Pregnancy Intention, Risk Perception, and Contraceptive Use in Pregnant Women Who Use Drugs

The aim of the study was to evaluate pregnancy intention, risk perception, and contraceptive utilization among women reporting substance use during pregnancy.

Data were obtained from the 2009 to 2011 Tennessee Pregnancy Risk Assessment Monitoring System (PRAMS), an annual cross-sectional survey which assesses behaviors before, during and after pregnancy. Substance use during pregnancy and contraceptive use at the time of conception and after delivery were captured by self-report in the postpartum period. Pregnancy intention was categorized as intended (pregnancy desired then or earlier) or unintended (pregnancy desired later or not at all). Weighted descriptive and multivariable analyses were performed.

A total of 3042 women completed the PRAMS survey, with 168 (5.4%) reporting substance use during pregnancy. Compared with women who did not report drug use, women who used drugs were more likely to have an unintended pregnancy (65.6% vs 48.4%, P = 0.003), were more ambivalent towards pregnancy planning or prevention (69.7% vs 46.2%, P < 0.001) and were less likely to report contraceptive use before pregnancy (31.3% vs 46.8%, P = 0.022) or in the postpartum period (79.6% vs 88.1%, P = 0.019). Finally, women reporting substance use in pregnancy had 2 times higher odds of reporting that they did not think they could get pregnant at the time of conception after adjusting for age, race, income, education, insurance, and smoking status (adjusted OR 2.18, 95% confidence interval 1.07-4.49, P = 0.033).

Women who report substance use in pregnancy have unique reproductive health needs and would benefit from additional education and counseling concerning their pregnancy intention, contraceptive use, and ability to conceive.