# Perceptions of stigma of pregnant individuals experiencing substance use disorder receiving prenatal care at magdalene clinic: a cross-sectional study

## TL;DR

This study explores how stigma affects pregnant individuals with substance use disorder and finds that stigma from healthcare providers and family is linked to delayed prenatal care.

## Contribution

The study provides new insights into how substance-related stigma varies by substance type and educational background in pregnant individuals.

## Key findings

- Higher internalized stigma was associated with delayed prenatal care initiation.
- Pregnant individuals using opioids/stimulants reported higher stigma from healthcare providers.
- Those with higher education faced more stigma from healthcare providers than those with less education.

## Abstract

Substance use disorder (SUD) is highly stigmatized with pregnant individuals experiencing substance-related stigma at greater levels than the general population due to perceived deviance from societal norms. Pregnant individuals experiencing stigma may be more likely to delay or receive inadequate prenatal care. The purpose of this cross-sectional study was to understand self-reported enacted, anticipated, and internalized stigma of pregnant individuals experiencing SUD receiving prenatal care at Magdalene Clinic, a collaborative, trauma-informed OB-GYN clinic.

The Substance Use Stigma Mechanism Scale was administered to 226 individuals to measure past, present, and anticipated future experiences of substance use related stigma from family, healthcare providers, and self. Participant demographics and SUD diagnosis were abstracted from the participant’s electronic medical record. One-way ANOVAs with Tukey’s post hoc tests were conducted in January 2025 using SAS version 9.4 to analyze the relationships between stigma and all study variables. Additionally, Welch’s ANOVAs with Games-Howell post hoc tests were run where Levene’s tests indicated a variance of homogeneity.

Significantly higher internalized stigma scores (n = 226) were associated with initiation of prenatal care in the second (M = 3.28, 95% CI [3.06, 3.50]) or third trimester (M = 3.73, 95% CI [3.32, 4.15]), compared to the first trimester. Individuals who used opioids/stimulants (M = 2.10, 95% CI [1.85, 2.34]) reported significantly higher stigma from healthcare providers than those using other substances. Individuals using stimulants (M = 2.77, 95% CI [2.51, 3.03]) reported higher levels of stigma from their family compared to those using other substances. Those with higher educational attainment reported significantly higher levels of stigma from healthcare providers than those with less than a high school diploma/GED (M = 1.64, 95% CI [1.42, 1.87]).

These findings suggest that higher internalized and source-specific stigma, particularly for opioid and stimulant use, may contribute to delayed prenatal care and highlight the need for stigma-reducing interventions for pregnant individuals with SUD. Additionally, these findings suggest that pregnant individuals with social advantages like higher educational attainment may face unique substance-related stigma. These results inform the need for supportive, empathetic healthcare that is need specific and responsive to the diverse experiences of those experiencing pregnancy and SUD.