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.