Exploring the Patterns of Substance Use Behaviors in a Nationally Representative Sample of Pregnant Women: a Latent Class Approach

The aim of this study is to estimate heterogeneous patterns of multiple past-month substance use behaviors and examine associated medico-socio-demographic factors among a nationally representative sample of pregnant women. A total of 2215 currently pregnant women were identified from 2016, 2017, and 2018 National Survey of Drug Use and Health study. Latent class analysis was conducted to characterize the heterogeneous patterns of past-month substance use behaviors based on the use of tobacco, alcohol, marijuana, cocaine/crack, and the misuse of opioid/prescription pain relievers and methamphetamine/prescription stimulants. Risk profiles for prenatal substance use were compared between nonusers and latent subclasses using regression analyses and propensity score methods. Among the 22.3% of pregnant women who reported past-month use of at least one substance, the following five latent classes were defined: Alcohol Only Users (34.56%), Marijuana Only Users (9.64%), Tobacco Only Users (45.84%), Tobacco/Opioid Dual-Users (4.53%), and Polysubstance Users (5.43%). Of these subclasses, Alcohol Only Users and Marijuana Only Users had a risk profile for prenatal substance use similar to that of nonusers, indicating possible challenges in identifying exclusively alcohol-using or marijuana-using pregnant women. Considerable heterogeneity in substance use behaviors exists among pregnant women in the USA. Public health intervention strategies should recognize these diverse patterns of prenatal substance use, as well as the psychological and legal challenges these women face, to improve the health of pregnant women and their infants.