Continuum of Care for Substance Use Disorders in Pregnancy: Evidence From the National Survey on Drug Use and Health

BACKGROUND: Substance use during pregnancy is a growing public health concern, yet little is known about how universal screening translates into the identification of a substance use disorder (SUD) and treatment engagement, across the perinatal SUD continuum of care. Persistent disparities in screening, identification, and treatment may contribute to missed opportunities for timely intervention and exacerbate inequities in maternal health. This study examined national patterns of substance use screening, SUD prevalence, and treatment engagement among pregnant women in the United States. METHODS: Data were drawn from the 2021 to 2023 National Survey on Drug Use and Health. The sample consisted of pregnant females aged 12 to 49 years (N = 2 051; weighted population estimate 2,037,128). Outcomes included healthcare professional-initiated screening for drug and alcohol use, SUD diagnosis, and SUD treatment engagement. Researchers estimated the prevalence of each outcome and conducted survey-weighted logistic regression to assess sociodemographic, clinical, and structural correlates. RESULTS: Nearly two-thirds of pregnant women (64.7%) reported being screened for substance use in the past year, 14.3% met criteria for a past-year SUD, and only 10% of those with SUD received treatment. Screening and SUD prevalence varied significantly by age, race/ethnicity, educational attainment, income level, insurance type, mental health status, and criminal justice involvement. Screening alone was not associated with treatment receipt; however, a provider-initiated conversation about treatment options and/or substance use was associated with more than 10-fold higher odds of treatment engagement. Substantial attrition between screening and treatment was observed, with disparities across sociodemographic and geographic groups. CONCLUSION: Most pregnant women receive substance use screening nationwide, but few who meet the criteria for a SUD ultimately receive treatment, indicating critical gaps in the perinatal SUD care continuum. Findings underscore the need to strengthen post-screening follow-up, including provider communication, care coordination, and integrated obstetric-behavioral health models, to ensure that identification leads to timely, patient-centered treatment. Addressing the barriers and inequities in screening, diagnosis, and treatment engagement is essential for advancing maternal health equity and improving outcomes for pregnant women with SUD.