Prenatal substance use linked to inadequate prenatal, perinatal care

May 11, 2022

People who engage in prenatal substance use are more likely to initiate prenatal care later in pregnancy and receive inadequate care before and after birth, according to a new study from the UNC Gillings School of Global Public Health.

Elizabeth Simmons

While the American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant people begin prenatal care in the first trimester, those who report substance use during pregnancy often initiate prenatal care in the second trimester and are less likely to receive adequate prenatal care and postpartum care. Researchers found the most pronounced difference in quality of care among those who reported illicit substance use during pregnancy.

“Qualitative studies have pointed to delays in seeking pre- and postnatal care among pregnant women who use substances, but our results are some of the first to quantify this association by different types of substance use,” said study co-author Lizzy Simmons, who is a doctoral student in maternal and child health at the Gillings School and a population health science trainee at the Carolina Population Center.

The study, published recently in Preventative Medicine, was conducted by Simmons and Anna Austin, PhD, assistant professor in the Department of Maternal and Child Health and core faculty at the UNC Injury Prevention Research Center.

Those who engage in substance use in pregnancy often experience unique barriers to care. These can include concurrent mental health concerns, lack of access to transportation or quality care facilities, and, most importantly, fears of judgment, loss of child custody or other criminal justice repercussions. This new study sheds further light on the association of specific types of prenatal substance use with the time prenatal care begins, adequacy of prenatal care and receipt of a postpartum health care visit.

Dr. Anna Austin

The study examined data from the Centers for Disease Control and Prevention’s Pregnancy Risk Monitoring Assessment System, which included a representative sample of women from nine states who delivered a live-born infant. The researchers compared data from women who reported prenatal use of any opioids, prescription opioids, marijuana and illicit drugs to those who did not report prenatal use of these substances.

These results indicate several areas where public health interventions can facilitate supportive, non-judgmental care that encourages people to seek prenatal services as soon as possible.

“Our findings that pregnant women who use substances are more likely to delay or receive inadequate care help support previous studies suggesting that fear of detection and experience of stigma in health care encounters leads to these delays in care-seeking,” said Simmons. “Efforts focused on reducing stigma at multiple points within the health care system may help increase women’s comfort in seeking care.”

“We have conducted additional research to assess the implications of the state policy context for receipt of essential care among those who engage in substance use in pregnancy,” Austin said. “Specifically, we have examined the association of punitive state policies, those that consider substance use in pregnancy child abuse and that require mandated reporting of substance use in pregnancy to child welfare agencies, with receipt of prenatal and postpartum care among women who reported prenatal substance use.”

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.