Prenatal Substance Use Counseling: Missed Opportunities for Intervention

Despite longstanding clinical guidance warning against substance use during pregnancy, new research presented at the 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical & Scientific Meeting, May 16-18, 2025, in Minneapolis, MN, reveals scenarios that pose a risk to expectant women and their unborn babies: perceived gaps in clinician counseling on abstinence and the dangers and overlooked influence of partners with substance use histories.1

In a survey conducted at Jefferson-Einstein Medical Center in Philadelphia, near-universal claims by obstetric clinicians that they counsel pregnant patients on the dangers of alcohol, tobacco, and marijuana use was countered by reports from patients, only about half of who recall receiving such guidance.

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For the study, researchers surveyed 38 obstetric clinicians and 38 pregnant patients to assess the frequency and effectiveness of counseling on substance use during pregnancy, according to presenting author Kathryne Staudinger, MD, and colleagues. Clinicians overwhelmingly reported delivering counseling on the cessation of alcohol, smoking, and marijuana during pregnancy at rates of 100%, 100%, and 92%, respectively. In contrast, only 50%, 55%, and 37% of patients recalled receiving counseling on these topics. ACOG recommends that obstetricians counsel against substance use during pregnancy as well as on risks posed to the developing fetus, according to the study abstract.1

Discrepancies persisted when Staudinger et al compared reports of counseling about fetal risks. Again, clinicians indicated near-total compliance, with 100% reporting counseling about alcohol-related risks, 97% about tobacco, and 84% about marijuana. However, only 58% of patients recalled receiving information on alcohol-related fetal risks, 61% on smoking, and 53% on marijuana.

Interestingly, clinician and patient beliefs about marijuana safety during pregnancy showed minimal divergence, with 26% of the former and 24% of the latter believing cannabis use was safe during pregnancy.1

The findings suggest a significant communication gap. Although providers believe they are meeting the ACOG guidelines, patients may not retain or recognize these messages, the authors suggest. The study underscores the need for improved strategies to ensure patients not only hear but understand and remember these critical warnings.1

Intimate Partner Influence
A separate large study by researchers from researchers at Kaiser Permanente Northern California found that pregnant individuals with a partner who has a history of problematic substance use face significantly higher odds of using alcohol, cannabis, e-cigarettes, and tobacco during early pregnancy. The area of partner history shaping prenatal behavior is little studied but of growing interest, presenting author Sarah Gallegos, and colleagues wrote in the study abstract.2

Researchers analyzed data from 82,180 pregnant people screened at approximately 8–10 weeks’ gestation during their first prenatal visit at Kaiser Permanente Northern California between 2021 and 2022. Among them, 1,010 (1.2%) reported a partner history of problematic substance use. The presence of such a history corresponded with a markedly increased risk of prenatal substance use across all categories studied. Specifically, adjusted odds ratios (aOR) revealed elevated odds of any prenatal substance use (aOR 1.80; 95% CI, 1.56–2.08), alcohol use (aOR 1.58; 95% CI, 1.33–1.87), cannabis use (aOR 1.89; 95% CI, 1.57–2.27), e-cigarette use (aOR 3.38; 95% CI, 2.43–4.58), and tobacco use (aOR 3.66; 95% CI, 2.63–4.96).2

Substance use was identified through both self-reported questionnaires and urine toxicology screens for cannabis. Frequency analysis further showed that partner history of substance use correlated with both frequent (weekly or daily) and infrequent (monthly or less) use compared to no use.2

Taken together, these findings emphasize the need to strengthen prenatal substance use prevention on two fronts: improving the clarity and consistency of clinician counseling and addressing the broader social context—particularly partner influence—that shapes patient behavior. Integrating both perspectives into early prenatal care could close critical gaps in communication and risk reduction.

Check out all the Patient Care ACOG 2025 coverage.

References
1. Staudinger K, Michelet M, Goldberg M, Goldberg J. How effective are obstetric providers at counseling about alcohol, tobacco, and marijuana use during pregnancy. Abstract presented at: 2025 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting; May 16-18, 2025; Minneapolis, MN.
2. Gallegos S, Slama NE, Duggan MC, Ansley DR, Castellanos CL, Young-Wolff CP. Prenatal substance use is associated with partner history of problematic use. Abstract presented at: 2025 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting; May 16-18, 2025; Minneapolis, MN.