Drug use among adolescent mothers: Prepregnancy to 18 months postpartum

doi:10.1016/S1054-139X(96)00052-3

Journal of Adolescent Health

Volume 19, Issue 5, November 1996, Pages 337-344

https://doi.org/10.1016/S1054-139X(96)00052-3 Get rights and content

Purpose:

Little is known about the substance use patterns of adolescent mothers, particularly in the postpartum period. This study provides descriptive, longitudinal data on the substance use behavior of a cohort of adolescent mothers.

Methods:

A total of 241 pregnant adolescents, under 18 years old and planning to carry the pregnancy to term, completed the initial interview. Respondents were interviewed again at 1, 6, 12, and 18 months postpartum. The data reported here are based on the 229 respondents who completed all five interviews.

Results:

Use of all substances decreased substantially during pregnancy, but increased steadily in the first 6 months postpartum. A similar pattern was observed for regular use of multiple substances. Regular use before and after the pregnancy, but not during it, was the most common pattern of substance use.

Conclusions:

The prevalence of substance use among adolescent mothers is significant. To capitalize on the large decreases in use during pregnancy, drug prevention programs for adolescent mothers should target the first 6 months postpartum.

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Cited by (71)

Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers
2016, Addictive Behaviors
Citation Excerpt :
Cannabis is the third most commonly used substance during pregnancy following tobacco and alcohol (El Marroun et al., 2008; Gilchrist, Hussey, Gillmore, Lohr, & Morrison, 1996; Havens, Simmons, Shannon, & Hansen, 2009). Although rates of cannabis use tend to decline during pregnancy (Bailey, Hill, Hawkins, Catalano, & Abbott, 2008; Gilchrist et al., 1996), an estimated 11% of women continue to use cannabis during pregnancy, with over 16% of pregnant cannabis users reporting near daily use (Ko, Farr, Tong, Creanga, & Callaghan, 2015). Women who are younger, less educated, single, unemployed, socioeconomically disadvantaged, or belong to a racial or ethnic minority group are more likely to use cannabis during pregnancy (El Marroun et al., 2008; Ko et al., 2015) as are multigravid women and women with unplanned pregnancies (El Marroun et al., 2008).
Following tobacco and alcohol, cannabis is the most commonly used substance during pregnancy. Given the high prevalence of concurrent cannabis and tobacco use as well as the health consequences associated with prenatal substance use, we sought to document the relative contributions of psychosocial and psychiatric factors commonly associated with cannabis use in predicting a lifetime cannabis use disorder (CUD) among women who had quit smoking tobacco as a result of pregnancy.
Pregnant former tobacco smokers (n = 273) enrolled in a larger randomized controlled trial for postpartum tobacco relapse prevention completed semi-structured psychiatric interviews and self-reported demographic, pregnancy, health, psychosocial, and tobacco use factors during their third trimester of pregnancy.
In total, 14% (n = 38) of women met criteria for a lifetime CUD. The strongest predictors of a lifetime CUD were a history of having multiple psychiatric disorders (OR = 36.44; 95% CI = 5.03–264.27; p < 0.001) followed by a lifetime alcohol use disorder (OR = 3.54; 95% CI = 1.27–9.87; p < 0.05). In addition, more frequent attempts to quit smoking tobacco (OR = 1.12; 95% CI = 1.01–1.25; p < 0.05) and lower self-efficacy about weight management after quitting smoking tobacco (OR = 0.78; 95% CI = 0.62–0.97; p < 0.05) also were significantly associated with a lifetime CUD.
Women with a history of both cannabis and tobacco dependence may represent a subset of women who need more specialized treatment during the perinatal period to improve substance use outcomes.
Moderators and mediators of the relationship between receiving versus being denied a pregnancy termination and subsequent binge drinking
2016, Drug and Alcohol Dependence
Citation Excerpt :
An alternative explanation is that those who continue pregnancies experience a pregnancy/parenting-related reduction in alcohol consumption (Roberts et al., 2015). Pregnancy/parenting-related reductions in alcohol consumption are well documented (Alvik et al., 2006; Chambers et al., 2005; Ethen et al., 2009; Gilchrist et al., 1996; Tough et al., 2006). Our recent research found sustained reductions in any and binge alcohol use among women who continued compared to women who terminated pregnancies (Roberts et al., 2015), demonstrating a pregnancy/parenting-related reduction among women who continued pregnancies.
Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy.
Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship.
Only having had a previous live birth modified the termination–binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years.
Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women – and not nulliparous women – denied terminations experienced sustained reductions in binge drinking over time.
Maternal age and trajectories of cannabis use
2015, Drug and Alcohol Dependence
Becoming a mother is a developmental transition that has been linked to desistance from substance use. However, timing of motherhood may be a key determinant of cannabis use in women, based on preliminary evidence from teenage mothers. The goal of this study was to identify trajectories of maternal cannabis use, and to determine if maternal age was associated with different trajectories of use.
This prospective study examined 456 pregnant women recruited at a prenatal clinic, ranging in age from 13 to 42 years. The women were interviewed about their cannabis use 1 year prior to pregnancy and during each trimester of pregnancy, and at 6, 10, 14, and 16 years post-partum.
A growth mixture model of cannabis use reported at each time point clearly delineated four groups: non/unlikely to use, decreasing likelihood of use, late desistance, and increasing likelihood/chronic use (Lo–Mendell–Rubin adjusted LRT test statistic = 35.7, p < .001). The youngest mothers were least likely to be in the “non/unlikely to use” group. Younger maternal age also differentiated between late desistance and increasing likelihood/chronic use, versus decreasing likelihood of use post-partum.
This is the first study to demonstrate that younger mothers are more likely to use cannabis across 17 years, including later desistance post-partum and increasing/chronic use. Other substance use and chronic depressive symptoms were also associated with more frequent use. These findings have implications for both prevention and treatment of cannabis use in mothers.
Substance use and teen pregnancy in the United States: Evidence from the NSDUH 2002-2012
2015, Addictive Behaviors
Few, if any, studies have systematically examined the relationship between substance use and teen pregnancy using population-based samples. We aim to provide a comprehensive examination of substance use among pregnant adolescents in the United States.
Employing data from the National Survey on Drug Use and Health between 2002 and 2012 (n = 97,850), we examine the prevalence of the past 12-month and the past 30-day substance use and substance use disorders among pregnant and non-pregnant adolescents (ages 12–17). We also examine psychosocial and pregnancy-related correlates of current substance use among the subsample of pregnant adolescents (n = 810).
Pregnant teens were significantly more likely to have experimented with a variety of substances and meet criteria for alcohol (AOR = 1.65, 95% CI = 1.26–2.17), cannabis (AOR = 2.29, 95% CI = 1.72–3.04), and other illicit drug use disorders (AOR = 2.84, 95% CI = 1.92–4.19). Pregnant early adolescents (ages 12–14; AOR = 4.34, 95% CI = 2.28–8.26) were significantly more likely and pregnant late adolescents (ages 15–17; AOR = 0.71, 95% CI = 0.56–0.90) significantly less likely than their non-pregnant counterparts to be current substance users.
Study findings point not only to a relationship between pregnancy and prior substance use, but also suggest that substance use continues for many teens during pregnancy. We found that substance use is particularly problematic among early adolescents and that the prevalence of substance use attenuates dramatically as youth progress from the first to the second and third trimesters of pregnancy.
Perinatal substance use: A prospective evaluation of abstinence and relapse
2015, Drug and Alcohol Dependence
Citation Excerpt :
Similar abstinence rates are reported among pregnant women with heavy alcohol use (Massey et al., 2011; Substance Abuse and Mental Health Services Administration, 2013). Offsetting the pregnancy-related decrease in substance use is the precipitous increase that occurs during the 6 months to one year after delivery (Ebrahim and Gfroerer, 2003; Gilchrist et al., 1996; Howell et al., 1999). For example, close to half of women who attain abstinence to smoking in pregnancy relapse within two weeks of delivery (Colman and Joyce, 2003), and 80% relapse within six months (DiClemente et al., 2000).
Substance use decreases in pregnancy but little prospective data are available on the rates of abstinence and relapse for specific substances. This study compared rates of abstinence in pregnancy and relapse postpartum for nicotine cigarettes, alcohol, marijuana, and cocaine.
Data from 152 women drawn from a randomized controlled trial comparing psychological treatments for substance use in pregnancy were analyzed. Self-reports of substance use and urine for toxicology testing throughout pregnancy and 3-months, 12-months and 24-months post-delivery were collected. Multivariate Cox models were used to compare rates of abstinence and relapse across substances.
In pregnancy, 83% of all women achieved abstinence to at least one substance. The mean (SE) days to abstinence was 145.81 (9.17), 132.01 (6.17), 151.52 (6.24), and 148.91 (7.68) for cigarettes, alcohol, marijuana and cocaine, respectively. Participants were more likely to achieve abstinence from alcohol (HR 7.24; 95% CI 4.47–11.72), marijuana (HR 4.06; 95% CI 1.87–6.22), and cocaine (HR 3.41; 95% CI 2.53–6.51), than cigarettes. Postpartum, 80% of women abstinent in the last month of pregnancy relapsed to at least one substance. The mean days to relapse was 109.67 (26.34), 127.73 (21.29), 138.35 (25.46), and 287.55 (95.85) for cigarettes, alcohol, marijuana and cocaine, respectively. Relapse to cocaine was only 34% (HR 0.34; 95% CI 0.15–0.77) that of cigarettes.
Pregnancy-related abstinence rates were high for all substances except cigarettes. Postpartum relapse was common, with cocaine using women being less likely to relapse after attaining abstinence compared to women using cigarettes, alcohol or marijuana.
Receiving versus being denied an abortion and subsequent drug use
2014, Drug and Alcohol Dependence
Some research finds that women receiving abortions are at increased risk of subsequent drug use and drug use disorders. This literature is rife with methodological problems, particularly inappropriate comparison groups.
This study used data from the Turnaway Study, a prospective, longitudinal study of women who sought abortions at 30 sites across the U.S. Participants included women presenting just prior to an abortion facility's gestational age limit who received abortions (Near Limit Abortion Group, n = 452), just beyond the gestational limit who were denied abortions (Turnaways, n = 231), and who received first trimester abortions (First Trimester Abortion Group, n = 273). This study examined the relationship between receiving versus being denied an abortion and subsequent drug use over two years. Trajectories of drug use were compared using multivariate mixed effects regression.
Any drug use, frequency of drug use, and marijuana use did not change over time among women in any group. There were no differential changes over time in any drug use, frequency of drug use, or marijuana use between groups. However, Turnaways who ultimately gave birth increased use of drugs other than marijuana compared to women in the Near Limit Abortion Group (p = .041), who did not increase use.
Women receiving abortions did not increase drug use over two years or have higher levels of drug use than women denied abortions. Assertions that abortion leads women to use drugs to cope with the stress of abortion are not supported.

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: Research reported here and the preparation of this report were supported by grant DA-05208 from the National Institute on Drug Abuse

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Original articleDrug use among adolescent mothers: Prepregnancy to 18 months postpartum

Purpose:

Methods:

Results:

Conclusions:

J Adolesc Health Care

J Adolesc Health

Addict Behav.

Association between parenthood and problem behavior in a national sample of adolescents

Pediatrics

Risking the future: Adolescent sexuality, pregnancy, and childbearing

Drug use among pregnant adolescents

J Consult Clin Psychol

Illicit drug use, smoking, and drinking by america's high school students, college students, and young adults

Patterns and prevalence of drug use among adolescent mothers

Predicting and understanding developmental delay of children of adolescent mothers: a multidimensional approach

Am J Ment Defic

Original article
Drug use among adolescent mothers: Prepregnancy to 18 months postpartum