Economic Stress and Substance Use During Pregnancy: The Buffering Role of Public Assistance Programs.

Abstract

<b>Objectives.</b> To examine whether receipt of public assistance among pregnant populations moderates the association between economic stress and prenatal substance use. <b>Methods.</b> The HEALthy Brain and Child Development (HBCD) Study is a 27-site ongoing US longitudinal cohort investigation. We analyzed 2023-2024 data from 1422 pregnant participants who completed their first HBCD visits. We used logistic regression to examine the association between economic stress and substance use (alcohol, tobacco, opioids, cannabis) during pregnancy, stratified by number of public assistance programs from which participants received benefits. <b>Results.</b> Economic stress was positively associated with substance use (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.33, 1.50). This relationship was strongest among participants with no public assistance (OR = 1.25; 95% CI = 1.05, 1.44) and remained positive in the low- and medium-assistance groups; however, it was negative in the highest receipt category (OR = 0.70; 95% CI = 0.50, 0.97). <b>Conclusions.</b> Our findings suggest that increased receipt of public assistance corresponded to a weaker association between economic stress and substance use during pregnancy. <b>Public Health Implications.</b> Reduced access to safety-net programs may compound economic stressors related to prenatal substance use, with potential downstream implications for maternal and child outcomes. (<i>Am J Public Health</i>. Published online ahead of print August 20, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308628).