title: Tobacco and alcohol use in pregnancy in France: the role of migrant status: the nationally representative ELFE study.
abstract: BACKGROUND
  Tobacco and alcohol use in pregnancy are modifiable yet frequent risk factors of poor perinatal outcomes. We examined whether characteristics associated with substance use in pregnancy vary between native and migrant women, who often differ in terms of socio-demographic characteristics.
  
  
  METHODS
  Data come from a nationally representative sample of children born in France in 2011 (ELFE study, n=18,014). Maternal substance use in pregnancy (tobacco: ≥1 cigarette/day, alcohol: ≥1 time, binge drinking: ≥3 units of alcohol on one occasion) was assessed using survey methodology by a) trained interviewers and b) self-reports. Migration status was determined based on country of birth (native-born vs. migrant). The sample included 2330 migrant women, predominantly from North Africa (35.4% - primarily Algeria and Morocco), Sub-Saharan Africa (27.3% - primarily Senegal, Ivory Coast, the Congo and Cameroun), Europe (20.2% - primarily Portugal and Germany) and Asia (10.2% - primarily Turkey). Characteristics potentially associated with substance use included socio-demographics (maternal age, number of children, relationship status, educational attainment, employment status), health (psychological difficulties, incomplete prenatal care) and partner's characteristics (migration status, employment).
  
  
  RESULTS
  Compared to the native-born, migrant women had lower levels of tobacco smoking (8.8 vs. 21.9%) and alcohol use (23.4 vs. 40.7%), but not binge drinking (2.9 vs. 3.3%). Unfavorable socioeconomic circumstances were associated with tobacco smoking in native-born women only. Single parenthood was associated with alcohol use only in migrant women. In migrant women, co-occurring use of another substance and psychological difficulties were more strongly associated with use of tobacco, alcohol or binge drinking than in native-born women.
  
  
  CONCLUSIONS
  Migrant women have less favorable socioeconomic characteristics than native women but are generally less likely to use tobacco and alcohol in pregnancy. However those who experience single-parenthood need special attention, as they are disproportionately likely to use psychoactive substances which put them and their children at risk of poor health outcomes.
authors.affiliation: INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France. Electronic address: maria.melchior@inserm.fr.
authors.forename: Maria
authors.initials: M
authors.lastname: Melchior
authors.affiliation: INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Chollet
authors.affiliation: INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.
authors.forename: Nine
authors.initials: N
authors.lastname: Glangeaud-Freudenthal
authors.affiliation: INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.
authors.forename: Marie-Josèphe
authors.initials: MJ
authors.lastname: Saurel-Cubizolles
authors.affiliation: Ined INSERM joint unit Elfe, Paris, France.
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Dufourg
authors.affiliation: INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013 Paris, France.
authors.forename: Judith
authors.initials: J
authors.lastname: van der Waerden
authors.affiliation: Bordeaux Univ., U657, F-33000 Bordeaux, France; INSERM, U657, F-33000 Bordeaux, France; University Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Sutter-Dallay
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D015406:Single Parent / Q000523:psychology / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D012959:Socioeconomic Factors; D014171:Transients and Migrants / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Alcohol; Migrants; Pregnancy; Socioeconomic factors; Tobacco