Location Shapes Maternal Substance Use Patterns

TOPLINE:

Between 2015 and 2019, rural pregnant women were more likely to use tobacco but less likely to consume alcohol than their urban counterparts, highlighting the need for targeted interventions to reduce perinatal tobacco use in rural areas and alcohol use in urban areas.

METHODOLOGY:

• Researchers analyzed cross-sectional data from the National Survey on Drug Use and Health (NSDUH) between 2015 and 2019 to explore disparities in perinatal substance use between rural and urban populations.
• They included 3444 pregnant women aged ≥ 18 years, of which 1463 lived in large urban counties, 1255 lived in small urban counties, and 726 in rural counties.
• Tobacco use, alcohol use, binge drinking, illicit drug use, and marijuana use were recorded if participants reported any of these on at least one occasion in the past month; binge drinking was defined as having four or more drinks on a single occasion within the last 30 days.
• Due to small sample sizes for specific illicit drugs, this study included a variable for illicit drug use, encompassing marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, and the misuse of prescription stimulants, tranquilizers, sedatives, and pain relievers, while those who reported using only marijuana in the past month were identified accordingly.

TAKEAWAY:

• Overall, tobacco use during pregnancy was the most common (12.5%), followed by alcohol use at 9.5%, illicit drug use at 6.1%, only marijuana use at 4.6%, and binge drinking at 4.3%.
• Rural pregnant participants reported higher tobacco use than those in small and large urban areas (24.7% vs 15.2% and 8.2% respectively; P < .0001).
• After adjusting for sociodemographic and health care needs, rural residents showed greater odds of tobacco use (adjusted odds ratio [aOR], 2.32; 95% CI, 1.66-3.25) but lower odds of alcohol use (aOR, 0.58; 95% CI, 0.34-0.98) than residents of large urban areas; no significant rural-urban differences were found in binge drinking, illicit drug use, or marijuana use.
• Participants in their first trimester showed greater odds of substance use than those in their third trimester, including tobacco use (aOR, 1.97; 95% CI, 1.38-2.80) and alcohol use (aOR, 5.52; 95% CI, 3.43-8.89).

IN PRACTICE:

“More importantly, given the prevalent tobacco and alcohol use during pregnancy, preventive efforts, screening, treatment, and recovery services should be a priority for public health and behavioral health stakeholders to help ensure healthy outcomes for mothers and their babies,” the authors wrote.

SOURCE:

The study was led by Emma Kathryn Boswell, MPH, from the University of South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina in Columbia. It was published online on March 24, 2025, in The Journal of Rural Health.

LIMITATIONS:

The study’s focus on rural pregnant women who report substance use resulted in a limited sample size, preventing analysis of substance use disorder treatment through the NSDUH data. Additionally, due to small sample sizes for certain individual substances, illicit drug use was combined, and drug and alcohol use were analyzed instead of substance use disorder. Substance use during pregnancy has likely been underreported due to concerns about consequences of disclosure, particularly among rural respondents who may have greater concerns about perceived stigma.

DISCLOSURES:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declared no conflicts of interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.