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Jump to Key Points The long-standing belief that pregnancy and motherhood shield women from substance use problems is being dismantled by mounting data.
Recent research suggests maternal substance use and prenatal drug exposure are on the rise — revealing that mothers are not only consuming more drugs and alcohol, but also that they may be experiencing disproportionate harm compared with their childless peers. In the US, recent data highlights rising rates of opioid use disorder during pregnancy, prenatal cannabis use concerns, and increasing alcohol consumption among pregnant women: A July JAMA analysis showed alcohol use among pregnant women climbed from 9% in 2011-2012 to nearly 15% in 2023-2024, with binge and heavy drinking more common among 18- to 24-year-olds.
The latest such study, from Ontario, Canada, looked at how these statistics translate to emergency medical care. Analyzing medical records for more than 2 million women ages 18-50, the matched cohort study found that the rate of emergency department visits for substance use increased 4.8% annually among mothers from 2008 to 2024, while the rate rose 1.7% for childless women of the same age. Hospital admissions rose at a rate of 6% annually for mothers compared with 3.3% for non-mothers.
“These findings need to be considered in the broader context of women’s mental health and the increasing pressures associated with parenting,” said Ariadna Forray, MD, professor of psychiatry and professor of obstetrics, gynecology & reproductive sciences at Yale School of Medicine in New Haven, Connecticut. (Forray was not involved in the study.)
- Maternal substance-related ED visits ↑ 4.8%/yr; childless women ↑ 1.7%/yr.
- Maternal hospital admissions ↑ 6%/yr vs 3.3% in non-mothers.
- Young mothers <25 drove increases; rates rose 4× faster than others.
- Alcohol caused 46% of maternal ED visits; 41% of hospitalizations in 2024.
- Amphetamines, cannabis, opioids showed greatest relative increases; postpartum period high-risk.
While no comparable acute care data exists for the US, Forray called the findings “highly relevant,” pointing to declines in self-reported maternal mental health, economic pressures, spotty insurance coverage, and punitive policies related to substance use during pregnancy, such as child protective services.
Younger Mothers Bear the Brunt
The increases in the Canadian study were driven by moms under age 25 — their substance use-related acute care rates grew four times faster than for other women. By contrast, young non-mothers’ rates improved over time, and moms over age 25 consistently experienced lower rates than their peers.
“This really isn’t a story about all moms,” said study author Colleen Webber, PhD, investigator at Bruyère Health Research Institute in Ottawa, Ontario, Canada. “It’s really concentrated in those youngest moms.”
Alcohol accounted for 46% of emergency department visits and for 41% of hospitalizations among mothers in 2024, holding its place as the main driver of substance-related acute care. Amphetamines, cannabis, and opioids were gaining ground and showed the greatest relative increases.
Why This Is Happening
Forray and Webber said the contributors to substance use during pregnancy and motherhood are varied, spanning the opioid epidemic and the rise of fentanyl to cannabis legalization, plus psychosocial factors and social determinants of health.
“We don’t have any reason to suspect that moms have been spared from the health harms related to these drug crises that we’re in,” Webber said. “We like to think maybe motherhood is protective, but there’s not any strong evidence to suspect that.” She called out “mommy wine culture” and the marketing of cannabis for dealing with parental stress.
The span of a couple of years from pregnancy through the postpartum period presents the greatest opportunity — and the greatest barriers — for intervention, Forray said, citing experiences from her own clinical practice.
“Pregnancy can be a powerful motivator for engaging in treatment,” she said. “However, the postpartum period brings new challenges, including sleep deprivation, changing relationships, financial pressures, and the demands of caring for an infant. At the same time, the intensity of healthcare contact often decreases after delivery, creating a particularly vulnerable transition.”
What Clinicians Need to Know
In Forray’s practice, she often has patients work “incredibly hard” toward recovery while preparing for birth but supports fall away afterward, even though the motivation to stay healthy remains.
“The other challenge they often have to navigate is interacting with child protective services, which for most women is a significant source of stress,” Forray said.
Forray advised clinicians to be alert to conversations that may sound like typical new parent chitchat but could indicate a trigger for mental health or substance use problems. Your patient might mention financial pressures, the challenges of balancing work and caregiving, or feeling like they’re going it alone.
“We may be underestimating the extent to which the circumstances surrounding motherhood influence women’s mental health and vulnerability to substance-related harms,” she said.
One key for clinicians, Forray said, is to recognize “that many of these women are deeply committed to their children. Their substance use should not be interpreted as evidence that they don’t care about their children or that they lack motivation to be healthy. In fact, fear of being judged as an unfit parent or losing custody of their children can become a major barrier to seeking treatment.”
The experts cited in this article reported having no relevant disclosures.
