N ational S urvey on D rug U se and H ealth

The NSDUH Report May 21, 2009

Substance Use among Women

During Pregnancy and Following
Childbirth

I
n the United States, substance use among
In Brief pregnant and postpartum women is a public
health issue. Previous studies based on data
●● ombined 2002 to 2007 data show
C from the National Survey on Drug Use and
that past month alcohol use among Health (NSDUH) have consistently shown that
women aged 18 to 44 was highest for
a substantial proportion of pregnant women,
those who were not pregnant and did
particularly those in the first trimester, were past
not have children living in the household
month alcohol, cigarette, or illicit drug users1,2,3
(63.0 percent) but comparatively low for
women in the first trimester of pregnancy
and that rates among recent mothers were much
(19.0 percent), and even lower for those higher than those among pregnant women.4 A
in the second (7.8 percent) or third recent study of this relationship that controlled
trimester (6.2 percent); similar patterns for women’s age and other socio-demographic
were seen with marijuana, cigarette, and characteristics found indirect evidence
binge alcohol use of resumption of substance use following
childbirth.5
●● ata suggest that use of these
D
This issue of The NSDUH Report examines
substances increases following
past month use of alcohol, cigarettes, and
childbirth; for example, marijuana use
marijuana among pregnant and parenting
was higher for recent mothers with
children under 3 months old in the
women aged 18 to 44 to shed light on how
household (3.8 percent) than for women rapidly use of these substances resumes after
in the third trimester of pregnancy (1.4 childbirth. It differentiates pregnant women by
percent), suggesting resumption of use trimester of pregnancy and recent mothers by
among mothers in the first 3 months age of the youngest child in the household.6
after childbirth

The NSDUH Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA).
All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies
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questions about this report, please e-mail: shortreports@samhsa.hhs.gov.
NSDUH_135
NSDUH REPORT: Substance Use among Women during Pregnancy and following Childbirth May 21, 2009

Figure 1. Women’s (Aged 18 to 44 Years) Figure 2. Women’s (Aged 18 to 44 Years) Past

Past Month Alcohol Use Rate by Pregnancy Month Binge Alcohol Use* Rate by Pregnancy
Trimester and Age of the Youngest Child in Trimester and Age of the Youngest Child in
Household: 2002 to 2007 Household: 2002 to 2007

NP,* No Child 63.0 NP,** No Child 32.6

Trimester 1 19.0 Trimester 1 8.0

Trimester 2 7.8 Trimester 2 1.8

Trimester 3 6.2 Trimester 3 1.0

NP, Child <3 months 31.9 NP, Child <3 months 10.0

NP, Child 3-5 months 43.9 NP, Child 3-5 months 15.5

NP, Child 6-8 months 46.4 NP, Child 6-8 months 14.6

NP, Child 9-11 months 52.1 NP, Child 9-11 months 16.9

NP, Child 12-14 months 49.4 NP, Child 12-14 months 17.6

NP, Child 15-17 months 54.9 NP, Child 15-17 months 16.8

NP, Child 18+ months 52.1 NP, Child 18+ months 19.7

0 20 40 60 80 0 10 20 30 40
Percent Percent

* NP = Nonpregnant * Binge alcohol use is defined as drinking five or more drinks at the same
time or within a couple of hours on at least 1 day in the past 30 days.
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and
Health (NSDUHs). **NP = Nonpregnant
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and
Health (NSDUHs).

Substance Use among Pregnant and

Nonpregnant Women
Combined 2002 to 2007 data show that past month alcohol use
among women aged 18 to 44 was highest for those who were
not pregnant and did not have children living in the household
(63.0 percent) (Figure 1). The rate was comparatively low for
those in the first trimester of pregnancy (19.0 percent) and
even lower for those in the second (7.8 percent) or third (6.2
percent) trimester. There were similar patterns across these four
subgroups of women for past month binge alcohol use (Figure
2), cigarette use (Figure 3), and marijuana use (Figure 4).
Resumption of Substance Use among
Recent Mothers
When compared with women in the third trimester of
pregnancy, nonpregnant women with children under 3 months
old in the household had much higher rates of past month
alcohol use (6.2 vs. 31.9 percent), binge alcohol use (1.0 vs. 10.0
percent), cigarette use (13.9 vs. 20.4 percent), and marijuana
use (1.4 vs. 3.8 percent) (Figures 1-4), suggesting resumption of
use among mothers in the 3 months after childbirth.
The increase in rates of substance use among parenting
women tended to level off as the age of the youngest child
increased. For alcohol, past month use increased from 31.9
percent for women with children under 3 months old to 43.9
percent for those with 3 to 5 month olds and 52.1 percent for
those with 9 to 11 month olds; thereafter, the rate ranged from
49.4 to 54.9 percent, not significantly different from the rate
among women with 9 to 11 month olds (Figure 1). The rate
of binge alcohol use was 15.5 percent among women whose
youngest children were aged 3 to 5 months and 19.7 percent for
those whose youngest children were aged 18 months or older
(Figure 2). Cigarette use among parenting women increased
to 30.3 percent for those whose youngest children were aged
18 months or older (Figure 3), but for marijuana, there was no
significant increase in use among women who had children
aged 3 months or older (Figure 4).
These data provide indirect evidence of dramatic increases
in the prevalence of substance use among mothers with babies
under 3 months old based on cross-sectional reports from
pregnant, parenting, and nonpregnant women. This increase
implies a resumption of substance use following childbirth
because new initiation of substance use among postpartum
women is too rare to account for the observed differences.
May 21, 2009 NSDUH REPORT: Substance Use among Women during Pregnancy and following Childbirth

Figure 3. Women’s (Aged 18 to 44 Years) Past Figure 4. Women’s (Aged 18 to 44 Years) Past
Month Cigarette Use Rate by Pregnancy Month Marijuana Use Rate by Pregnancy
Trimester and Age of the Youngest Child in Trimester and Age of the Youngest Child in
Household: 2002 to 2007 Household: 2002 to 2007

NP,* No Child 33.3 NP,* No Child 10.9

Trimester 1 21.8 Trimester 1 4.6

Trimester 2 14.4 Trimester 2 2.9

Trimester 3 13.9 Trimester 3 1.4

NP, Child <3 months 20.4 NP, Child <3 months 3.8

NP, Child 3-5 months 22.3 NP, Child 3-5 months 4.3

NP, Child 6-8 months 25.2 NP, Child 6-8 months 5.0

NP, Child 9-11 months 24.1 NP, Child 9-11 months 5.3

NP, Child 12-14 months 23.7 NP, Child 12-14 months 4.7

NP, Child 15-17 months 27.1 NP, Child 15-17 months 4.1

NP, Child 18+ months 30.3 NP, Child 18+ months 3.8

0 10 20 30 40 0 2 4 6 8 10 12
Percent Percent

* NP = Nonpregnant * NP = Nonpregnant
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and
Health (NSDUHs). Health (NSDUHs).

2 Substance Abuse and Mental Health Services Administration, Office of

Discussion
Alcohol, cigarette, and illicit drug use during pregnancy
can cause poor pregnancy outcomes and early childhood
behavioral and development problems. The findings in this
report suggest that many U.S. women, particularly those in
the third trimester, are getting the message and abstaining
from substance use. Still, a sizeable proportion of women
in the first trimester of pregnancy were past month users of
alcohol, cigarettes, or marijuana, and one in seven women
used cigarettes in the second or third trimester. In addition,
many women are resuming use of these substances after
childbirth, and that resumption appears to be rapid given
the higher rates for mothers of infants under 3 months old
compared with pregnant women in the second or third
trimesters. Effective interventions for women to further
reduce substance use during pregnancy and to prevent
postpartum resumption of use could improve the overall
health and well-being of mothers and infants.
End Notes
1 Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. (May 17, 2002). The NHSDA report: Substance use among
pregnant women during 1999 and 2000. Rockville, MD.
Applied Studies. (February 9, 2007). The NSDUH report: Cigarette use
among pregnant women and recent mothers. Rockville, MD.
3 Muhuri, P. K., & Gfroerer, J. C. (2008). Substance use among women:
Associations with pregnancy, parenting, and race/ethnicity. Maternal and
Child Health Journal. Online preprint publication, DOI10.1007/s10995-008-
0375-8. Retrieved on January 12, 2009, from
http://www.springerlink.com/index/152552148rwx2241.pdf
4 See End Note 2.
5 See End Note 3.
6 Pregnant women with or without a child in the household were classified
into pregnancy trimester categories, and nonpregnant women’s parenting
status was classified according to the age of the youngest child living in
the household, including biological, step-, adopted, or foster children. (An
earlier analysis showed that 99.1 percent of nonpregnant women with
children aged 0 to 2 years in the household were the biological mothers.)
Nonpregnant women with no children living in the household were the
residual group. Groups shown in the figures followed these definitions and
are mutually exclusive.
Suggested Citation
Substance Abuse and Mental Health Services Administration, Office of
Applied Studies. (May 21, 2009). The NSDUH Report: Substance Use among
Women During Pregnancy and Following Childbirth. Rockville, MD.
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Research findings from the SAMHSA 2002 to 2007 National Surveys on Drug Use and Health (NSDUHs)

Substance Use among Women During Pregnancy

and Following Childbirth
●● ombined 2002 to 2007 data show that past
C survey sponsored by the Substance Abuse and Mental Health Services
month alcohol use among women aged 18 to 44
was highest for those who were not pregnant and
did not have children living in the household (63.0
percent) but comparatively low for women in the
first trimester of pregnancy (19.0 percent), and
even lower for those in the second (7.8 percent) or
third trimester (6.2 percent); similar patterns were
seen with marijuana, cigarette, and binge alcohol
use
●● ata suggest that use of these substances
D publication:
increases following childbirth; for example,
marijuana use was higher for recent mothers with
children under 3 months old in the household (3.8
percent) than for women in the third trimester of
pregnancy (1.4 percent), suggesting resumption
of use among mothers in the first 3 months after
childbirth
The National Survey on Drug Use and Health (NSDUH) is an annual
Administration (SAMHSA). The 2002-2007 NSDUH data used in this
report were based on information obtained from 113,140 females aged
18 to 44 including 6,036 who were in their first, second, or third trimester
of pregnancy at the time of the survey interview. The survey collects
data by administering questionnaires to a representative sample of the
population through face-to-face interviews at their place of residence.
The NSDUH Report is prepared by the Office of Applied Studies
(OAS), SAMHSA, and by RTI International in Research Triangle Park,
North Carolina. (RTI International is a trade name of Research Triangle
Institute.)
Information on the most recent NSDUH is available in the following
Office of Applied Studies. (2008). Results from the 2007 National Survey
on Drug Use and Health: National findings (DHHS Publication No. SMA
08-4343, NSDUH Series H-34). Rockville, MD: Substance Abuse and
Mental Health Services Administration. Also available online:
http://oas.samhsa.gov.
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
Substance Abuse & Mental Health Services Administration
Office of Applied Studies
www.samhsa.gov