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Systematic Review: Polysubstance Prevalence Estimates Reported during Pregnancy, US, 2009–2020



The objective of this systematic review is to describe polysubstance studies and their prevalence estimates among pregnant people in the US.


This review was not subject to protocol preparation or registration with the International Prospective Register of Systematic Reviews (PROSPERO) because outcome data were not reported. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist was followed. Four scientific literature databases were used to identify articles published from January 1, 2009 to June 3, 2020 reporting prenatal exposure to two or more substances in the US. A standardized process of title and abstract screening followed by a two-phase full-text review was used to assess study eligibility.


A total of 119 studies were included: 7 case–control studies, 7 clinical trials, 76 cohort studies, and 29 cross-sectional studies. Studies varied with respect to study design, time period, region, sampling and participant selection, substances assessed, and method of exposure ascertainment. Commonly reported polysubstance prevalence estimates among studies of pregnant people included combinations with alcohol, marijuana, and/or tobacco/nicotine. The range of prevalence estimates was wide (alcohol 1–99%; marijuana 3–95%; tobacco/nicotine 2–95%).


Polysubstance use during pregnancy is common, especially with alcohol, marijuana, and/or tobacco/nicotine. Future research to assess polysubstance use during pregnancy could help better describe patterns and ultimately help mitigate its effects on maternal and infant health outcomes.

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The authors acknowledge Joanna Taliano from the Centers for Disease Control and Prevention (CDC) library for assistance with the systematic literature search, Gitangali B. Baroi from the CDC for assistance with the initial title and abstract screening phase of the review, and Lucas K. Gosdin from the CDC for assistance with the development of Fig. 2. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


This project was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the Centers for Disease Control and Prevention.

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ELT, LJE, YP, and CHD led the evidence acquisition. ELT led the synthesis of evidence, data analysis, and writing of the manuscript. LJE, CHD, and SYK provided conceptualization oversight. LJE, YP, CHD, and SYK provided guidance, subject matter input, and manuscript editing.

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Correspondence to Emmy L. Tran.

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See Tables 4, 5 and 6.

Table 4 Search strategy for prenatal polysubstance use among databases from conception to June 3, 2020
Table 5 Number of prenatal polysubstance use-related articles reporting information on regiona, by base substance category, 2009–2020
Table 6 Number of prenatal polysubstance use-related articles describing the exposure ascertainment method, by base substance categorya 2009–2020

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Tran, E.L., England, L.J., Park, Y. et al. Systematic Review: Polysubstance Prevalence Estimates Reported during Pregnancy, US, 2009–2020. Matern Child Health J 27, 426–458 (2023).

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