Canadian health care providers’ perspectives on alcohol and nicotine use in pregnancy and postpartum: Results of a cross-sectional survey

Introduction: Alcohol and nicotine use during pregnancy and postpartum are associated with adverse maternal and fetal outcomes. While Canadian guidelines recommend abstinence from alcohol during pregnancy, comparable national guidance for nicotine is limited. This study assessed a sample of Canadian health care providers’ (HCPs) knowledge, attitudes, and practices related to alcohol and nicotine use during the perinatal period. Methods: A 46-item online survey with open- and closed-ended questions was distributed in February 2025 through the Society of Obstetricians and Gynaecologists of Canada and partner networks. Eligible participants were HCPs providing pregnancy or postpartum care. Quantitative data were analyzed descriptively, and open-text responses underwent descriptive and semantic thematic analysis. Results: Sixty-nine HCPs from across Canada completed the survey. Most reported routinely screening for alcohol (96.97%) and nicotine (95.45%) use and generally recommended abstinence during pregnancy. However, inconsistencies were evident in guidance regarding low-level alcohol use, nicotine replacement therapies, and alcohol and nicotine use during breastfeeding. Barriers included limited training, uncertainty about harm reduction strategies, limited community supports, and lack of clear referral pathways. While nearly all respondents endorsed behavioural counselling, fewer felt confident providing brief interventions, particularly for alcohol. Only half reported awareness of relevant clinical guidelines. Discussion: HCPs recognize perinatal risks associated with alcohol and nicotine use but face gaps in training, resources, and consistent guidance. Findings highlight the need for standardized national guidance, enhanced education, updated clinical resources, and system-level supports for evidence-informed, nonjudgemental perinatal care.