Am J Perinatol
DOI: 10.1055/s-0042-1753502
Original Article

The Impact of Self-Reported Alcohol, Tobacco, and Recreational Drug Use during Pregnancy on Adverse Pregnancy Outcomes in First-Time Mothers

1   Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
Robert M. Silver
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
David Guise
1   Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
David M. Haas
3   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Funding This work was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to Research Triangle Institute (U10 HD063036); Case Western Reserve University (U10 HD063072); Columbia University (U10 HD063047); Indiana University (U10 HD063037); Magee-Women's Hospital (U10 HD063041); Northwestern University (U10 HD063020); University of California at Irvine (U10 HD063046); University of Pennsylvania (U10 HD063048); and University of Utah (U10 HD063053). In addition, support was provided by respective Clinical and Translational Science Institutes to Indiana University (UL1TR001108) and the University of California Irvine (UL1TR000153).


Objective The objective of this study was to derive profiles of alcohol, tobacco, and recreational drug use during pregnancy for first-time mothers with latent class growth analysis (LCGA) and determine the association of these classes with the risk of adverse pregnancy outcomes (APO).

Study Design A secondary analysis of a prospective cohort of Nulliparous Outcomes in Pregnancy: Monitoring Mothers-to-Be was conducted in eight medical centers across the United States from September 30, 2010, to September 23, 2013. Self-reported use of any alcohol, tobacco, or recreational drugs in the 1 month prior to the visit was assessed at up to four visits throughout pregnancy, and APOs included a composite of preterm birth, hypertensive disorder of pregnancy (HDP), small for gestational age (SGA) infant, or stillbirth, and each adverse outcome separately.

Results Four latent classes were identified from the LCGA for 10,031 nulliparous pregnant women that were on average 26.9 years old (standard deviation [SD] = 5.7) and mostly non-Hispanic White (59.7%). Classes included consistent tobacco users (N = 517, 5.2%), nonusers (N = 8,945, 89.2%), alcohol users (N = 500, 5.0%), and a combination of alcohol/tobacco/drug users (N = 69, 0.7%). Logistic regression demonstrated that the class of tobacco users was more likely to have an APO (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.22–1.81), preterm birth (OR = 1.53, 95% CI = 1.15–2.02), and SGA (OR = 1.79, 95% CI = 1.36–2.35) relative to the class of nonusers. The class of alcohol users was more likely to have HDP (OR = 1.37, 95% CI = 1.11–1.70) and less likely to have preterm birth (OR = 0.59, 95% CI = 0.38–0.90) and SGA (OR = 0.61, 95% CI = 0.40–0.93) compared to nonusers.

Conclusion Trajectories of substance use are associated with APOs; thus, interventions to mitigate the use when encountered early in pregnancy are warranted.

Key Points

  • Four classes of substance use were identified.

  • Tobacco users were at a higher risk of APO and alcohol users were at higher risk of HDP.

  • Mitigation strategies are warranted to reduce APO.

Authors' Contributions

J.K.D. had full access to the deidentified data in the study and takes responsibility for the integrity of the data and the accuracy of the data analyses.

D.G., J.K.D., and D.M.H. are responsible for acquisition, analysis, and interpretation of data. D.G. was the data manager.

J.K.D. and D.M.H. are responsible for the drafting of the manuscript.

D.M.H. and R.M.S. were responsible for the critical revision of the manuscript for important intellectual content.

J.K.D. was responsible for statistical analysis.


Comments and views of the author do not necessarily represent the views of the National Institutes of Health.

Trial Registration


Supplementary Material

Publication History

Received: 20 January 2022

Accepted: 03 June 2022

Article published online:
12 September 2022

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