Disclaimer: The term " pregnant woman " is primarily used to refer to individuals who are pregnant. We acknowledge ongoing scholarly and clinical discussions about inclusive language in reproductive and maternal health research, including the use of terms such as 'pregnant people', 'pregnant individuals' or ‘childbearing’ to recognise gender diversity.

For this article, the term pregnant women is used to align with the terminology most commonly employed in biomedical and public health literature and to ensure clarity when discussing sex-specific physiological, anatomical, and clinical outcomes. This choice also reflects the language used in the majority of studies included in this review, many of which focus on populations identified as women.

This terminology is not intended to exclude transgender, non-binary, or gender-diverse individuals who may experience pregnancy. It is adopted primarily for consistency, clinical clarity, and accessibility, particularly in contexts where clear biological framing is central to understanding maternal and infant health. Where relevant, findings are considered applicable to all individuals who experience pregnancy.

Introduction

Substance use during pregnancy has emerged as a growing public health concern worldwide, given its association with a range of adverse physical, developmental, and psychosocial outcomes for both mother and child [1]. Pregnant women increasingly turn to the internet as a primary source of health-related information, including guidance on pregnancy, childbirth, and maternal wellbeing [1]. The rapid growth of eHealth and mHealth technologies represents an increasingly accessible and cost-effective application of information and communication technologies (ICT) in health and health-related fields ([2]. Such technologies can help address gaps in health education and awareness and may support efforts to reduce the risk and prevalence of substance use during pregnancy [3]. The World Health Organization defines eHealth as “the use of information and communications technology in support of health and health-related fields,” while mHealth is described as a subset of eHealth involving “the use of mobile wireless technologies for health” [4].

Health Risks and Complexity of Substance Use in Pregnancy

Figure 1: Graphical abstract of the effects of prenatal methamphetamine use on maternal, fetal, neonatal, and neurodevelopmental outcomes. Reprinted from [4].

Substance use during pregnancy not only compromises fetal development but also poses significant risks to maternal health and wellbeing [6]. Women may engage in polysubstance use, increasing the likelihood of compounded developmental risks for the fetus, including low birth weight, neurodevelopmental delays, and long-term cognitive or behavioural challenges [7]. The combined effects of pregnancy, psychotropic substance use, and medication misuse are linked to higher rates of pregnancy complications, such as preterm birth, gestational hypertension, and placental abnormalities. Women who use substances during pregnancy are also less likely to engage consistently with prenatal care, limiting opportunities for early detection and management of complications. In addition, substance use increases vulnerability to infectious diseases, including HIV, sexually transmitted infections (STIs), and hepatitis [6], [8]. Psychosocial and structural factors, such as stigma, fear of punitive responses, and reduced social support, can exacerbate these health risks, discouraging disclosure to healthcare providers and limiting access to effective interventions [9], [10]. 

Global Prevalence and Epidemiological Trends

Globally, prevalence data illustrate the scope of this issue. According to the United States National Survey on Drug Use and Health (NSDUH), 8–11% of pregnant women aged 15–44 years reported using illicit drugs, tobacco products, or alcohol within the past month, an increase from 5% in 2012 [11]. The National Hospital Care Survey found that in 2020, 8.3% of pregnant women reported illicit substance use, while 8.4% reported tobacco use [12]. Furthermore, the Behavioral Risk Factor Surveillance System (BRFSS) indicated that between 2018 and 2020, nearly 14% of pregnant women aged 18–49 reported current alcohol consumption [13]. More recent data from the 2021–2023 NSDUH show a decline in cannabis use among pregnant women, decreasing from 7.2% in 2021 to 4.8% in 2023. In Australia, between 2020 and 2023, 2.3 - 2.6% of pregnant women consumed alcohol during the first 20 weeks of pregnancy, with a smaller proportion (0.5 - 0.8%) continuing use beyond this period [14]. In contrast, studies from Aotearoa New Zealand indicate that approximately one in five women reported alcohol use during pregnancy, with 13% continuing consumption after the first trimester, and prevalence being higher among women under 19 years of age [15].

Digital Access and the Rise of eHealth and mHealth

The widespread ownership of electronic devices, including mobile phones, tablets, and computers has greatly enhanced access to the internet, enabling digital engagement among pregnant women. Approximately four in five people globally own a mobile phone, with 82% of individuals aged 10 and older reporting ownership in 2025 [16]. Estimates indicate that 7.3 billion people used mobile phones within a global population of 8.2 billion in 2025, with projections exceeding 7.9 billion by 2028 [17], [18]. For women in low- and middle-income countries (LMICs), mobile devices are often the primary means of accessing the internet. In 2019, nearly 50% of women in LMICs accessed the internet via mobile devices, rising to 63% in 2024 [19], [20]. Studies indicate that mobile phone penetration is nearly three times higher than desktop computers, and while desktops may facilitate more complex tasks, users often prefer mobile devices for their portability, touch interfaces, and ease of use [21], [22].

Despite expanding access, gender and income disparities persist. In 2024, approximately 3.7 billion people in LMICs accessed the internet via mobile phones [16], [20]. Globally, women remain 10% less likely to own a mobile phone than men, and 14% less likely to use the internet in LMICs [20], with income strongly correlating with digital access [20], [21]. Nevertheless, the GSMA Mobile Economy Report (2025) estimates that in LMICs, 83% of women own mobile phones, 61% own smartphones, and 63% use mobile internet [20].

Digital Health-Seeking Behaviours in Pregnancy

Digital technologies provide continuous access to health information, interactive tools, and tailored content, positioning online platforms as scalable and cost-effective means for delivering health education and behavioural support. For pregnant populations, particularly those facing barriers to in-person care, digital access offers anonymity, convenience, and autonomy in health-related decision-making. However, this shift may also reduce direct interactions with healthcare providers, potentially limiting personalised guidance [23].

Evidence suggests that pregnant women frequently engage in online health information seeking. Conrad (2022) found that women’s digital information-seeking behaviours intensify during pregnancy [24], with the Second National U.S. Survey of Women’s Childbearing Experiences reporting over 100 online searches per pregnancy for information on childbirth and maternal health[25]. Many primiparous women rate pregnancy-related websites and mobile applications as highly valuable sources [25]. Digital environments, including online health communities (OHCs), blogs, forums, and general health websites, provide accessible resources beyond traditional healthcare settings [26]. A cross-sectional study in German hospitals found that 50.7% of pregnant women sought health information online, with 22.4% using mHealth pregnancy applications [20]

However, patterns of digital engagement are uneven. Among 63 young, low-income pregnant women in the United States (average age 21 years), the internet was reported as one of the least utilised sources of health information [1]. Similarly, a study across 24 countries found that while 97.4% accessed commercial websites, only 62% consulted health professional sites, and even fewer accessed medical journals (50.1%), local health service websites (47.3%), or government platforms [27].

Quality, Trust, and Safety Concerns in Digital Health Information

Concerns regarding the quality, accuracy, and trustworthiness of online health information remain significant. Pregnancy-related content is often inconsistent, misleading, or unsupported by evidence, with commonly used platforms, including OHCs, blogs, and general websites more likely to contain unverified information [1]. In digital interventions designed for pregnant women who use substances, key challenges include privacy concerns, data security, and logistical barriers. Participants highlighted apprehension around how data would be used, who would have access, and the potential repercussions for women in recovery who had previously faced punitive measures [28]. Additionally, outside regulated platforms, many pregnancy apps claim to provide expert guidance without formal quality control mechanisms to verify their accuracy [29]. Limited clinical oversight further compounds this issue, as healthcare professionals often remain unaware of the digital resources patients use or how these sources influence decision-making [30], [31]

​​Effectiveness of Digital Interventions for Substance Use

In response to these challenges, there has been a marked increase in digital interventions aimed at reducing substance use during pregnancy. These programs are designed to deliver evidence-based education, screening, and behavioural support while addressing barriers present in both traditional healthcare settings and informal online environments. Common features include screening tools, tailored feedback, motivational messaging, and interactive components, providing structured, accessible, and private alternatives to unregulated online information. Evidence for their effectiveness is emerging [3]: Ingersoll et al. (2018) reported that participants using the CARRII interactive digital intervention experienced a significant reduction in risky drinking from pre- to post-treatment (23.53%, p < .02). However, this effect was attenuated by the six-month follow-up (18.18%, p < .09), underscoring the challenge of sustaining long-term behaviour change. In contrast, participants receiving static patient education materials showed no significant reductions at either post-treatment or follow-up, highlighting the limited efficacy of non-interactive approaches [2].

Substance use during pregnancy represents a multifaceted public health concern, with significant risks for both maternal and fetal health. Digital technologies, including eHealth and mHealth platforms, offer promising avenues to improve access to information and support, particularly for populations facing barriers to traditional care. However, uneven access, quality concerns, and privacy considerations must be addressed to ensure these tools are effective and safe. A comprehensive approach that combines digital interventions with clinical oversight and supportive social structures is essential to mitigate the harms of substance use during pregnancy and promote positive maternal and fetal outcomes.