthcare in safety net clinics in the southwestern United States.

The study received funding from the Eunice kennedy Shriver National Institute of Child Health and Human Development, the National institute on alcohol Abuse and Alcoholism, and the Susan Thompson Buffett Foundation. these funding entities reportedly had no involvement in the study’s design, data collection, analysis, interpretation, report writing, or publication submission decisions.