Harmful substance use during pregnancy : A Qualitative Meta-Synthesis of Pregnant Women’s Experiences and Perceptions

Background: Late detection of pregnancy and substance use increases the risk of complications, making early antenatal care, screening, and empathetic approaches crucial. Research has primarily focused on medical consequences, while women’s own experiences remain less explored. Aim: To illuminate women’s experiences of pregnancy in the context of harmful substance use. Method: A qualitative metasynthesis using meta-ethnographic and thematic analysis was conducted. Systematic searches of relevant databases identified ethically reviewed studies. The analysis followed a structured process to produce a credible synthesis. Results: Pregnancy accompanied by substance use is characterized by ambivalence, guilt, and fear. Women worry about the child’s health, often conceal their substance use, and may distrust healthcare services. Shame and fear of social consequences hinder openness, yet pregnancy can also be perceived as an opportunity for change. Social support and respectful treatment are essential for building trust and promoting engagement with care. Conclusion: Empathetic treatment, individualized care, and coordinated interventions are crucial to meeting women’s needs and reducing risks for the child. Clinical implications and future research: Integrated care models are limited in Sweden and should be evaluated. Future studies should examine how coordinated interventions can improve care and support for pregnant women with substance use.