Skip to main content

Substance Use in Pregnancy Among Vulnerable Women Seeking Addiction and Parenting Support


Substance use during pregnancy is associated with obstetrical and fetal complications. Though use of some substances is discontinued during pregnancy, use of others persists. Our goal was to characterize substance-specific use and patterns of use throughout pregnancy among vulnerable women who attended an early intervention program for women with substance use issues. Through retrospective analyses of client records (1995–2016; N = 470), results indicated that the greatest number of women continued use of tobacco and cannabis for the duration of pregnancy (n = 232; 84.4% and n = 102; 60.0%, respectively), while the proportion of women continuing opioid use was relatively high (n = 33; 57.9%). Relapse rates were high for women who initially attempted to discontinue use of cocaine, crack cocaine, and heroin. Results can inform intervention and treatment by indicating which substances are more difficult to discontinue, as well as substances associated with high rates of relapse.

This is a preview of subscription content, access via your institution.

Fig. 1


  • Aghamohammadi, A., & Zafari, M. (2016). Crack abuse during pregnancy: maternal, fetal and neonatal complication. The Journal of Maternal-Fetal & Neonatal Medicine, 29(5), 795–797.

    Article  Google Scholar 

  • American College of Obstetricians and Gynecologists. (2016). ACOG statement on opioid use during pregnancy. Retrieved from

  • Andrews, N. C. Z., Motz, M., Pepler, D. J., Jeong, J. J., & Khoury, J. (2018). Engaging mothers with substance use issues and their children in early intervention: understanding use of service and outcomes. Child Abuse and Neglect, 83, 10–20.

    Article  PubMed  Google Scholar 

  • Avner, M., & Koren, G. (2004). Breaking the cycle - a unique model for FASD research. Journal of FAS International, 1.

  • Azuma, S. D., & Chasnoff, I. J. (1993). Outcome of children prenatally exposed to cocaine and other drugs: a path analysis of three-year data. Pediatrics, 92(3), 396–402.

    PubMed  CAS  Google Scholar 

  • Bailey, B. A., McCook, J. G., Hodge, A., & McGrady, L. (2012). Infant birth outcomes among substance using women: why quitting smoking during pregnancy is just as important as quitting illicit drug use. Maternal and Child Health Journal, 16(2), 414–422.

    Article  PubMed  Google Scholar 

  • Bauer, C. R., Shankaran, S., Bada, H. S., Lester, B., Wright, L. L., Krause-Steinrauf, H., Smeriglio, V. L., Finnegan, L. P., Maza, P. L., & Verter, J. (2002). The maternal lifestyle study: drug exposure during pregnancy and short-term maternal outcomes. American Journal of Obstetrics and Gynecology, 186(3), 487–495.

    Article  PubMed  Google Scholar 

  • Bottorff, J. L., Kalaw, C., Johnson, J. L., Stewart, M., & Greaves, L. (2005). Tobacco use in intimate spaces: issues in the study of couple dynamics. Qualitative Health Research, 15(4), 564–577.

    Article  PubMed  Google Scholar 

  • Brands, B., Blake, J., & Marsh, D. (2002). Changing patient characteristics with increased methadone maintenance availability. Drug and Alcohol Dependence, 66, 11–20.

    Article  PubMed  Google Scholar 

  • Carson, G. (2010). Alcohol use and pregnancy consensus clinical guidelines. Journal of Obstetrics and Gynaecology, 32(8), 1–2.

    Google Scholar 

  • Castles, A., Adams, E. K., Melvin, C. L., Kelsch, C., & Boulton, M. L. (1999). Effects of smoking during pregnancy: five meta-analyses. American Journal of Preventive Medicine, 16, 208–215.

    Article  PubMed  CAS  Google Scholar 

  • Daley, M., Argeriou, M., & McCarty, D. (1998). Substance abuse treatment for pregnant women: a window of opportunity? Addictive Behaviors, 23(2), 239–249.

    Article  PubMed  CAS  Google Scholar 

  • Daley, M., Argeriou, M., McCarty, D., Callahan, J. J., Shepard, D. S., & Williams, C. N. (2000). The costs of crime and the benefits of substance abuse treatment for pregnant women. Journal of Substance Abuse Treatment, 19(4), 445–458.

    Article  PubMed  CAS  Google Scholar 

  • De Santis, M., De Luca, C., Mappa, I., Quattrocchi, T., Angelo, L., & Cesari, E. (2011). Smoke, alcohol consumption and illicit drug use in an Italian population of pregnant women. European Journal of Obstetrics Gynecology and Reproductive Biology, 159(1), 106–110.

    Article  Google Scholar 

  • Della Grotta, S., LaGasse, L. L., Arria, A. M., Derauf, C., Grant, P., Smith, L. M., Shah, R., Huestis, M., Liu, J., & Lester, B. M. (2010). Patterns of methamphetamine use during pregnancy: results from the infant development, environment, and lifestyle (IDEAL) study. Maternal and Child Health Journal, 14(4), 519–527.

    Article  PubMed  Google Scholar 

  • Ebrahim, S. H., & Gfroerer, J. (2003). Pregnancy-related substance use in the United States during 1996-1998. Obstetrics and Gynecology, 101(2), 374–379.

    Article  PubMed  Google Scholar 

  • Edelin, K. C., Gurganious, L., Golar, K., Oellerich, D., Kyei-Aboagye, K., & Hamid, A. (1988). Methadone maintenance in pregnancy: consequences to care and outcome. Obstetrics and Gynecology, 71(3), 399–404.

    PubMed  CAS  Google Scholar 

  • Eguiagaray, I., Scholz, B., & Giorgi, C. (2016). Sympathy, shame, and few solutions: news media portrayals of fetal alcohol spectrum disorders. Midwifery, 40, 49–54.

    Article  PubMed  Google Scholar 

  • Espinet, S. D., Motz, M., Jeong, J. J., Jenkins, J. M., & Pepler, D. (2016). Breaking the cycle’ of maternal substance use through relationships: a comparison of integrated approaches. Addiction Research & Theory, 24(5), 375–388.

    Article  Google Scholar 

  • Finnegan, L. (2013). Licit and illicit drug use during pregnancy: maternal, neonatal and early childhood consequences. (Canadian Centre on Substance Abuse, Ed.). Ottawa, ON.

  • Flemming, K., Graham, H., Heirs, M., Fox, D., & Sowden, A. (2013). Smoking in pregnancy: a systematic review of qualitative research of women who commence pregnancy as smokers. Journal of Advanced Nursing, 69(5), 1023–1036.

    Article  PubMed  Google Scholar 

  • Harrison, P. A., & Sidebottom, A. C. (2009). Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation. Maternal and Child Health Journal, 13(3), 386–394.

    Article  PubMed  Google Scholar 

  • Havens, J. R., Simmons, L. A., Shannon, L. M., & Hansen, W. F. (2009). Factors associated with substance use during pregnancy: results from a national sample. Drug and Alcohol Dependence, 99, 89–95.

    Article  PubMed  Google Scholar 

  • Hayatbakhsh, M. R., Kingsbury, A. M., Flenady, V., Gilshenan, K. S., Hutchinson, D. M., & Najman, J. M. (2011). Illicit drug use before and during pregnancy at a tertiary maternity hospital 2000-2006. Drug and Alcohol Review, 30(2), 181–187.

    Article  PubMed  Google Scholar 

  • Ko, J. Y., Farr, S. L., Tong, V. T., Creanga, A. A., & Callaghan, W. M. (2015). Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age. The American Journal of Obstetrics & Gynecology, 213, 201.e1–201.e10.

  • Kost, K. (2015). Unintended pregnancy rates at the state level: estimates for 2010 and trends since 2002. (G. Institute, Ed.). New York, NY.

  • Latuskie, K. A., Andrews, N. C. Z., Motz, M., Leibson, T., Austin, Z., Ito, S., & Pepler, D. J. (2018). Reasons for substance use continuation and discontinuation during pregnancy: a qualitative study. Women and Birth.

  • Lind, J. N., Petersen, E. E., Lederer, P. A., Phillips-Bell, G. S., Perrine, C. G., Li, R., & Anjohrin, S. (2015). Infant and maternal characteristics in neonatal abstinence syndrome - selected hospitals in Florida, 2010-2011. Morbidity and Mortality Weekly Report, 64, 213–216.

    PubMed  PubMed Central  Google Scholar 

  • Moore, D. G., Turner, J. D., Parrott, A. C., Goodwin, J. E., Fulton, S. E., Min, M. O., Fox, H. C., Braddick, F. M. B., Axelsson, E. L., Lynch, S., Ribeiro, H., Frostick, C. J., & Singer, L. T. (2010). During pregnancy, recreational drug-using women stop taking ecstasy (3,4-methylenedioxy-N-methylamphetamine) and reduce alcohol consumption, but continue to smoke tobacco and cannabis: initial findings from the development and infancy study. Journal of Psychopharmacology, 24(9), 1403–1410.

    Article  PubMed  Google Scholar 

  • Motz, M., Espinet, S. D., Jeong, J. J., Major, D., Racine, N., Chamberlin, J., & Pepler, D. J. (2011). The role of the mother-child relationship in developmental outcomes of infants and young children with and without prenatal alcohol exposure. Journal of Population Therapeutics and Clinical Pharmacology, 18(3), 544–563.

    Google Scholar 

  • Motz, M., Leslie, M., Pepler, D., Moore, T., & Freeman, P. (2006). Breaking the cycle: measures of progress 1995-2005. Journal of FAS International, 4, 1–134.

    Google Scholar 

  • Paone, D., & Alperen, J. (1998). Pregnancy policing: policy of harm. International Journal of Drug Policy, 9(2), 101–108.

    Article  Google Scholar 

  • Pinto, S. M., Dodd, S., Walkinshaw, S. A., Siney, C., Kakkar, P., & Mousa, H. A. (2010). Substance abuse during pregnancy: effect on pregnancy outcomes. European Journal of Obstetrics Gynecology and Reproductive Biology, 150(2), 137–141.

    Article  CAS  Google Scholar 

  • Public Health Agency of Canada. (2009). What mothers say: The Canadian maternity experiences survey. Ottawa, ON.

  • Racine, N., Motz, M., Leslie, M., & Pepler, D. J. (2009). Breaking the cycle pregnancy outreach program. Journal of the Association for Research on Mothering, 11, 279–290.

    Google Scholar 

  • Singer, L. T., Moore, D. G., Fulton, S., Goodwin, J., Turner, J. J. D., Min, M. O., & Parrott, A. C. (2012). Neurobehavioral outcomes of infants exposed to MDMA (ecstasy) and other recreational drugs during pregnancy. Neurotoxicology and Teratology, 34(3), 303–310.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Toro, R., Leonard, G., Lerner, J. V., Lerner, R. M., Perron, M., Pike, G. B., Richer, L., Veillette, S., Pausova, Z., & Paus, T. (2008). Prenatal exposure to maternal cigarette smoking and the adolescent cerebral cortex. Neuropsychopharmacology, 33, 1019–1027.

    Article  PubMed  CAS  Google Scholar 

  • Willford, J. A., Leech, S. L., & Day, N. L. (2006). Moderate prenatal alcohol exposure and cognitive status of children at age 10. Alcoholism: Clinical and Experimental Research, 30(6), 1051–1059.

    Article  Google Scholar 

  • Wong, S., Ordean, A., & Kahan, M. (2011). Substance use in pregnancy. International Journal of Gynecology & Obstetrics, 114(2), 190–202.

    Article  Google Scholar 

Download references


The authors would like to thank Prateek Lala for his very helpful revisions and suggestions early on in the production of this work.


This work was supported by the Division of Clinical Pharmacology and Toxicology, the Hospital for Sick Children as well as Mothercraft, Early Intervention Department.

Author information

Authors and Affiliations


Corresponding authors

Correspondence to Mary Motz or Shinya Ito.

Ethics declarations

Ethics approval was obtained from the research ethics board at the Hospital for Sick Children, Toronto, Canada.

Conflicts of Interest

The authors declare that they have no potential conflicts of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Latuskie, K.A., Leibson, T., Andrews, N.C.Z. et al. Substance Use in Pregnancy Among Vulnerable Women Seeking Addiction and Parenting Support. Int J Ment Health Addiction 17, 137–150 (2019).

Download citation

  • Published:

  • Issue Date:

  • DOI: