Understanding the Links Between Pandemic Stress and Prenatal Substance Use

A groundbreaking study led by researchers including those from Bournemouth University's Centre for Midwifery and Women's Health (CMWH) has shed new light on how the stresses of the COVID-19 pandemic influenced substance use among pregnant women in the United Kingdom. Published in early 2026, this research draws from a large cohort of over 3,292 participants, capturing data during the height of the crisis from June to November 2020. The findings reveal critical connections between mental health challenges, pandemic-induced pressures, and the continuation of substances like tobacco and alcohol after pregnancy recognition.

Pregnancy is a transformative period marked by profound physical and emotional changes, and the arrival of COVID-19 amplified these experiences for many. Lockdowns, healthcare disruptions, and widespread uncertainty created a perfect storm of stressors. This Bournemouth University-involved study, part of the international EPPOCH cohort (Effect of the Pandemic on Pregnancy Outcomes and Childhood Health), underscores the need for integrated mental health support in maternal care, especially during global crises.

The EPPOCH Cohort: A Comprehensive Look at Pandemic-Era Pregnancies

The EPPOCH project, spearheaded by Dr. Melanie Conrad at Charité – Universitätsmedizin Berlin, with key contributions from UK partners like Bournemouth University and University Hospitals Dorset NHS Foundation Trust, provides a robust dataset for analyzing prenatal exposures. Participants, primarily Caucasian (95.8%) and UK-born (91.3%), completed detailed online questionnaires via REDCap, covering substance use, mental health metrics, and COVID-19-specific stressors.

Validated tools were employed: the Edinburgh Postnatal Depression Scale (EPDS) for depression, PROMIS Anxiety for general anxiety, and Pregnancy-Related Anxiety Questionnaire (PRAQ) for pregnancy-specific worries. Pandemic stressors were quantified using visual analogue scales (VAS) for factors like financial difficulties, personal health threats, and inadequate care access. This mixed-methods approach, including thematic analysis of 380 open-ended responses, offers both quantitative rigor and qualitative depth.

Prevalence and Patterns of Substance Use Before and After Pregnancy Awareness

Before recognizing their pregnancy, alcohol was the predominant substance, with 82.7% reporting lifetime use and 74.3% recent use. Tobacco followed at 37.5% lifetime and 26.3% recent, cannabis at 14.9% lifetime and 6.2% recent, and illicit drugs at 5.5% lifetime and 2.1% recent. Remarkably, most women (83.7%) abstained entirely post-recognition, showing a significant drop: alcohol from 5.17 to 2.21 standard drinks per week, tobacco from 65 to 30 products per week.

However, a minority persisted: tobacco at 8.75%, alcohol at 8.60%, cannabis at 1.49%, and illicit drugs at 0.12%. Co-use of two or more substances occurred in a small but notable subset, highlighting complex behaviors. These patterns align with prior UK estimates of high prenatal alcohol exposure (41-75%), but this study notes a pandemic-era decline, possibly due to heightened health awareness.

Strong Ties to Maternal Depression and Anxiety

Tobacco use post-recognition showed clear associations with elevated depressive symptoms (EPDS mean 13.3, 57% scoring ≥13 clinically significant). Linear regression revealed a positive link (B=0.212, p=0.001), even after adjusting for demographics and prior use. Co-use was similarly tied to higher depression (B=0.002, p=0.027). Anxiety links were weaker but present bivariately (Spearman's ρ=0.093-0.116, p<0.001).

With 33.9% reporting prior depression and 41.5% prior anxiety, the cohort reflected pandemic-exacerbated mental health burdens. Pregnancy-related anxiety averaged 23.1 on PRAQ, compounding general distress. These findings suggest substances like nicotine may serve as maladaptive coping mechanisms, releasing dopamine amid emotional turmoil.

Pandemic Stressors: Health Fears, Financial Strain, and Care Disruptions

COVID-19 stressors were pivotal. Tobacco users reported higher perceived personal health threats (mean VAS 45.6/100) and inadequate care access (47.7/100), with significant correlations (ρ=0.040-0.147, p<0.05). Cannabis and co-use linked to financial difficulties (mean 25.1/100; B=0.002/0.000, p<0.01). Overall distress peaked at 6.2/10 on the Distress Thermometer.

Lockdowns isolated families, financial instability loomed, and maternity services faced strains—virtual appointments replaced in-person support, delaying interventions. Professor Edwin van Teijlingen from Bournemouth University noted, “Psychological distress from worrying about health threats, finances, and disrupted care were key factors.” These insights, shared with the UK COVID Inquiry, emphasize crisis-resilient systems.Read the full BU announcement.

Voices from Participants: Qualitative Themes Emerge

Analysis of 380 responses revealed three themes: unintentional early exposure due to delayed recognition (many unaware until 8+ weeks, missing organogenesis window); vaping as harm reduction (switching to low-nicotine e-cigarettes, seen as safer); and midwifery influence (advice on vaping as acceptable, mixed on alcohol). One participant shared, “I vaped until my midwife said it was okay in moderation.”

These narratives humanize statistics, showing substance use as intertwined with circumstance, not recklessness. Vaping's rise, while transitional, carries risks like toxins and low birth weight, urging clearer guidelines.

Health Risks to Mothers and Babies

Prenatal substance exposure poses serious threats. Tobacco increases miscarriage, preterm birth, low birth weight, and sudden infant death syndrome risks. Alcohol risks fetal alcohol spectrum disorders (FASD), with lifelong cognitive impacts. Cannabis affects neurodevelopment; illicit drugs heighten neonatal abstinence syndrome.

In the UK, smoking in pregnancy hovers around 10-12%, contributing to inequalities—higher in deprived areas. The study reinforces that even post-recognition use, often coping-driven, amplifies vulnerabilities during a pandemic when neonatal care was stretched.NHS guidance on quitting smoking in pregnancy.

Bournemouth University's Leadership in Midwifery Research

Bournemouth University's CMWH has long championed maternal health research. Professor van Teijlingen's involvement exemplifies BU's interdisciplinary approach, blending sociology, health sciences, and clinical insights. Collaborations with UHD and international partners amplify impact, informing policy like the COVID Inquiry.

BU's focus equips future midwives with evidence-based tools, vital as UK births decline amid workforce shortages. This study positions BU as a key player in addressing post-pandemic legacies.

UK Maternal Mental Health Landscape During COVID-19

UK-wide, perinatal mental health deteriorated: depression rates doubled, anxiety surged. A Maternal Mental Health Alliance report noted significant declines, with isolation and service disruptions key culprits. Substance use rose as coping, mirroring global trends but hitting UK's high prenatal alcohol baseline hard.

Post-pandemic, 1 in 5 women report lasting anxiety; targeted interventions lag. Studies from UCL and others confirm stressor-substance links, validating BU's findings.

Recommendations: Screening, Education, and Support

Lead author Swarali Datye advocates routine mental health screenings in antenatal care, alongside preconception education. Minesh Khashu stresses early awareness. Consistent midwifery guidance on vaping/alternatives is crucial.

• Integrate EPDS/PROMIS routinely.
• Offer psychosocial support pre-conception.
• Address socioeconomic barriers via targeted funding.
• Train providers for crisis scenarios.

These steps could mitigate risks, fostering healthier outcomes.

Photo by Jo Anto Photography on Unsplash

Future Outlook and Ongoing Research

EPPOCH continues tracking child outcomes, promising longitudinal insights. BU plans expanded CMWH studies on vaping, financial interventions. As UK rebuilds, prioritizing maternal wellbeing counters demographic shifts—falling fertility demands healthier pregnancies.

This research, accessible via Frontiers in Public Health, calls for systemic change, blending academia, NHS, and policy for resilient care.