Timing of intimate partner violence and alcohol and cigarette use across the perinatal period among American Indian and Alaska Native women.

backgroundIntimate partner violence (IPV) and substance use are closely linked and pose significant risks during the perinatal period. American Indian and Alaska Native (AI/AN) women experience disproportionately high rates of IPV and inequities related to perinatal substance use outcomes, yet research is limited regarding timing of IPV exposure and how it relates to perinatal substance use. This study examined associations between IPV exposure before and during pregnancy and patterns of alcohol use and cigarette smoking across the perinatal and postpartum periods among AI/AN women.

methodsWe analyzed pregnancy risk assessment monitoring system (PRAMS) data from 2016 to 2022 in a cross-sectional design. IPV exposure was categorized as occurring before pregnancy, during pregnancy, or both. Outcomes included alcohol use frequency, heavy drinking (≥ 8 drinks per week), and cigarette smoking before pregnancy, during pregnancy, and postpartum. Survey-weighted ordinal logistic and logistic regression models were used, adjusting for sociodemographic and pregnancy-related factors. Predicted probabilities were calculated. Exploratory analyses examined associations between partner race and IPV.

resultsAI/AN women reported higher prevalence of IPV before and during pregnancy (p < 0.001). In adjusted models, IPV before pregnancy was not associated with alcohol use frequency but was associated with higher odds of heavy drinking (aOR = 1.75, 95% CI 1.07-2.85). AI/AN women had higher odds of heavy drinking compared with Non-Hispanic White (NHW) women (aOR = 1.80, 95% CI 1.31-2.46), with the highest predicted probabilities observed among AI/AN women experiencing IPV (12.1%). IPV before pregnancy was also associated with higher odds of cigarette smoking before pregnancy, during late pregnancy, and postpartum (aORs 1.45-1.89), while IPV during pregnancy was associated with postpartum smoking (aOR = 2.82, 95% CI 1.23-6.44). Predicted probabilities indicated higher smoking across periods among those with IPV exposure, particularly among AI/AN women. In exploratory analyses, partner racial concordance was associated with lower odds of reported IPV among AI/AN women.

conclusionsIPV exposure was associated with more severe and persistent patterns of perinatal substance use, with the highest predicted probabilities of heavy drinking and persistent smoking observed among AI/AN women experiencing IPV. These findings underscore the importance of trauma-informed, culturally grounded harm reduction approaches that address both IPV and substance use across the perinatal period. Efforts should be situated within the broader context of structural and historical inequities while recognizing Indigenous communities strengths and resilience.