Reproductive
Substance Use and Pregnancy Attempts in the Apple Women’s Health Study Michelle Klawans* Michelle Klawans Klawans Klawans Klawans Klawans National Institute of Environmental Health Sciences
Background: Use of alcohol, electronic nicotine devices (ENDs), and cannabis is common and increasing among women of reproductive age. However, little is known about patterns of use when starting an attempt to conceive a pregnancy.
Methods: We analyzed data from Apple Women’s Health Study (AWHS) participants aged 18-44 years who consented and enrolled between November 2019 and July 2025 and began a pregnancy attempt after enrollment. Substance use was reported on a monthly questionnaire along with whether a participant was trying to become pregnant that month. We calculated the overall prevalence of tobacco, alcohol, and cannabis use in the first study cycle. We also calculated first study-cycle prevalence of use for those who started a pregnancy attempt at any time during follow-up and compared this with the prevalence of use among those who did not start a pregnancy attempt within 6 months of enrollment.
Results: A total of 104,368 participants were included, of whom 6,549 reported starting a pregnancy attempt during follow-up. In the first study cycle from all participants, the prevalence of alcohol use was 61% (n=63,418), cigarettes, 3.4% (n=3,596), ENDs, 16% (n=17,401), and cannabis, 28% (n=29,250). In the first month of attempting pregnancy, the prevalence of current cannabis use was 20% (n=329/1,647) which was similar to use among those not attempting pregnancy, 21% (n=396/1,910). Those in the first month of attempting to conceive were slightly less likely to report current alcohol use than those who were not attempting to conceive (n=994/1,654; 60.0% vs. n=1285/1921; 66.9%).
Conclusion: In this sample of AWHS participants, those who started attempting to conceive a pregnancy had a similar prevalence of current cannabis use as those who did not start a pregnancy attempt. Use of alcohol and cannabis were common in those beginning a pregnancy attempt.