Maternal adverse childhood experiences, financial stress, and substance use in pregnancy
Introduction: Maternal substance use during pregnancy is linked to poor delivery outcomes and severe long-term effects on children. Recent literature has found associations between maternal substance misuse and history of Adverse Childhood Experiences (ACEs), including abuse, neglect, and household dysfunction. However, it is unknown to what extent other highly comorbid social risk factors such as mental health difficulties and financial issues may play a role in this association. The goal of the study was to determine whether maternal ACEs, financial stress, depression, and anxiety predict substance use behaviour during pregnancy using a patient population.
Methods: Data was obtained from the healthcare records of 209 mothers in a maternity clinic in Calgary, Alberta. Mothers retrospectively reported their ACEs during their second prenatal visit. Mothers were screened for anxiety and depression using the Generalized Anxiety Disorder-2 item (GAD-2) and Personal Health Questionnaire-2 item (PHQ-2). Use of tobacco products, alcohol, marijuana, and illicit drugs during pregnancy, as well as perceived financial difficulties, were extracted from healthcare files. Logistic regression was conducted.
Results: No participants were excluded. 12% of the sample used at least one substance during pregnancy. 33% had at least one ACE. Individuals with financial stress were significantly more likely to use substances during pregnancy (OR=6.19, 95% CI=1.43, 26.73). After controlling for other variables including financial stress, a high ACE score was also associated with substance use (OR=1.96, 95% CI=1.30, 2.95). Depression and anxiety were not significantly predictive of substance use.
Conclusion: Maternal ACEs and financial stress can predict substance use during pregnancy. Financial stress alone may be more useful in screening for substance use than ACEs and may minimize the risk of re-traumatization that may be caused by the ACEs questionnaire. Increasing knowledge of prevalence of substance use may reduce barriers to care.