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Associations of maternal alcohol and non-prescribed substance use with early child growth

Yukiko Washio^1,2, Zugui Zhang³, Mona Lisa Baishya⁴

¹Women's Global Health Imperative, RTI International, Media, Pennsylvania, United States.

The South African Journal of Psychiatry : SAJP : the Journal of the Society of Psychiatrists of South Africa

|July 4, 2025

Insights

Combined alcohol and substance use during pregnancy and postpartum is linked to lower child growth. Interventions are needed to mitigate these adverse effects on infant development.

Area of Science:

Perinatal health
Child development
Substance use research

Background:

Perinatal alcohol and non-prescribed substance use can negatively impact fetal and infant development.
Continued use of these substances throughout pregnancy and postpartum poses risks.

Purpose of the Study:

To investigate the association between combined and continued alcohol and non-prescribed substance use during antenatal and postnatal periods.
To examine the impact on child length and weight outcomes up to 24 months.

Main Methods:

Observational study using data from the Drakenstein Child Health Study (DCHS) cohort (n=1098).
Analysis of alcohol and non-prescribed substance use and child growth outcomes at 12, 18, and 24 months.
Generalized estimating equations used for standardized length and weight outcomes.

Main Results:

Combined alcohol and substance use (primarily tobacco) was associated with significantly lower child length and weight.
Continuous use throughout pregnancy and the first year postpartum also correlated with reduced child growth.
Findings were confirmed by multivariable analyses (p < 0.001).

Conclusions:

Combined and continuous alcohol and substance use during pregnancy and postpartum negatively affects early child growth.
Interventions are necessary to address the long-term consequences of such use on child development.

Read full analysis

Abstract

Background:

Perinatal alcohol and non-prescribed substance use may be detrimental to foetal and infant growth.

Aim:

This observational study investigated how combined and continued alcohol and non-prescribed substance use throughout antenatal and 1-year postnatal periods were associated with adverse child length and weight outcomes up to 24 months.

Setting:

Data from participants (n = 1098) with information on alcohol and non-prescribed substance use and infant and child outcomes, were drawn from a prospective birth cohort in the Drakenstein Child Health Study (DCHS), conducted in the Western Cape province of South Africa.

Methods:

Generalised estimating equations were conducted on standardised child length and weight outcomes at 12, 18 and 24 months.

Results:

Non-prescribed substances consisted mostly of tobacco use (77%). Child length and weight were significantly lower in those exposed to the combined use of alcohol and substances compared to no-use and all other use groups (p < 0.001), as confirmed by multivariable analyses. Child length and weight were also significantly lower in those exposed to alcohol and/or substance use throughout the antenatal and 1-year postnatal periods, as confirmed by multivariable analyses.

Conclusion:

Interventions to address the potential long-term adverse effects of combined alcohol and substance use particularly tobacco use, as well as continuous use throughout antenatal and early postnatal periods on subsequent child growth, are needed.

Contribution:

This study has contributed to the field by showing that combined and continued use of alcohol and other substances during pregnancy and postpartum is associated with impaired early child growth.

Keywords:

combined alcohol and substance use early postpartum infant child length infant child weight pregnancy

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