Under What Circumstances Do Pregnant Women Use Cannabis and Alcohol? The Contributions of Risk Perception, Mental Health, and Individual Context

Background: Alcohol and cannabis use during pregnancy are prevalent health concerns in the United States due to potentially hazardous effects to both mother and fetus, however pregnant women still use both substances at high rates. Perceived risk of substance use is generally protective, but factors that modulate risk perception among pregnant women are not fully understood. Methods: Secondary analysis was conducted using data from the National Survey of Drug Use and Health (NSDUH) from 1985 to 2019 to investigate the moderating role of mental health (i.e., depression, anxiety, suicidal ideation, externalizing behaviors) and contextual factors (i.e., trimester, poverty, education) on perceived risk of substance use in pregnant women. Results: Risk perception in pregnant women reduces substance use, but its benefit varied as a function of mental health and contextual factors. Specifically, pregnant women with lower risk perception who were depressed, had elevated externalizing problems, were living in poverty, were not receiving government assistance, had graduated high school, and were later in pregnancy were significantly more likely to use cannabis. Pregnant women with lower risk perception who had anxiety, had graduated high school, and were later in pregnancy were significantly more likely to use alcohol. However, there were few differences within moderators at higher risk perception levels, indicating that high risk perception was still protective. Conclusions: When taken together, results indicate that prenatal and perinatal healthcare providers may need to screen for mental health struggles and certain individual contexts and personalize care to increase risk perception of substance use while pregnant.