Tobacco, alcohol and caffeine use during pregnancy and lactation: A narrative review

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Introduction The perinatal period is crucial for maternal and fetal health, with lifestyle factors significantly shaping pregnancy outcomes and child development. This narrative review consolidates existing literature on the prevalence of substance use, its impacts on fetal and neonatal health, maternal risk factors associated with such behaviors, and management strategies for tobacco, alcohol, and caffeine consumption during pregnancy and lactation. Methods This narrative review synthesized studies published in English from 2000 onwards, identified through electronic databases such as PubMed and Google Scholar, using specific key terms. Screening and data extraction were conducted independently by two investigators, with any disagreements resolved through discussion or consultation with a third investigator. A formal quality assessment of the included studies was not undertaken. Results Global tobacco use during pregnancy ranges from 1.7% (95% CI: 0.0–4.5) to 21% (95% CI: 17–26), with smoking rates during lactation at 1.16% (95% CI: 1.11–1.21) in low- and middle-income countries. In Greece, rates vary from 12.4%–48% during pregnancy and 5.6%–22% during breastfeeding. Approximately 10% of pregnant women globally consume alcohol, with cultural norms influencing regional variations; Greece mirrors global trends. Alcohol use during lactation ranges from 5.5% in Greece to 47% in Australia. Caffeine consumption exceeds 80% in the United States and Greece during pregnancy, with lactation rates from 49.3%–84.8% in diverse national studies. Maternal use of these substances is associated with adverse outcomes, such as fetal growth restriction, developmental delays, and cognitive impairments. Psychosocial, cultural, and physiological factors are key risk factors, highlighting the importance of tailored interventions. Conclusions Evidence-based strategies, including cessation programs, education, and tailored support, are vital for reducing risks and encouraging healthier maternal behaviors. Combining pharmacologic and non-pharmacologic approaches enables healthcare providers, particularly midwives, to enhance maternal and infant outcomes during pregnancy and postpartum.