Prevalence of substance use during pregnancy in New Jersey: Investigating the effects of the COVID-19 public health emergency.

Background: Emerging evidence suggests that maternal substance use patterns may have changed following the declaration of the COVID-19 pandemic. We used comprehensive administrative birth record data to examine these changes at the population level. Methods: We examined trends in prenatal substance use (alcohol, tobacco, and other substances) in New Jersey using birth certificate data from January 2016 to June 2021 (N = 566,568). Segmented logistic regression models were used to evaluate changes in substance use odds around the declaration of the COVID-19 public health emergency (March 1, 2020). All models were adjusted for maternal age and race/ethnicity. Interaction analyses were conducted to test whether observed changes differed by maternal employment and education. Results: Alcohol and other substance use increased significantly after the declaration of COVID-19 public health emergency, while tobacco use decreased. Those changes in odds-ratios corresponded to an estimated 312 and 155 additional babies exposed to prenatal alcohol and other substance use, and 221 fewer babies exposed to prenatal tobacco during the year following declaration of the COVID-19 pandemic. Changes in alcohol and other substance use following the COVID-19 public health emergency differed as a function of maternal employment and education. Conclusions: The COVID-19 pandemic was associated with significant shifts in trends in maternal substance use during pregnancy in New Jersey.