TOPLINE:
Heavy drinking increases pregnancy risk by 51% among those most wanting to avoid conception. Cannabis use shows similar elevated desire to avoid pregnancy but does not significantly impact pregnancy outcomes.
METHODOLOGY:
- Researchers conducted a longitudinal cohort study involving 2015 individuals aged 15-34 years from 23 primary and reproductive healthcare facilities across five southwestern US states during 2019-2022.
- Participants completed electronic surveys over 13.5 months, reporting past-month alcohol, cannabis, and other drug use at baseline, with quarterly assessments of pregnancy preferences using the Desire to Avoid Pregnancy scale.
- Analysis included adjusted mixed effects linear regression models to assess associations between baseline substance use and quarterly Desire to Avoid Pregnancy scores, and Cox proportional hazard models to investigate differential pregnancy preference attainment.
TAKEAWAY:
- At baseline, 40% (795/1968) of participants reported heavy drinking, 16% (308/1968) reported cannabis use, and 3% (53/1968) reported other drug use.
- Heavy drinking was positively associated with pregnancy among those with high Desire to Avoid Pregnancy scores (adjusted hazard ratio [AHR], 1.51; 95% CI, 1.12-2.04; P < .01).
- Less than daily cannabis use vs no use was associated with pregnancy among those with low Desire to Avoid Pregnancy scores (AHR, 1.64; 95% CI, 1.13-2.38; P < .01).
- Among participants with mid-range Desire to Avoid Pregnancy scores, heavy drinking was inversely associated with pregnancy (AHR, 0.62; 95% CI, 0.42-0.90; P = .01).
IN PRACTICE:
“Alcohol use among nonpregnant women of reproductive age is common, legal, and accepted in the United States. Most people reduce alcohol use when they become pregnant, but fewer modify drinking before becoming pregnant even if they intend to become pregnant. It can be difficult to implement and sustain behavior
changes in advance of a potential pregnancy, particularly given that many pregnancies are not explicitly planned. In contrast, cannabis and other drug use, especially during pregnancy, have historically been more stigmatized and punished through the criminal justice and child welfare systems, in part because of the legal status of the substances and the war on drugs in the United States,” the authors of the study wrote.
SOURCE:
The study was led by Sarah Raifman, Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health, University of California, San Francisco, School of Medicine in Oakland, California. It was published online in Addiction.
LIMITATIONS:
According to the authors, substance use was only measured at baseline, preventing analysis of fluctuations over time or substance use at conception. Additionally, potential underreporting of alcohol and drug use may have occurred, though the nonpregnant status at baseline reduced differential reporting bias by pregnancy preferences or status. The results may not be generalizable beyond women seeking primary and reproductive healthcare in safety net clinics in the southwestern United States.
DISCLOSURES:
This 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. The funding entities had no role in the study design, data collection, analysis, interpretation, report writing, or publication submission decisions.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.