Use of tobacco, alcohol, cannabis, and illicit drugs is dangerous in pregnancy, increasing risks of stroke, miscarriage, preterm delivery, low birth weight and infant neurodevelopmental problems. Yet according to the 2020 National Survey of Drug Use and Health, more than 20 percent of pregnant women in the United States report using one or more of these substances.

A new study published in the Journal of Addiction Medicine conducted by a team of Stony Brook University researchers used the PROMOTE Prenatal Screener — a unique screening tool for use during pregnancy — to pinpoint vulnerabilities for substance use.

The study, led by Heidi Preis, assistant professor of research in the Department of Obstetrics, Gynecology and Reproductive Medicine in the Renaissance School of Medicine (RSOM), focused on vulnerabilities for tobacco, cannabis, or alcohol use in pregnancy.

“When patients complete the PROMOTE at the start of their prenatal care, their health care providers can identify any psychological, social, or other needs and determine whether a particular patient is likely to use harmful substances during pregnancy,” explained Preis, who also has academic affiliations and collaborates with Stony Brook’s Program in Public Health and Department of Psychology. “This way a patient’s needs can be addressed very early and she can be referred for counseling, treatment, or resources, and this reduces harms for both mother and child.”

Public health experts agree on the need to identify pregnant women who are most vulnerable to using harmful substances. Preis and her colleagues developed the PROMOTE with a grant from the National Institutes of Health’s National Institute on Drug Abuse (NIDA). Prior to its creation, a comprehensive yet concise screening tool to detect psychosocial and substance use risk was not available in prenatal care settings.

The PROMOTE includes 18 core items that address vulnerabilities in areas such as education, financial stability, living conditions, partner and family stress and support, exposure to violence, and mental health.

For their current study, the team reviewed medical charts of 1,842 patients who completed the PROMOTE during their first prenatal visit to a New York State health system outpatient clinic.  They found that 188 patients (10.2%) used at least one substance during pregnancy, including 132 (7.2%) tobacco, 50 (2.7%) cannabis, and 45 (2.4%) alcohol. Patients with limited education were most likely to use tobacco during pregnancy, single and unpartnered patients were most likely to use cannabis, and those who experienced a major stressful life event were most likely to use alcohol during pregnancy. Other vulnerabilities were also associated with harmful substance use.

Their study results highlight the value of using a well-developed screening tool to gain a better understanding of the life context of pregnant patients and identify those who are most vulnerable or might be struggling with substance use. Preis stresses that addressing their needs has great potential to improve the health and well-being of pregnant women and their children.

Co-authors and collaborators on the PROMOTE project include: Marci Lobel, Department of Psychology and Department of Obstetrics, Gynecology and Reproductive Medicine; Cassandra Heiselman, DO, Department of Obstetrics, Gynecology and Reproductive Medicine; Ayesha Azeem, RSOM student and first author of the publication; David Garry, MD, Department of Obstetrics, Gynecology and Reproductive Medicine.