Evaluating alcohol, tobacco, and other substance use in pregnant women

Use of tobacco, alcohol, and psychoactive substances during pregnancy is associated with increased risks of preterm birth. Concurrent use of these substances is also quite common and further increases the risk of adverse outcomes. Health-care providers should ask pregnant women about their exposure to tobacco, second-hand smoke, alcohol, and illicit substances (past and present) at every antenatal visit using validated screening instruments and offer brief interventions.

Pregnant women with alcohol or substance dependence should be assessed individually and offered psychosocial interventions (e.g. motivational interviewing, cognitive behavioural therapy, contingency management). Pregnant women should be advised to quit and referred to detoxification services or opioid substitution treatment (for opioid users). Pharmacological treatment for maintenance and relapse prevention is not recommended for amphetamine, cannabis, and cocaine dependence and requires individual risk-benefit analysis for alcohol dependence. Opioid maintenance therapy with methadone or buprenorphine is recommended for opiate dependence. Pregnant women who are current tobacco users or have recently quit should be offered psychosocial interventions (e.g. counselling, incentives, social support). Evidence on impact of pharmacological interventions for cessation of tobacco use is limited. Interventions to make public places and homes smoke-free are recommended. Evidence of impact of these interventions in reducing PTB especially in LMIC settings is low and further research recommended.