Time-varying effects of substance craving on substance use among pregnant people in substance use disorder treatment

Objective Prenatal substance use is associated with negative outcomes for both the pregnant person and child. Entering substance use treatment during pregnancy is associated with improved outcomes but there are many barriers to treatment such as stigma. To improve prevention and treatment outcomes, it is critical to understand the relationship between risk/protective factors for substance use during pregnancy and to look for temporal changes in these relationships.Method Pregnant people (N = 32) with substance use disorder and a history of trauma exposure were included in this secondary analysis. Participants completed ecological momentary assessment (EMA), three times per day for 28 days. We used time-varying effects models (TVEMs) to examine the effects of craving on substance use, PTSD symptoms on craving, prenatal bonding on craving, and PTSD symptoms on prenatal bonding.Results Craving predicted substance use from gestational weeks 19.58 to 26.96. The relationship decreased over time and was not significant after week 27. PTSD symptoms predicted cravings at three times (weeks: 19.96–20.30, 23.36–31.68, 36.22–36.79). Maternal-fetal quality of attachment predicted craving from weeks 19.58–25.63. Maternal-fetal intensity of preoccupation predicted craving from weeks 19.58–22.42 and 31.31–31.87. PTSD symptoms predicted maternal fetal quality of attachment between weeks 25.06–26.20. There was no relationship between PTSD symptoms and maternal-fetal intensity of preoccupation over time.Conclusions These findings support prior research on the relationship between risk/protective factors for substance use during pregnancy. However, these relationships appear to fluctuate over time indicating that other factors might impact substance use during pregnancy.