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Problem Statement/Hypotheses: Substance use during pregnancy and the postpartum period is a major health concern for the fetus/newborn and family, with healthcare policy implications. This study addresses two questions: Are there differences in the trajectory of use of cigarettes, alcohol, and marijuana among Latino and African American adolescents from pregnancy through the postpartum? and What factors influence resumption and level of use following childbirth? Substance use was hypothesized to decrease during pregnancy and increase steadily following childbirth.

Literature Review: Adolescents face risk for perinatal substance use because of a number of factors, including past history of use and other risky behaviors. Few studies have described the trajectory of substance use over time. The use of cross-sectional designs limits our ability to understand factors associated with and predicting use.

Methodology:  This study employed longitudinal data from a larger clinical trial (Project CHARM). A secondary analysis was performed with 245 Latina and 60 African-American females recruited from alternative schools in Los Angeles. Data collected at four time points capture changes in substance use from pregnancy through the postpartum. Use of cigarettes, alcohol, and marijuana was examined in relation to three categories of predictor variables: 1) psychosocial - social support, depressive symptoms, self-worth, childhood abuse history, 2) behavioral – lifetime history of substance use, age at sexual debut and lifetime number of partners; and 3) sociodemographic - age, race/ethnicity, religiosity, family structure, acculturation. 

Data Analysis and Results:  Three separate latent growth curve analyses assessed the impact of variables on resumption of/change in use of cigarettes, alcohol, and marijuana. In the cigarette use model, lifetime smoking (p ≤ .05), abuse history (p ≤ .05), and being African American (p ≤ .01) predicted greater initial levels of smoking during pregnancy. Resumption of and increased cigarette smoking were influenced by lifetime history of smoking (p ≤ .001), less religiosity (p ≤ .05), and childbirth (p ≤ .05). Few variables predicted the initial level of alcohol use, partially because drinking was rare at baseline. Resumption and/or more drinking behavior during the postpartum was influenced by a history of alcohol use (p ≤ .001), past abuse, having a drug-using boyfriend, higher acculturation, less religiosity (all p ≤ .05), and lower self-worth (p ≤ .01). Following birth, adolescents were much more likely to increase their use of alcohol (p ≤ .001). Predictors of marijuana use included abuse history, having a substance-using boyfriend (both p ≤ .05), lifetime use of marijuana (p ≤ .001) and being African American (p ≤ .01). Many who reported ever using marijuana had discontinued use after birth or continued to use the drug at lower levels.

Discussion and Conclusions: These findings demonstrate that adolescents with a history of substance use often decrease or stop using cigarettes, alcohol, and marijuana during pregnancy. However, they face risk of resumption following childbirth. Pregnancy and the postpartum period offer a window of opportunity for supporting positive behavior changes and helping to prevent resumption of use. Assessment of factors associated with substance use will help identify adolescents facing risk.