Archives of Women's Mental Health

, Volume 18, Issue 3, pp 523–537 | Cite as

Predictors of alcohol and tobacco use prior to and during pregnancy in the US: the role of maternal stressors

  • Whitney P. Witt
  • Kara C. Mandell
  • Lauren E. Wisk
  • Erika R. Cheng
  • Debanjana Chatterjee
  • Fathima Wakeel
  • Hyojun Park
  • Dakota Zarak
Original Article


The purpose of the study was to understand the association between stressful life events prior to conception (PSLEs) and women’s alcohol and tobacco use prior to and during pregnancy, and the continuation of such use through pregnancy. Data were from the Early Childhood Longitudinal Study-Birth Cohort (n = 9,350). Data were collected in 2001. Exposure to PSLEs was defined by indications of death of a parent, spouse, or previous live born child, divorce or marital separation, or fertility problems prior to conception. Survey data determined alcohol and tobacco usage during the 3 months prior to and in the final 3 months of pregnancy. Weighted regressions estimated the effect of PSLEs on alcohol and tobacco use at each time point and on the continuation of use, adjusting for confounders. Experiencing any PSLE increased the odds of tobacco use prior to (adjusted odds ratio [AOR] 1.52, 95 % confidence interval (CI) 1.23–1.87) and during pregnancy (AOR 1.57, 95 % CI 1.19–2.07). Women exposed to PSLEs smoked nearly five additional packs of cigarettes in the 3 months prior to pregnancy (97 cigarettes, p = 0.011) and consumed 0.31 additional alcoholic drinks during the last 3 months of pregnancy than unexposed women. PSLEs are associated with tobacco use before pregnancy and alcohol and tobacco use during pregnancy. Alcohol and tobacco screening and cessation services should be implemented prior to and during pregnancy, especially for women who have experienced PSLEs.


Pregnancy Preconception Life course Stress Substance use 



This project was made possible by a Health Resources and Services Administrative (HRSA) (WPW, LEW, and DC R40MC23625; PI WP Witt) grant. Additional funding for this research was provided by grants from the Agency for Healthcare Research and Quality (KM and LEW T32 HS00083; PI M. Smith), the Health Disparities Research Scholars Program (FW T32 HD049302; PI G. Sarto), the 2012–2013 Herman I. Shapiro Distinguished Graduate Fellowship (LEW), and the Science and Medicine Graduate Research Scholars Fellowship from the University of Wisconsin in the College of Agriculture and Life Sciences and the School of Medicine and Public Health (ERC). ERC was additionally supported by a National Research Service Award institutional training grant (T32-HD075727) and LEW was supported by an AHRQ training grant (5T32HS000063-21) and the Thomas O. Pyle Fellowship.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Whitney P. Witt
    • 1
  • Kara C. Mandell
    • 2
  • Lauren E. Wisk
    • 3
  • Erika R. Cheng
    • 4
  • Debanjana Chatterjee
    • 5
  • Fathima Wakeel
    • 6
  • Hyojun Park
    • 2
  • Dakota Zarak
    • 2
  1. 1.Maternal and Child Health ResearchTruven Health AnalyticsDurhamUSA
  2. 2.Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Center for Child Health Care Studies, Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonUSA
  4. 4.Division of General Academic PediatricsHarvard Medical School and Massachusetts General Hospital for ChildrenBostonUSA
  5. 5.Division of General Pediatrics and Adolescent HealthUniversity of Minnesota-Twin Cities Medical SchoolMinneapolisUSA
  6. 6.Public Health ProgramsFerris State University College of Health ProfessionsBig RapidsUSA

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