Cited by 182Prenatal Substance Exposure EffectsSubstance Abuse Treatment and OutcomesMaternal Mental Health During Pregnancy and Postpartum

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Perinatal substance use: A prospective evaluation of abstinence and relapse

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Forray, Ariadna, Merry, Brian, Lin, Haiqun, Ruger, Jennifer Prah, Yonkers, Kimberly A.·2015·Drug and Alcohol Dependence

DOI 10.1016/j.drugalcdep.2015.02.027PMC PMC4387084

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Abstract

Background 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.Methods 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.Results 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.Conclusions 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.

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“The majority of women with PSUDs will abstain from substance use in pregnancy, but 80% will relapse postpartum, increasing their risk for overdose and death [3].”
Background
“He gets mad that I'm sober”: Experiences of substance use coercion among postpartum women in recovery
Fusco, R. A., Kulkarni, S. J., & Pless, J. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209407 · Cited by 8
Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records
Stevens, M., Cooper, M., Cusack, L., Ali, R. L., Holmwood, C. B., & Briley, A. L. (2024) · Drug and Alcohol Review · doi:10.1111/dar.13927 · Cited by 8
“This is problematic, as evidence suggests that while many women with a history of substance use remain abstinent during pregnancy, a significant proportion will return to use post-birth [40].”
Background
Marijuana use, fetal growth, and uterine artery Dopplers
Bruno, A. M., Blue, N. R., Allshouse, A. A., Haas, D. M., Shanks, A. L., Grobman, W. A., Simhan, H. N., Reddy, U. M., Silver, R. M., & Metz, T. D. (2021) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2021.1960973 · Cited by 8
“Marijuana use typically decreases across gestation [37,38]; therefore, those with ongoing use at the time of visit two may be those with heavier use, and results may therefore demonstrate a larger discrepancy than would be seen with lower frequency of MJ use, or cessation early in pregnancy.”
Background
The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review
Towobola, A., Towobola, B., Nair, B., & Makwana, A. P. (2021) · BJPsych Bulletin · doi:10.1192/bjb.2021.102 · Cited by 9
At a Juncture: Exploring Patterns and Trends in FASD Prevention Research from 2015 – 2021 Using the Four-Part Model of Prevention
Wolfson, L., Poole, N., Harding, K. D., & Stinson, J. (2022) · Journal of Fetal Alcohol Spectrum Disorder · doi:10.22374/jfasd.v4isp1.13 · Cited by 8
Поиски равновесного состояния в миграционной теории
Лисицын, П. П., Резаев, А. В., & Stepanov, A. V. (2024) · Journal of Economic Sociology · doi:10.17323/1726-3247-2024-1-137-160 · Cited by 7
Alcohol and other substance use disorder recovery during pregnancy among patients with posttraumatic stress disorder symptoms: A qualitative study
Henry, M. C., Sanjuan, P. M., Stone, L. C., Cairo, G. F., Lohr-Valdez, A., & Leeman, L. M. (2021) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2021.100013 · Cited by 7
“Many women with SUD prior to pregnancy detection are able o abstain from or substantially reduce substance use during pregnancy, ut many others continue to struggle with substance use throughout regnancy, and postpartum substance use recurrence rates are high for oth groups ( Forray et al., 2015 ).”
Background
Impact of pregnancy on psychoactive substance use among women with substance use disorders recruited in addiction specialized care centers in France
Pochard, L., Dupouy, J., Frauger, É., Giocanti, A., Micallef, J., Lapeyre‐Mestre, M., & French Addictovigilance Network (2018) · Fundamental and Clinical Pharmacology · doi:10.1111/fcp.12346 · Cited by 7
Maternal and child biomonitoring strategies and levels of exposure in western Canada during the past seventeen years: The Alberta Biomonitoring Program: 2005–2021
MacDonald, A. M., Gabos, S., Braakman, S., Cheperdak, L., Lee, B. E., Hrudey, S. E., Le, X. C., Li, X., Mandal, R., Martin, J. W., et al. (2022) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2022.113990 · Cited by 6
Ecological momentary assessment of heavy episodic drinking in the early postpartum period: A feasibility study
Dauber, S. E., Beacham, A. R., West, A. L., Devkota, J., Barrie, K., & Thrul, J. (2023) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2023.100146 · Cited by 6
A scoping review of Aotearoa New Zealand women's experiences of substance use, alcohol and drug services
Jackson, S., Chubb, L. A., & Haan, I. D. (2023) · Aotearoa New Zealand Social Work · doi:10.11157/anzswj-vol35iss3id1060 · Cited by 6
“International research has also highlighted the importance of wraparound services and comprehensive care that are trauma informed and gender specific (Forray et al., 2015; Schamp et al., 2021).”
Background
Outcomes and mortality in parturient and non-parturient patients with peripartum cardiomyopathy: A national readmission database study
Chhabra, N., Gupta, A., Chibber, R., Minhaj, M. M., Hofer, J. E., Mueller, A., Tung, A., O’Connor, M. F., Scavone, B. M., Rana, S., et al. (2017) · Pregnancy Hypertension · doi:10.1016/j.preghy.2017.07.147 · Cited by 6
Contraceptive uptake in postpartum people with and without opioid use disorder and opioid use with co-occurring substance use
Bello, J. K., Xu, K. Y., Salas, J., Kelly, J. C., & Grucza, R. A. (2024) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2024.100248 · Cited by 6
“Against this backdrop, the postpartum period can be especially difficult for people with OUD, as return to use and treatment discontinuation rates are known to surge after delivery (Forray et al., 2015; Jagodzinski and Fleming, 2007; Wilder et al., 2015).”
Background
Postpartum psychoactive substance abuse after severe maternal morbidity
Pereira, C. M., Pacagnella, R. C., Parpinelli, M. Â., Andreucci, C. B., Zanardi, D. M. T., Souza, R. T., Angelini, C. R., Silveira, C., & Cecatti, J. G. (2019) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.12967 · Cited by 7
Этика искусственного интеллекта: кейсы и варианты решения этических проблем
Stahl, B. C., Schroeder, D., & Rodrigues, R. (2024) · Journal of Economic Sociology · doi:10.17323/1726-3247-2024-1-85-95 · Cited by 12
Development of a Clinical Decision-Making Framework to Address Parental Substance Use and Child Safety
Schiff, D. M., Walt, G., Kane, M. T., Maitland, M., Liu, G., Wakeman, S. E., & Gray, J. R. (2024) · Parenting · doi:10.1080/15295192.2024.2422872 · Cited by 6
“However, the postpartum year, when women with SUD are parenting young children or are separated from them, is a time of increased risk of overdose (Forray et al., 2015; Schiff et al., 2018).”
Toward Enhancing Treatment for Pregnant Smokers: Laying the Groundwork for the Use of Complementary and Alternative Medicine Approaches
Loree, A. M., Ondersma, S. J., & Grekin, E. R. (2016) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntw262 · Cited by 5
Symptomology Associated with in Utero Exposures to Polysubstance in an Appalachian Population.
Lester, W., Andrews, L., Nellhaus, E. M., Murray, S., Loudin, S., & Davies, T. H. (2019) · Marshall Journal of Medicine · doi:10.33470/2379-9536.1212 · Cited by 7
Postpartum heavy episodic drinking: A survey to inform development of a text messaging intervention
Dauber, S. E., West, A. L., Hammond, C., Cohen, I., & Thrul, J. (2021) · Drug and Alcohol Review · doi:10.1111/dar.13341 · Cited by 5
“While most women reduce their drinking during pregnancy, more than half return to pre-pregnancy levels by 3 months postpartum [2], and 8%–12% show postpartum patterns of escalating HED [3].”
Pre-natal and post-natal screening and testing in neonatal abstinence syndrome
Ostfeld‐Johns, S. (2024) · Seminars in Perinatology · doi:10.1016/j.semperi.2024.152009 · Cited by 4
Postnatal ethanol exposure impairs social behavior and operant extinction in the adult female mouse offspring
Bariselli, S., Reuveni, N., Westcott, N., Mateo, Y., & Lovinger, D. M. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1160185 · Cited by 4
“, 1990), while about 30–50% of those who remained abstinent during pregnancy relapsed during the three-month post-parturition period (Jagodzinski and Fleming, 2007; Forray et al., 2015).”
Background
Lessons from Maternal Mortality Reviews. How Addiction Care Providers can help improve Outcomes for Pregnant, Postpartum, and Parenting people
Schauberger, C. W., Smid, M. C., Terplan, M., & Wright, T. E. (2024) · Substance Use & Misuse · doi:10.1080/10826084.2024.2422957 · Cited by 4
“Pregnancy frequently inspires an abstinence-based treatment approach (Forray et al., 2015) .”
Treatment for substance use disorder in mothers of young children: A systematic review of maternal substance use and child mental health outcomes
Joyce, K. M., Delaquis, C. P., Alsaidi, T. H., Sulymka, J., Conway, A., Garcia, J., Paton, A., Kelly, L. E., & Roos, L. E. (2025) · Addictive Behaviors · doi:10.1016/j.addbeh.2024.108241 · Cited by 5
Parenting through the eyes of mothers with substance use disorder: Implications for treatment and related services
Smith, B. T., Davidov, D. M., Gannon, M. A., Groth, C. P., & Kristjánsson, Á. L. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112782 · Cited by 7
“One study found that 80 % of mothers who achieved abstinence during pregnancy returned to use postpartum (Forray et al., 2015).”
Midwifery student's perceptions of caring for substance-using pregnant women
Doleman, G., Geraghty, S., & DeLeo, A. (2019) · Nurse Education Today · doi:10.1016/j.nedt.2019.01.027 · Cited by 4
Development of an Electronic Screening and Brief Intervention to Address Perinatal Substance Use in Home Visiting: Qualitative User-Centered Approach
Dauber, S. E., Hammond, C., Hogue, A., Henderson, C. E., Nugent, J., Ford, V. L., Brown, J., Scott, L., & Ondersma, S. J. (2022) · JMIR Formative Research · doi:10.2196/37865 · Cited by 5
“The risk of relapse increases because of hormonal changes, the stress of caring for a newborn, sleep deprivation, and social isolation, making the early postpartum weeks a critical period for intervention [8,9].”
Nutrient Supplementation during the Prenatal Period in Substance-Using Mothers: A Narrative Review of the Effects on Offspring Development
Serwatka, C., Griebel-Thompson, A. K., Eiden, R. D., & Kong, K. L. (2023) · Nutrients · doi:10.3390/nu15132990 · Cited by 5
“0 oz of absolute alcohol per day or ≥4 or more standard drinks per occasion), 22% of pregnant individuals who use cannabis, 27% of pregnant individuals who snort cocaine, and 68% of individuals who smoke cigarettes on a regular basis continued to engage in these behaviors after learning of their pregnancy [26].”
Background
The Association Between Maternal Early Life Forced Sexual Intercourse and Offspring Birth Weight: The Role of Socioeconomic Status
Gavin, A. R., & Morris, J. (2017) · Journal of Women s Health · doi:10.1089/jwh.2016.5789 · Cited by 4
The Potential Utility for Massage Therapy During Pregnancy to Decrease Stress and Tobacco Use
O’Hair, C. M., Kathryn Armstrong, M., & Rutherford, H. J. V. (2018) · International Journal of Therapeutic Massage & Bodywork Research Education & Practice · doi:10.3822/ijtmb.v11i3.379 · Cited by 4
“(10) Indeed, while approximately 50% of women quit smoking upon learning of their pregnancy, many struggle to maintain abstinence, with 40% of women relapsing within 6 months of delivery.”
Background
Cuidado de mulheres usuárias de crack na gestação
Ribeiro, M. C. L., Giusti, B. B., Ciosak, S. I., & da Silva, I. M. (2018) · SMAD Revista Eletrônica Saúde Mental Álcool e Drogas (Edição em Português) · doi:10.11606/issn.1806-6976.smad.2018.000407 · Cited by 4
“Os estudos analisados apontam diversas complicações gestacionais recorrentes entre gestantes usuárias de cocaína-crack(15,20-22,28-29,34,43), porém o texto do Manual Técnico de Pré-Natal de Alto Risco limitase a reconhecer o problema, sem apontar sugestões para o cuidado dessa população.”
Background
Exploring the Patterns of Substance Use Behaviors in a Nationally Representative Sample of Pregnant Women: a Latent Class Approach
Kim, S. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00886-y · Cited by 4
“…(Forray et al., 2015), opioids and tobacco (Jarlenski et al., 2020), cannabis and alcohol (Young-Wolff et al., 2022), and tobacco, alcohol, and marijuana (Forray et al., 2015), a generalized understanding of these diverse substance use behaviors among pregnant women is limited for several reasons.”
Influential
The Prevention of Smoking Relapse in Postpartum Women: A Systematic Review and Network Meta-analysis
Tangamornsuksan, W., Boonpattharatthiti, K., Aiumtanaporn, N., Pongpetch, T., Thananithisak, C., Sadeghirad, B., Dhippayom, T., & Guyatt, G. H. (2025) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001522 · Cited by 3
Discontinuation of treatment for alcohol use disorder during pregnancy and postpartum in the United States
Martin, C. E., Bello, J. K., Galati, B. M., Buss, J. L., Terplan, M., Jones, H. E., Mitchell, K. T., Martins, S. S., Grucza, R. A., Suarez, E. A., et al. (2025) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.70117 · Cited by 4
Understanding the needs of postpartum emerging adults with substance use disorders to improve recovery supports
Cioffi, C. C., Lewis, L. F., & Gau, J. M. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1521093 · Cited by 3
Perceived racial discrimination and tobacco and cannabis use in pregnant Black Americans: The mediating role of depressive symptoms
Stanfield, J., Dunlop, A. L., Barr, D. B., Corwin, E. J., Panuwet, P., Yakimavets, V., & Brennan, P. A. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112660 · Cited by 3
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Authors: Forray, A., Merry, B., Lin, H., Ruger, J. P., & Yonkers, K. A.
Affiliations: Yale University (US)
Leonard Davis Institute of Health Economics (US)
Corresponding author: Forray, Ariadna
ORCID: Forray, Ariadna
Lin, Haiqun
Ruger, Jennifer Prah
Yonkers, Kimberly A.
Venue: Drug and Alcohol Dependence
Publisher: Elsevier BV
Published: 2015-05
Volume: 150
Pages: 147-155
ISSN: 0376-8716 (ISSN-L)
DOI: 10.1016/j.drugalcdep.2015.02.027
PMC: PMC4387084
OpenAlex: W2055580782
Cited by: 182
References: 46
Citations by year: 2026: 19 · 2025: 26 · 2024: 34 · 2023: 21 · 2022: 17 · 2021: 12 · 2020: 10 · 2019: 16 · 2018: 9 · 2017: 11 · 2016: 5 · 2015: 2
FWCI: 8.95
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Drug and Alcohol Dependence (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (UL1TR000142)
National Institute on Drug Abuse (R01DA025555, R01DA019135, K12DA000167)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords: perinatal substance use, substance use in pregnancy, abstinence, relapse, postpartum period, nicotine, alcohol, cannabis, cocaine
MeSH terms: Adolescent, Adult, Female, Humans, Pregnancy, Prospective Studies, Recurrence, Smoking, Health Behavior, Substance-Related Disorders, Pregnant People, Young Adult, Self Report

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Perinatal substance use: A prospective evaluation of abstinence and relapse

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