Vermonters demonstrate resiliency and mental wellness

% live births to women who used substances (alcohol, tobacco, or illicit drugs) during pregnancy


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Story Behind the Curve

Vermont has higher rates of alcohol, tobacco, and marijuana use during pregnancy compared to other U.S. states. Over the years we have seen very little decline in use, and in some cases an increase in use (marijuana). For more information regarding specific substances, view our Maternal and Infant Health Scorecard.

  • The Vermont Department of Health:
    • Division of Alcohol and Drug Abuse Programs
    • Maternal and Child Health
    • Office of Local Health – District Offices
  • Department of Vermont Health Access/ Vermont Medicaid
  • Vermont Child Health Improvement Program
  • Healthcare Providers
  • Maternal Child Health Coalitions
  • Community Health Teams
  • National Jewish Health for Quitline and Quit Online services through the Tobacco Program
  • Quit Partners – collaboration between Blueprint and VDH and the tobacco cessation specialists serving communities across the state,
What Works

What works depends a bit on the substance.

The American Academy of Pediatrics recommends that the primary care pediatrician's role in addressing prenatal substance exposure includes prevention, identification of exposure, and recognition of medical issues for the exposed newborn infant, protection of the infant, and follow-up of the exposed infant.

In the case of smoking during pregnancy, the CDC recommends the following individual strategies to address smoking in pregnancy: 1) pregnancy-specific counseling by health care providers, based on the 5-A model; 2) nicotine replacement therapies, under close supervision by a health care provider; 3) Quitline counseling; and 4) provider reminders, documentation of smoking status and cessation interventions. Population-based interventions that decrease smoking prevalence in the general population also reduce smoking among pregnant women. These strategies include: 1) increasing the price of tobacco products by increasing the tax on cigarettes; 2) clean indoor air policies and legislation banning smoking in workplaces and other areas; and 3) expanded Medicaid/health insurance coverage of tobacco-cessation services and products.

To reduce/prevent alcohol use in pregnancy, the following strategies have been shown to be evidence-based: education and information campaigns to increase awareness of the risks of alcohol use for pregnancy; and healthcare workers providing information and brief support to women of childbearing age on the risks alcohol use for pregnancy.


Currently, the Health Department has contracted to conduct formative evaluation to provide information, insight and recommendations on future communications, messaging and outreach strategies related to substance use (alcohol, tobacco, marijuana, and opioids) during pregnancy.

The Health Department conducts ongoing outreach to healthcare providers to encourage them to advise women and families about the risks of substance use during pregnancy, which includes individuals who are planning on becoming pregnant.

The Health Department is working with the Rutland Regional Medical Center to pilot a program in a community-based obstetrical practice to improve rates of smoking cessation in pregnancy.

Similar to statewide efforts, local partners use data to drive local strategy

The Vermont Child Health Improvement Program's (VCHIP) Improving Care for Opioid-Exposed Newborns (ICON) project partners with the Division of Alcohol and Drug Abuse Programs (VDH - ADAP) and the UVM Children's Hospital to study the quality of care provided to Medicaid-eligible opioid-dependent women and their opioid-exposed newborns and implements various activities targeted to improving the care these populations receive across the State.

Vermont's home visiting programs routinely screen pregnant women for substance use. Home visitors provide needed education, referrals, and follow-up to women who screen positive.

Why Is This Important?

Prenatal substance abuse continues to be a problem worldwide. Substance use during pregnancy can adversely affect a growing fetus. Early in pregnancy, fetal malformations may occur while, later in pregnancy, it is the developing fetal brain that is more vulnerable to injury. There is a growing body of research describing the adverse effects of substance use on fetal development, including malformations, abnormal brain development and growth retardation.

The American Academy of Pediatrics (AAP) technical report, "Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus," in the March 2013 Pediatrics (published online Feb. 25), provides information for the most common substances involved in fetal exposure: nicotine, alcohol, marijuana, opiates, cocaine and methamphetamines.

Women who smoke during pregnancy are more likely than nonsmokers to have an ectopic pregnancy, vaginal bleeding, placental abruption, placenta previa or stillbirth. Babies born to women who smoke during pregnancy are more likely to be of low birthweight or born prematurely, increasing their risk of serious health problems.

Prenatal exposure to alcohol is one of the leading preventable causes of birth defects, intellectual disabilities and other developmental disorders in newborns. We are just beginning to learn the impact of marijuana use in pregnancy.

Notes on Methodology

Substance use includes any use of alcohol, tobacco, or e-cigarettes during the last 3 months of pregnancy, or any of the following at any point during pregnancy: Prescription pain relievers such as hydrocodone (Vicodin®), oxycodone (Percocet®), or codeine; Adderall®, Ritalin® or another stimulant; Marijuana or hash; Synthetic marijuana; Heroin; Amphetamines; Cocaine; and/or maintenance treatment drugs such as Methadone.

Data not available before 2016.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy