Select Page


British Journal of Health Psychology (2005), 10, 255–268

Substance Use Among Pregnant Women in the Context of Previous Reproductive Loss and Desire for Current Pregnancy

Women with a history of induced abortion are three times more likely to use illegal drugs during a subsequent pregnancy… 

The study supports a growing body of evidence which suggests that later pregnancies may arouse unresolved grief over prior abortions which women may seek to suppress by increased reliance on drugs and alcohol…At least 21 previous studies have linked abortion with increased rates of subsequent drug and alcohol abuse.

Researchers [Bowling State Univ, Univ of Texas, and the Elliot Institute] examined data from a study sponsored by the U.S. Department of Health and Human Services (HHS) & the National Institute on Drug Abuse.

The data included 1,020 women who gave birth in one of 8 Washington, D.C.-area hospitals during 1992.

Analyses of the data revealed that while women who had induced abortions were significantly more likely to engage in substance use during subsequent pregnancies, women who had experienced miscarriages or stillbirths were not.

Previous studies have found that women with a history of abortion are subsequently at increased risk for depression, generalized anxiety disorder, suicidal tendencies and psychiatric hospitalization. At least 21 previous studies have linked abortion with increased rates of subsequent drug and alcohol abuse.

“Most women have deeply conflicted feelings about their past abortions,” said Elliot Institute director Dr. David Reardon, one of the authors of the new study. “Later pregnancies may arouse or aggravate unsettled emotions. Some women will experience increased anxiety, perhaps about the health of their unborn baby. Others are so awed by the life within them that they begin to question their past choice and feel drowned in self-blame. Still others may find that they have a lot of unmourned grief related to a past abortion that is interfering with their ability to enjoy and bond with their new baby.

“Whatever the individual experience, it is clear that pregnant women with a history of abortion are at greater risk of trying to suppress their turbulent emotions by relying on more alcohol, cigarettes, or illegal drugs.”

Substance use during pregnancy is an increasing public health concern. Alcohol and drug use has been linked to numerous problems in infants such as congenital birth defects, low birth weight, developmental and learning problems, and death.

This new study confirms a study recently published in the American Journal of Obstetrics and Gynecology that also revealed higher rates of substance use during later pregnancies among women with a history of induced abortion.

Medical professionals should be aware of these issues so they can more easily identify which pregnant women are at greater risk of substance use,” Reardon said. “Referral to post-abortion counseling and substance abuse programs may not only help protect the unborn child from exposure to dangerous substances, it may also help the mother to resolve issues related to the traumas of a past abortion.”

Study Citation:

Priscilla K. Coleman, D. Reardon, Jesse Cougle, “Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy,” British Journal of Health Psychology (2005), 10:255-268. [;, Elliot Institute, 12Jul05]


Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy
Authors: Coleman, Priscilla K.1; Reardon, David C.2; Cougle, Jesse R.3
British Journal of Health Psychology, May 2005, vol. 10, no. 2, pp. 255-268(14)

Publisher: British Psychological Society

The primary objectives of this study were to explore maternal history of perinatal loss and pregnancy wantedness as correlates of substance use during pregnancy.

Method: The research design involved interviewing women who gave birth in Washington DC hospitals during 1992. Interview data included pregnancy history (prior births, induced abortions, miscarriages, and stillbirths), desire for the pregnancy (wanted, not wanted, mistimed), socio-demographic information, timing of onset of prenatal care, and substance use (cigarettes, alcohol, and drugs) during pregnancy.

Results: A history of induced abortion was associated with elevated risk for maternal substance use of various forms; whereas other forms of perinatal loss (miscarriage and stillbirth) were not related to substance use. Unwanted pregnancy was associated with cigarette smoking during pregnancy, but not with any other forms of substance use.

Conclusions: Reproductive history information may offer insight to professionals pertaining to the likelihood of women using substances in a later pregnancy.

Adler, N. E. (1975). Emotional responses of women following therapeutic abortion: How great a
problem? Journal of Applied Social Psychology, 6, 240–259.
Alan Guttmacher Institute (2003). State facts about abortion: The District of Columbia, on line,
Alan Guttmacher Institute [
Altfed, S., Handler, A., Burton, D., & Berman, L. (1997). Wantedness of pregnancy and prenatal
health behaviors. Women & Health, 26, 29–43.
Armstrong, D. S. (2000). Emotional distress and prenatal attachment in pregnancy after perinatal
loss. Journal of Nursing Scholarship, 32, 339–345.
Bracken, M. B., & Kasi, S. (1975). First and repeat abortions: A study of decision-making and delay.
Journal of Biosocial Science, 7, 473–491.
Bradley, C. F. (1984). Abortion and subsequent pregnancy. Canadian Journal of Psychiatry, 29,
Braveman, P., Marchi, K., Egerter, S., Pearl, M., & Neuhaus, J. (2000). Barriers to timely prenatal
care among women with insurance: The importance of prepregnancy factors. Obstetrics and
Gynecology, 95, 874–880.
Burke, T., & Reardon, D. C. (2002). Forbidden grief: The unspoken pain of abortion. Springfield,
IL: Acorn Books.
Chasnoff, I. J., Landress, G. H., & Barnett, M. E. (1990). The prevalence of illicit drug or alcohol use
during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. New
England Journal of Medicine, 322, 1202–1206.
Coleman, P.K., & Nelson, E.S. (1998). The quality of abortion decisions and college students’
reports of post-abortion emotional sequelae and abortion attitudes. Journal of Social and
Clinical Psychology, 17, 425–442.
Coleman, P. K., Reardon, D. C., Rue, V., & Cougle, J. (2002). Prior history of induced abortion and
substance use during pregnancy. American Journal of Obstetrics and Gynecology, 187,
Conklin, M. P., & O’Connor, B. P. (1995). Beliefs about the fetus as a moderator of post-abortion
psychological well-being. Journal of Social and Clinical Psychology, 14, 76–95.
Dailard, C., Nash, E (December, 2000). The Guttmacher Report on Public Policy, on line, Alan
Guttmacher Institute, 3(6) [].
Drower, S. J., & Nash, E. S. (1978). Therapeutic abortion on psychiatric grounds. Part I. A local
study. South African Medical Journal, 54, 604–608.
Fisher, S. (1986). Reflections on repeat
ed abortions: The meanings and motivations. Journal of
Social Work Practi
ce, 2, 70–87.
Frank, D. A., Zuckerman, B. S., Amaro, H., Aboagye, K., Bauchner, H., Cabral, H., Fried, L., Hingson,
R., Kayne, H., & Levenson, S. M. (1988). Cocaine use during pregnancy: Prevalence and
correlates. Pediatrics, 82, 888–895.
Graham, K., & Koren, G. (1991). Characteristics of pregnant women exposed to cocaine in
Toronto between 1985 and 1990. Canadian Medical Association Journal, 144, 563–568.
Hans, S. L. (1999). Demographic and psychosocial characteristics of substance-abusing pregnant
women. Clinics in Perinatology, 25, 55–74.
Harlap, S., & Davies, A. (1975). Characteristics of pregnant women reporting previous induced
abortions. Bulletin of the World Health Organization, 52, 149.
Harlap, S., Shiono, P., & Ramcharan, S. (1979). Prospective study of spontaneous fetal losses after
induced abortion. New England Journal of Medicine, 301, 677–681.
Harmon, R. J., Plummer, N. S., & Frankel, K. A. (2000). Perinatal loss: Parental grieving, family
impact, and intervention services. In J. D. Osofsky & H. E. Fitzgerald (Eds.), World association
for infant mental health handbook of infant mental health: Volume 4, Infant mental health
in groups at risk. New York: Wiley.
Priscilla K. Coleman et al. 266
Hellerstedt, W. L., Pirie, P. L., Lando, H. A., Curry, S. J., McBride, C. M., Grothaus, L. C., & Nelson,
J. V. (1998). Differences in preconceptual and prenatal behaviors in women with intended and
unintended pregnancies. American Journal of Public Health, 88, 663–666.
Henshaw, S., & Silverman, J. (1988). The characteristics and prior contraceptive use of U.S.
abortion patients. Family Planning Perspectives, 20, 158–168.
Hulsey, T. M. (2001). Association between early prenatal care and mother’s intention of and desire
for the pregnancy. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 30, 275–282.
Hutchings, D. E. (1993). The puzzle of cocaine’s effects following maternal use during pregnancy.
Are there reconcilable differences? Neurotoxicology and Teratology, 15, 281–286.
Jones, E. F., & Forrest, J. D. (1992). Under reporting of abortion in surveys of U.S. women: 1976 to
1988. Demography, 29, 113–126.
Joyce, T.J., Kaestner, R., & Korenman, S. (2000). The effect of pregnancy intention on child
development. Demography, 37, 83–94.
Kost, K., Landry, D. J., & Darroch, J. E. (1998). Predicting maternal behaviors during pregnancy:
Does intention status matter? Family Planning Perspectives, 30, 79–88.
Kullander, S., & Kallen, B. (1971). A prospective study of smoking and pregnancy. Acta Obstetrica
et Gynecological Scandinavica, 50, 83–94.
Kuzma, J., & Kissinger, D. (1981). Patterns of alcohol and cigarette use in pregnancy.
Neurobehavioral Toxicology and Teratology, 3, 211–221.
Leach, J. (1977). The repeat abortion patient. Family Planning Perspectives, 9, 37–39.
Leathers, S. J., & Kelley, M. A. (2000). Unintended pregnancy and depressive symptoms among
first-time mothers and fathers. American Journal of Orthopsychiatry, 70, 523–531.
Lemkau, J. P. (1988). Emotional sequelae of abortion: Implications for clinical practice. Psychology
of Women Quarterly, 12, 461–472.
Major, B., & Gramzow, R.H. (1999). Abortion as a stigma: Cognitive and emotional implications of
concealment. Journal of Personality and Social Psychology, 77, 735–745.
Mayor, J. P. (1997). Unintended childbearing, maternal beliefs, and delay of prenatal care. Birth,
24, 247–252.
Meirik, O., & Nygren, K. G. (1984). Outcome of first delivery after second trimester two staged
induced abortion. Acta Obstetrica et Gynecological Scandinavica, 63, 45–50.
Mendelson, M. T., Maden, C. B., & Daling, J. R. (1992). Low birth weight in relation to multiple
induced abortions. American Journal of Public Health, 82, 391–394.
Miller, W. B., Pasta, D. J., & Dean, C. L. (1998). Testing a model of the psychological consequences
of abortion. In L. J. Beckman & S.M. Harvey (Eds.), The new civil war: The psychology, culture,
and politics of abortion. Washington, DC: American Psychological Association.
Ondersma, S. J., Simpson, S. M., Brestan, E. V., & Ward, M. (2000). Prenatal drug exposure and
social policy: The search for an appropriate response. Child Maltreatment: Journal of the
American Professional Society on the Abuse of Children, 5, 93–108.
Oro, A. S., & Dixon, S. D. (1987). Perinatal cocaine and methamphetamine exposure: Maternal and
neonatal correlates. Journal of Pediatrics, 111, 571–578.
Pagnini, D. L., & Reichman, N. E. (2000). Psychosocial factors and the timing of prenatal care
among women in New Jersey’s HealthStart Program. Family Planning Perspectives, 32,
Peppers, L. G., & Knapp, R. J. (1980). Maternal reactions to involuntary fetal/infant death.
Psychiatry, 43, 155–159.
Poole, V. L., Klerman, L. V., Flowers, J. S., Goldenberg, R. L., & Cliver, S. P. (1997). Journal of Drug
and Alcohol Abuse, 26, 61–75.
Reardon, D. C., & Ney, P. G. (2000). Abortion and subsequent substance abuse. American Journal
of Drug and Alcohol Abuse, 26, 61–75.
Rue, V., Shutova, L (March, 2001). Posttraumatic Stress Symptoms and Elective Abortion:
A Comparison of U.S. and Russian Women. Paper presented at the 1st World Congress on
Women’s Mental Health, Berlin.
Substance use in pregnancy 267
Shusterman, L. R. (1979). Predicting the psychological consequences of abortion. Social Science and Medicine, 13, 683–689.
Streissguth, A. P. (1997). Fetal alcohol syndrome: A guide for families and communities. Baltimore, MD: Paul H. Brookes.
Streissguth, A. P., Barr, H. M., & Sampson, P. D. (1990). Moderate prenatal alcohol exposure: Effects on child IQ and learning problems at age seven and a half years. Alcoholism: Clinical and
Experimental Research, 14, 662–669.
Streissguth, A. P., Barr, H. M., Sampson, P. D., & Bookstein, F. L. (1994). Prenatal alcohol and offspring development. The first fourteen years. Drug and Alcohol Dependence, 36, 89–99.
United States Department of Health and Human Services (1998). National Institute on Drug Abuse. Washington, DC Metropolitan Area Drug Study, 1992: Drug Use Among DC Women Delivering Live Births in DC Hospitals (Computer file)/ICPSR version. Research Triangle Park,
NC: Research Triangle Institute (producer), 1995. Ann Arbor, MI: Inter-university Consortium for Political and Social Research (distributor).
United States General Accounting Office (1990). Drug exposed infants: A Generation at Risk: Report to the Chairman, Committee on Finance, U.S. Senate (GAO Publication No. HRD 90–138) Washington, DC: U.S. Government Printing Office.
Vila, K. L. (2002). Maternal attitude following abortion, miscarriage, and perinatal loss. Dissertation abstracts international: Section B: The sciences & engineering, 62, 5397.
Zavodny, M. (2001). The effect of partners’ characteristics on teenage pregnancy and its resolution. Family Planning Perspectives, 33, 192–199 See also page 205.
Zuckerman, B., & Brown, E. R. (1993). Maternal substance use and infant development. In C. H. Zeanah (Ed.), Handbook of infant mental health (pp. 143–158). New York: Guilford.

Received 19 May 2003; revised version received 18 March 2004


Priscilla K. Coleman1*, David C. Reardon2 and Jesse R. Cougle3
1Bowling Green State University, USA
2Elliot Institute, USA
3University of Texas, USA

DOI: 10.1348/135910705X25499