Socio-Ecological Factors Impacting Smoking and Recreational Drug Use During Pregnancy: Insights from the Albany Infant and Mother Study

INTRODUCTION: Smoking and recreational drug use during pregnancy are significant public health challenges with multifactorial etiology. Most research focuses on the independent contributions of single risk factors. Grounded in the socio-ecological model and the problem behavior theory, this study aimed to identify the broad range of life course individual, interpersonal, and social-contextual factors influencing smoking and recreational drug use during pregnancy among a socioeconomically disadvantaged and racial/ethnic diverse study population. METHODS: Participants were 291 pregnant women from the Albany Infant and Mother Study (NY, USA). We employed a multimodal design incorporating participant self-reports, physician-assessed clinical characteristics, and area-level measures of neighborhood context. RESULTS: 15.1% of participants reported smoking, and 21.0% reported recreational drug use during pregnancy. Pregnancy conditions were linked to lower odds of smoking during pregnancy (OR=0.36, 95% CI: 0.13-0.98), while experience of discrimination increased the odds (OR=1.34, 95% CI: 1.08-1.65). Higher parity (OR=4.27), pre-pregnancy physical health conditions (OR=1.39), adverse childhood experiences (ACEs) (OR=1.21), and a poor home physical environment (OR=1.15) were all associated with increased odds of recreational drug use during pregnancy. CONCLUSIONS: Several different psychosocial, physical health, and socio-environmental factors were associated with tobacco and substance use behaviors among pregnant women, thereby providing a holistic understanding of these behaviors. The study offers insights for the development of interventions thereby contributing to improved maternal and fetal health outcomes.