Beyond Single Use: The Combined Effect of Alcohol and Tobacco Use on Depression Among Pregnant Women
Abstract
Depression remains a pervasive mental health challenge during pregnancy, affecting approximately 25% of expectant mothers worldwide. Substance use during pregnancy, an under-recognized and under-supported condition, has been consistently associated with prenatal depressive symptoms. While alcohol and tobacco use have each been individually linked to prenatal depression, research directly comparing single-substance use with co-use as predictors is limited. Investigating potential additive or synergistic effects of co-use could inform the development of targeted, integrated interventions addressing co-occurring substance use and mental health conditions during pregnancy. The primary aim of this study is to examine the association between substance use patterns during pregnancy (cigarette smoking, e-cigarettes, alcohol) and self-reported prenatal depression with adjustment for key confounders. Data were drawn from the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2016-2022), a nationally population-based representative surveillance system of women with recent live births in the United States. The analytic sample consists of participants with complete data on the self-reported outcome (prenatal depression) and primary exposure (8-level substance use pattern of single or combined use), yielding a total of N=219,274 observations. Statistical analysis was done using ANOVA for continuous variables and chi-square tests for categorical variables. Participants reporting prenatal depression were modestly younger, from slightly smaller households, lower-income, and more often reported unwanted or mistimed pregnancies, as well as exposure to domestic violence and pregnancy complications. Overall, these patterns demonstrate substantial socioeconomic, behavioral, and psychosocial differences between outcome groups and support inclusion as covariates in multivariable modeling. After covariate adjustment, all substance exposure patterns were associated with a higher prevalence of prenatal depression relative to no substance use, with the highest rate seen in smoking combined with e-cigarettes at a rate of 2.7 (1.11-6.67), compared to those not using any substance.
Start Time
15-4-2026 9:00 AM
End Time
15-4-2026 12:00 PM
Room Number
Culp Ballroom 316
Poster Number
60
Presentation Type
Poster
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Emily Flores
Beyond Single Use: The Combined Effect of Alcohol and Tobacco Use on Depression Among Pregnant Women
Culp Ballroom 316
Depression remains a pervasive mental health challenge during pregnancy, affecting approximately 25% of expectant mothers worldwide. Substance use during pregnancy, an under-recognized and under-supported condition, has been consistently associated with prenatal depressive symptoms. While alcohol and tobacco use have each been individually linked to prenatal depression, research directly comparing single-substance use with co-use as predictors is limited. Investigating potential additive or synergistic effects of co-use could inform the development of targeted, integrated interventions addressing co-occurring substance use and mental health conditions during pregnancy. The primary aim of this study is to examine the association between substance use patterns during pregnancy (cigarette smoking, e-cigarettes, alcohol) and self-reported prenatal depression with adjustment for key confounders. Data were drawn from the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2016-2022), a nationally population-based representative surveillance system of women with recent live births in the United States. The analytic sample consists of participants with complete data on the self-reported outcome (prenatal depression) and primary exposure (8-level substance use pattern of single or combined use), yielding a total of N=219,274 observations. Statistical analysis was done using ANOVA for continuous variables and chi-square tests for categorical variables. Participants reporting prenatal depression were modestly younger, from slightly smaller households, lower-income, and more often reported unwanted or mistimed pregnancies, as well as exposure to domestic violence and pregnancy complications. Overall, these patterns demonstrate substantial socioeconomic, behavioral, and psychosocial differences between outcome groups and support inclusion as covariates in multivariable modeling. After covariate adjustment, all substance exposure patterns were associated with a higher prevalence of prenatal depression relative to no substance use, with the highest rate seen in smoking combined with e-cigarettes at a rate of 2.7 (1.11-6.67), compared to those not using any substance.
