Preconception Health and Substance Use

Guidance for Health Care Providers

Key Messages for Providers

  • Preconception substance use care is preventive, not punitive.
  • Universal screening reduces stigma and improves equity.
  • Stabilization before conception improves maternal and intergenerational outcomes.
  • Harm reduction and shared decision-making are evidence-aligned.
  • Substance use and mental health care should be integrated.

Why Substance Use Belongs in Preconception Care

Substance use is a modifiable risk factor that can influence fertility, early embryonic development, pregnancy outcomes, and long-term child health. Because many pregnancies are unplanned and early gestational exposure often occurs before pregnancy recognition, substance use assessment should occur routinely during reproductive-aged care. Preconception care shifts the focus from reactive management in pregnancy to early identification, stabilization, and prevention.

Key rationale:

  • Many pregnancies are unplanned
  • Early embryogenesis occurs before pregnancy recognition
  • Substance-related risks are greatest in early gestation
  • Stabilization prior to conception improves maternal and fetal outcomes
  • Substance use frequently co-occurs with mental health conditions

Preconception care reframes substance use management from crisis response in pregnancy to early identification, stabilization and prevention.

Clinical Pearl: Early Exposure Happens Before Pregnancy Recognition. Because organ development begins before many individuals know they are pregnant, routine preconception screening and stabilization meaningfully reduce fetal exposure risk.

Core Clinical Principles

Preconception substance use care should be grounded in universal screening, trauma-informed practice, harm reduction, and shared decision-making. Providers play a critical role in normalizing screening, reducing stigma, and ensuring equitable access to care. These principles support engagement, improve disclosure, and enhance continuity across the reproductive life course.

Preconception substance use care should emphasize:

  • Universal screening
  • Trauma- and violence-informed care
  • Harm reduction approaches
  • Shared decision-making
  • Integration with mental health services

These principles support disclosure, improve engagement, and reduce stigma.

Routine Screening and Assessment

Routine, nonjudgmental screening for substance use should be integrated into care for all individuals of reproductive age, regardless of pregnancy intention. Universal approaches reduce stigma, improve equity and avoid selective screening based on assumptions or appearance. Screening is most effective when paired with accessible referral pathways and longitudinal follow-up.

Substance use screening should be:

  • Routine
  • Non-judgmental
  • Repeated over time
  • Independent of pregnancy intention

Avoid risk-based or appearance-based screening. Screening is most effective when paired with clear referral pathways and follow-up care.

Use validated tools where appropriate, recognizing that disclosure may increase with trust and continuity.

Validated Screening Tools for Substance Use

Name

Description

Primary Population

Links

Parents, Peers, Partner, Pregnancy and Past (The 5Ps)

Alcohol, tobacco and drug use

Adults, including pregnant women

5 Ps PSU Screening Tool.pdf

Parents, Partners, Past and Pregnancy
(The 4Ps)

Alcohol use

Pregnant women

The 4P’s Plus© Screening Instrument

NIDA Quick Screen
Alcohol, Smoking and Substance Involvement Screening Test
(NIDA-Modified ASSIST)

Drug and alcohol use

Adults, including pregnant women

NIDA Quick Screen V1.0

Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT)

Drug and alcohol use

Women 26 years or younger

The CRAFFT Interview (2.1)

Tolerance, Anger/annoyance, Cut Down, Eye-opener
(T-ACE)

Alcohol use

Pregnant Women

T-ACE Screening Tool

Tolerance, Worried, Eye-opener, Amnesia, Cut Down
(TWEAK)

Alcohol use

Pregnant women

TWEAK Screening Tool

Alcohol Use Disorders Identification Test (AUDIT)

Alcohol use

Adults including pregnant women

AUDIT-C Alcohol Screening Tool

Drug Abuse Screening Test (DAST)

Drug use

Adults

Drug Abuse Screening Test (DAST-10)

*Adapted from Indiana Perinatal Quality Improvement Collaborative[1]

Practice Tip: Screen Universally — Not Selectively. Avoid appearance-based or risk-based screening. Universal, nonjudgmental screening improves disclosure and reduces stigma.

Trauma and Violence-Informed and Equity-Oriented Care

Substance use disorders are closely linked with structural vulnerability, trauma, and social inequities. A trauma- and violence-informed approach improves trust, disclosure, and care engagement. Providers should clarify confidentiality limits, avoid punitive framing, and ensure screening does not inadvertently increase surveillance or harm.

Individuals with substance use disorders (SUD) disproportionately experience:

  • Poverty
  • Racism
  • Colonization
  • Intimate partner violence
  • Mental illness
  • Child welfare involvement

Providers should:

  • Clarify confidentiality limits
  • Avoid punitive or judgmental language
  • Use trauma and violence-informed communication
  • Provide clear referral pathways

For more information about trauma and violence-informed care see the SOGC’s HUB on Trauma and Trauma-Informed Practice.

Equity Alert: Screening Can Cause Harm if Not Trauma-Informed. Substance use disproportionately affects individuals facing structural inequities. Clarify confidentiality limits and avoid documentation practices that may increase surveillance or child welfare involvement.

Motivational Interviewing and Harm Reduction

While abstinence may be the safest recommendation for some substances, harm reduction approaches often improve engagement and outcomes. Motivational interviewing supports autonomy, explores ambivalence, and builds intrinsic motivation for change. Incremental risk reduction prior to conception can meaningfully improve maternal and fetal health outcomes.

Examples:

  • Reducing quantity/frequency
  • Avoiding binge use
  • Switching to safer medication-assisted treatment
  • Contraception until stabilization
  • Integrating mental health support

Motivational interviewing principles:

  • Explore ambivalence
  • Support autonomy
  • Avoid confrontation
  • Reinforce self-efficacy

Substance-Specific Considerations

Alcohol

Alcohol exposure in early pregnancy poses a significant neurodevelopmental risk, and there is no known safe level of use during pregnancy. Because organogenesis occurs before many individuals recognize pregnancy, preconception counselling is critical. Management should integrate screening, brief intervention, relapse prevention planning, and coordination of care when dependence is present.

Key Preconception Actions

  • Screen routinely for alcohol use
  • Encourage abstinence when planning pregnancy
  • Provide brief counselling and relapse prevention planning
  • Assess dependence and coordinate care if needed
  • Screen for co-occurring mental health conditions

Clinical Pearl: No safe amount, no safe time, no safe type of alcohol during pregnancy.

Summary of Alcohol Use Interventions in Pregnancy

Intervention Category

Key Components

Evidence and Effectiveness

Clinical Considerations

Universal Screening (Core Intervention)

Routine screening at preconception and every antenatal visit; assess frequency, quantity, binge patterns

Strong evidence that screening reduces alcohol-exposed pregnancies

Universal, nonjudgmental screening recommended as standard prenatal care

Brief Behavioural Counselling

Clear advice that no alcohol is safe; personalized risk feedback; goal setting focused on abstinence

Proven to reduce alcohol use and alcohol-exposed pregnancies

First-line intervention should be delivered early and repeated

Motivational Interviewing (MI)

Empathy, autonomy support, exploration of ambivalence, intrinsic motivation

Effective for women uncertain about abstinence

Recommended for ambivalence or continued use

Preconception Counseling

Advise abstinence when planning pregnancy; address misconceptions about “safe” drinking

Prevents early embryonic exposure

Preconception abstinence due to early fetal vulnerability is emphasized

Management of Alcohol Use Disorder (AUD)

Referral to addiction and mental health services; psychosocial treatment

Improves maternal stability and pregnancy outcomes

Integrated, multidisciplinary care encouraged; pharmacotherapy generally avoided

Pharmacotherapy for AUD

Medications for AUD

Insufficient safety data in pregnancy

Not routinely recommended

Partner and Social Environment Interventions

Address partner drinking; promote alcohol-free environments

Reduces relapse and ongoing exposure

Family- and partner-inclusive counselling

Public Health Messaging

“No safe amount, no safe time, no safe type”

Improves awareness and prevention

Consistent with prevention messaging

Postpartum Relapse Prevention

Continued screening; counseling; mental health support

Reduces relapse risk postpartum

Ongoing substance use assessment postpartum is recommended

Trauma and Violence-Informed Care

Nonjudgmental, culturally safe approach

Improves disclosure and engagement

Explicitly supported by SOGC to reduce stigma

For more information, see SOGC Guideline No. 405: Screening and Counselling for Alcohol Consumption DuringPregnancy.

Nicotine and Tobacco (Including Vaping)

Nicotine exposure affects fertility, placental development, fetal growth and increases the risk of stillbirth. Preconception cessation or reduction improves both maternal and pregnancy outcomes. Counselling should address all nicotine products, including vaping and second-hand exposure, and include behavioural and pharmacologic supports when indicated.

Key Preconception Actions

  • Support cessation prior to conception
  • Address all nicotine products, including vaping
  • Offer behavioural counselling and cessation supports
  • Consider nicotine replacement therapy if behavioural supports are insufficient

Clinical Pearl: Stopping smoking before pregnancy significantly improves maternal and fetal outcomes.

Strategies for Smoking Cessation Interventions

Intervention Category

Key Components

Evidence and Effectiveness

Clinical Considerations in Pregnancy

Behavioural Counselling (Core Intervention)

≥15-minute sessions; repeated throughout pregnancy; education on risks, withdrawal symptoms, triggers, coping strategies; relapse prevention

Strong evidence from clinical trials shows increased quit rates

First-line intervention; should begin early and continue antenatally and postnatally

Cognitive Behavioural Therapy (CBT)

Self-monitoring, craving management, stress reduction, goal setting, problem-solving, and self-efficacy building

Demonstrated improvement in cessation rates among pregnant women

Effective for managing cravings, stress, and relapse risk

Motivational Interviewing (MI)

Empathy, autonomy support, exploring ambivalence, and strengthening intrinsic motivation

Effective for women ambivalent or resistant to quitting

Particularly useful when readiness to quit is low

Nicotine Replacement Therapy (NRT)

Patch (daytime) + short-acting forms (gum/lozenge); lowest effective dose; remove patch at night if appropriate

Modestly increases quit rates; safer than continued smoking

Consider when counselling alone fails; it requires informed discussion of risks and benefits

Bupropion

Antidepressant with smoking cessation properties

Limited and low-quality evidence in pregnancy

Not routinely recommended; safety data insufficient

Varenicline

Nicotinic receptor partial agonist

Insufficient safety data in pregnancy

Not recommended during pregnancy or breastfeeding

Digital Interventions (mHealth)

Text messaging, computer-based programs, tailored content; self-efficacy and coping support

Effective as adjuncts, text-based interventions show benefit

Useful for women underutilizing traditional services; best combined with personal support

Electronic Cigarettes (E-cigarettes)

Nicotine delivery without combustion

Insufficient evidence on fetal safety; lower CO exposure than cigarettes

Not recommended; may be considered only as harm reduction when other options fail (jurisdiction-dependent)

5As / 3As Framework

Ask, Advise, Assess, Assist, Arrange follow-up (or Ask, Advise, Act)

Widely endorsed best-practice model

Should be applied at every antenatal visit

5Rs (Low Motivation)

Relevance, Risks, Rewards, Roadblocks, Repetition

Effective for enhancing motivation

Appropriate when women are unwilling or not ready to quit

Second-hand Smoke Reduction

Partner/family counselling; smoke-free homes and vehicles

Reduces fetal and neonatal risks

Involve partners and household members

Postpartum Relapse Prevention

Continued counselling; breastfeeding support; coping strategies; focus on intrinsic motivation

High relapse rates without support

Counselling should extend into the postpartum period

For more information, see SOGC Guideline No. 349-Substance Use in Pregnancy.

Cannabis

Cannabis use is increasingly normalized, yet early exposure may affect placental function and neurodevelopment. Risk perception often influences use patterns, making anticipatory counselling essential. Providers should address misconceptions, support cessation before conception and integrate mental health and substance use care where appropriate.

Key Preconception Actions

  • Screen routinely for cannabis use
  • Address misconceptions about safety
  • Encourage cessation before conception
  • Integrate mental health support when needed

Clinical Pearl: Cannabis is often perceived as low risk; anticipatory counselling improves cessation.

Summary of Cannabis Use Interventions in Pregnancy

Intervention Category

Key Components

Evidence and Effectiveness

Clinical Considerations

Universal Screening (Core Intervention)

Routine screening at preconception and each antenatal visit; assess frequency, route, potency

Improves identification and counselling opportunities

Universal, nonjudgmental screening

Brief Behavioural Counselling

Clear advice that no cannabis use is safe; education on fetal risks; goal of abstinence

Effective in reducing prenatal exposure

First-line intervention in pregnancy

Motivational Interviewing (MI)

Explore ambivalence; address safety misconceptions; support intrinsic motivation

Useful when cannabis use is normalized or perceived as low risk

Recommended for continued use or ambivalence

Preconception Counseling

Advise discontinuation prior to conception

Prevents early fetal and placental exposure

Emphasis on abstinence when planning pregnancy

Management of Cannabis Use Disorder

Referral to addiction and mental health services; psychosocial therapies

Improves maternal stability and engagement

Pharmacologic treatment is not recommended

Pharmacotherapy

None approved for cannabis cessation in pregnancy

Insufficient safety and efficacy data

Not recommended

Symptom Management Alternatives

Non-pharmacologic and pregnancy-safe treatments for nausea, anxiety, and sleep

Supports abstinence

Address perceived medical use of cannabis

Partner and Social Environment Interventions

Address partner use; promote a cannabis-free home

Reduces continued use and relapse

Support family-inclusive counseling

Postpartum Relapse Prevention

Continued screening, mental health support, and breastfeeding counselling

Reduces resumption of use

Cannabis is discouraged during breastfeeding

Trauma and Violence-Informed Care

Respectful, stigma-free approach

Improves disclosure and adherence

Critical component

For more information, see SOGC Guideline No. 425b: Cannabis Use Throughout Women’s Lifespans Part 2:Pregnancy, the Postnatal Period, and Breastfeeding.

Opioids

Opioid use disorder requires stabilization and coordinated, multidisciplinary care prior to conception. Abrupt cessation is not recommended; opioid agonist therapy improves maternal and neonatal outcomes. Preconception planning allows optimization of dosing, relapse prevention strategies, and integration of addiction, primary care, and mental health services.

Key Preconception Actions

  • Screen for opioid use disorder
  • Continue or initiate opioid agonist therapy (OAT) when indicated
  • Coordinate addiction medicine care
  • Provide overdose prevention supports
  • Integrate mental health services

Clinical Pearl: Opioid agonist therapy (methadone or buprenorphine) improves maternal and neonatal outcomes.

Summary of Opioid Use Interventions in Pregnancy

Intervention Category

Key Components

Evidence and Effectiveness

Clinical Considerations

Universal Screening (Core Intervention)

Routine screening for prescribed and non-prescribed opioid use; validated tools (4Ps, NIDA, CRAFFT)

Improves early identification and engagement

Universal, trauma-informed screening

Brief Counselling and Education

Nonjudgmental counselling; education on risks and treatment options

Improves treatment uptake

Emphasize the safety of treatment over abstinence

Motivational Interviewing (MI)

Explore ambivalence; build trust and autonomy

Effective for engagement in care

Recommended for hesitancy or fear of disclosure

Preconception Counseling

Optimize health; review opioid and pain management; plan pregnancy

Reduces early pregnancy risks

Support preconception stabilization

Opioid Agonist Therapy (OAT)

Methadone or buprenorphine maintenance

Strong evidence for improved maternal and neonatal outcomes

First-line, standard of care in pregnancy

Medically Supervised Withdrawal

Tapering or detoxification

High relapse and fetal risk

Not recommended

Pharmacotherapy Safety

Methadone/buprenorphine; naloxone access

Benefits outweigh risks

Safe in pregnancy and breastfeeding

Integrated Multidisciplinary Care

Obstetrics, addiction, mental health, and social services

Improves retention and outcomes

Strongly encouraged

Partner and Social Support Interventions

Address partner use; assess social determinants

Supports sustained engagement

Trauma-informed, family-inclusive approach

Postpartum Relapse and Overdose Prevention

Continued OAT; mental health care; naloxone; breastfeeding support

Reduces relapse, overdose, and NOWS severity

Critical postpartum focus

For more information, see SOGCGuideline No. 443b: Opioid Use Throughout Women’s Lifespan: OpioidUse in Pregnancy and Breastfeeding.

Clinical Pearl: Opioid Agonist Therapy Is Safer Than Withdrawal. Methadone or buprenorphine improves outcomes. Abrupt cessation increases relapse and overdose risk.

Stimulants (e.g., methamphetamine, cocaine)

Stimulant use is associated with cardiovascular strain, placental complications, and fetal growth restriction. Preconception care should prioritize stabilization, harm reduction, and assessment of co-occurring social and medical risks. Addressing housing instability, intimate partner violence, and nutrition before conception can meaningfully improve outcomes.

Key Preconception Actions

  • Assess pattern of use
  • Address polysubstance exposure
  • Screen for cardiovascular risk
  • Stabilize sleep, nutrition, and housing where possible
  • Coordinate addiction services

Clinical Pearl: Addressing social determinants such as housing and nutrition can significantly improve outcomes.

For more information, see SOGC Guideline No. 349-Substance Use in Pregnancy.

Partner Substance Use

Preconception counselling should include partners, when possible, as paternal exposures may influence fertility, sperm quality, and epigenetic programming. Addressing partner substance use supports safer home environments and reduces relapse risk. A family-centered approach strengthens preconception health outcomes.

Include androgen use (testosterone), anabolic steroids, alcohol, cannabis, and tobacco in review.

Pregnancy Timing and Contraception

When substance use presents elevated risk, discussions about pregnancy timing may support stabilization and safety.

Counselling should:

  • Support reproductive autonomy
  • Avoid coercive framing
  • Align with patient goals
  • Emphasize health optimization prior to conception

Equity Alert: Contraception Counselling Must Be Autonomy-Supportive. Frame pregnancy timing as protective - never coercive. Align recommendations with patient goals and reproductive justice principles.

Documentation and Continuity

Objective, non-stigmatizing documentation supports continuity and coordinated care. Substance use assessment should be revisited regularly over time and integrated with chronic disease and mental health management. Continuity across preconception, pregnancy, and postpartum care reduces fragmentation and improves outcomes.

Risk Framing

Patients often face competing risks, including medication exposure versus untreated illness or immediate cessation versus destabilization. Risk framing supports balanced, individualized decision-making. Avoid binary counselling; emphasize shared decision-making and patient values.

Clinical Pearl: Risk Framing Is Essential. Compare risks of continued use with risks of destabilization from abrupt cessation. Avoid binary counselling.

Structural and System-Level Considerations

Effective preconception substance use care requires integrated primary care, mental health services, addiction medicine access, and culturally safe models of care. Collaboration with community partners improves engagement and retention. System-level supports are essential to reduce inequities and improve intergenerational outcomes.

Practice Tip: Integrate Mental Health Screening. Substance use frequently co-occurs with depression, anxiety, PTSD and bipolar disorder. Address both simultaneously.

Practical Clinical Actions

Preconception substance use care can be embedded into routine visits. Asking about reproductive goals, screening universally, reviewing medications, integrating mental health care, and arranging follow-up are actionable steps. Small, consistent interventions across visits can meaningfully reduce risk before conception.

At routine visits:

  • Ask about reproductive goals
  • Screen for alcohol, tobacco, cannabis, opioids, and stimulants
  • Assess co-occurring mental health conditions
  • Review medications
  • Offer harm-reduction supports
  • Discuss contraception when appropriate
  • Coordinate referrals and follow-up

Small, consistent interventions, such as universal screening, harm reduction, and trauma-informed care, integrated into routine preconception visits, can significantly reduce risk before conception and support healthier families.

Resources for Health Care Providers

To support comprehensive, trauma-informed preconception mental health care, the following resources provide clinical guidance, education, and practical tools.

SOGC Resources

Preconception Health and Substance Use: Provider At-a-Glance Summary
A provider-facing summary that outlines key considerations for substance use before pregnancy, including screening, counselling, harm reduction, and trauma-informed care.

Preconception Health and Substance Use
A provider-facing summary that outlines key considerations for addressing substance use before pregnancy, including screening, harm reduction, trauma-informed care, and shared decision-making.

Preconception Substance Use – Clinician Quick Reference Guide
A quick guide to screening, harm reduction, referral, and care planning for substance use before pregnancy.

HUBs for Health Care Providers

Trauma and Violence-Informed Care HUB
A resource hub that provides information, tools, and learning resources to support trauma and violence-informed practice in health care.

Perinatal Mental Health for Health Care Providers HUB
A resource hub for health care providers that summarizes key evidence and recommendations on perinatal mental health and links to tools, guidelines, and learning resources to support care during pregnancy and the postpartum period.

Alcohol Use in Pregnancy and Postpartum: A HUB for Health Care Providers
A resource hub for health care providers that summarizes key evidence and recommendations on alcohol use in pregnancy and postpartum and links to screening tools, guidance, and support resources.

Virtual Care for Substance Use: A Hub for Health Care Providers
A resource hub for health care providers that explores how virtual care can support screening, diagnosis, treatment, and follow-up for substance use disorders during pregnancy and postpartum.

SOGC Clinical Guidelines

No 454: Identification and Treatment of Perinatal Mood and Anxiety DisordersA clinical practice guideline that outlines evidence-based approaches to the identification and treatment of perinatal mood and anxiety disorders during pregnancy and the postpartum period.

No 349: Substance Use in PregnancyA clinical practice guideline that outlines evidence-based recommendations for screening, counselling, and managing substance use during pregnancy.

No 405: Screening and Counselling for Alcohol Consumption During PregnancyA clinical practice guideline that outlines evidence-based recommendations for screening and counselling women of child-bearing age and pregnant women about alcohol use and related risks.

No 425a: Cannabis Use Throughout Women’s Lifespans – Part 1: Fertility, Contraception, Menopause, and Pelvic PainA clinical practice guideline that outlines evidence-based recommendations on cannabis use across the female lifespan, including fertility, contraception, menopause, and pelvic pain.

No 443a: Opioid Use Throughout Women’s Lifespan: Fertility, Contraception, Chronic Pain, and MenopauseA clinical practice guideline that outlines evidence-based recommendations on opioid use across women’s health care, including screening, treatment, harm reduction, and pregnancy-related considerations.

Online Courses

Perinatal Mood and Anxiety Disorders
An SOGC online course that builds knowledge and practical skills in screening, counselling, and treatment planning for perinatal mood and anxiety disorders.

Trauma and Violence-Informed Care
An SOGC online course that builds knowledge and practical skills in trauma and violence-informed care to support safer, more effective patient care.

Alcohol and Pregnancy
An SOGC online course that summarizes current recommendations on alcohol use during pregnancy and builds practical skills in screening, intervention, and treatment.

Transgender & Gender Diverse Health 101
An SOGC online course that builds knowledge and practical skills to support inclusive, culturally competent care for transgender, non-binary, and gender-diverse patients.

Gender Affirming Hormone Therapy
An SOGC online course that builds knowledge and practical skills to support inclusive, culturally competent care for transgender, non-binary, and gender-diverse patients.

Cannabis and Women’s Health
An SOGC online course that builds knowledge and practical skills to support informed, non-judgmental care for women who use cannabis, including screening, brief intervention, and counselling on women’s health and pregnancy-related considerations.

Opioids Use and Women’s Health
An SOGC online course that builds knowledge and practical skills to support informed, non-judgmental care for women who use opioids, including screening, treatment, and women’s health and pregnancy-related considerations.

Contraception: It’s a Plan
An SOGC online course that uses case-based learning to build practical skills in contraceptive counselling and clinical decision-making.

The Prevention Conversation
An online training program that provides evidence-informed education on preventing alcohol-exposed pregnancies and supporting preconception and pregnancy-related care.

Websites

Canada FASD Research Network
A Canadian research and resource hub that provides evidence-based information, tools, and education on fetal alcohol spectrum disorder, including prevention, diagnosis, intervention, and family supports.

Centre for Addiction and Mental Health (CAMH)
A Canadian mental health resource hub that provides information, clinical services, education, and tools to support mental health and substance use care.

Healthy Pregnancy Hub
A Canadian resource hub that provides evidence-informed information, fact sheets, and tools on medications, health conditions, and pregnancy to support informed decision-making.

Canadian Centre on Substance Use and Addiction (CCSA)
A Canadian resource hub that provides evidence-based information, policy resources, and tools to support substance use prevention, harm reduction, and treatment.

META:PHI (Mentoring, Education, and Clinical Tools for Addiction)
A Canadian clinical resource hub that provides education, guidance, and practical tools to support evidence-based substance use health care.

Canadian Women’s Foundation
A Canadian organization that provides advocacy, funding, and resources to advance gender equality and support the safety, well-being, and leadership of women, girls, and gender-diverse people.

National Collaborating Centre for Determinants of Health (NCCDH)
A Canadian public health resource hub that provides publications, webinars, tools, and learning resources focused on the social and structural determinants of health and health equity.

Centre of Excellence for Women’s Health
A Canadian research and knowledge exchange hub that provides resources, publications, and tools focused on women’s health and health equity.

Tools and Resources

Centre for Addiction and Mental Health Screening Tools
A clinical resource that provides guidance on screening for harmful alcohol use in women to support early identification and appropriate care.

5Ps PSU Screening Tool
A screening tool for pregnant patients that helps health care providers identify substance use, depression, and intimate partner violence and guide brief intervention and follow-up.

The 4P’s Plus© Screening Instrument
A validated screening instrument designed for pregnant patients that helps health care providers identify alcohol, tobacco, marijuana, and illicit drug use and guide follow-up assessment and support.

NIDA Quick Screen V1.0
A validated screening tool that helps health care providers identify substance use and related risk across multiple substances to support brief intervention and referral to treatment.

The CRAFFT Interview (2.1)
A validated adolescent substance use screening tool that helps health care providers identify alcohol, cannabis, nicotine, and other drug use and guide brief intervention and follow-up.

T-ACE Screening Tool
A validated alcohol screening tool used to help identify risk drinking in pregnancy and support further assessment and counselling.

TWEAK Screening Tool
A validated alcohol screening tool used to help identify risk drinking in pregnancy and support further assessment and counselling.

AUDIT-C Alcohol Screening Tool
A brief alcohol screening tool that helps identify hazardous drinking and supports further assessment, brief intervention, and follow-up care.

Drug Abuse Screening Test (DAST-10)
A validated 10-item screening tool that helps identify problematic drug use and supports further assessment, scoring, and follow-up care.

Resources for Patients

Frequently Asked Questions Substance Use and Preconception Health
An SOGC resource that answers common questions about substance use before pregnancy and supports informed, non-judgmental discussions with a health care provider.

Substance Use Before Pregnancy
An SOGC and CanFASD resource that outlines key considerations related to substance use before pregnancy and supports informed, non-judgmental preconception care.

Myth vs Fact: Substance Use Before Pregnancy Alcohol, Smoking, Vaping and Other Substances
An SOGC resource that addresses common myths and facts about substance use before pregnancy to support informed, non-judgmental preconception decision-making.

Substance Use and Preconception Health - Key Takeaways
An SOGC resource that provides patient-friendly information on substance use before pregnancy, including key considerations to support informed, non-judgmental preconception planning.

Substance Use and Mental Health in the Preconception Period
An SOGC and Canadian Public Health Association resource that highlights key considerations related to substance use before pregnancy and supports informed, non-judgmental preconception care.

The Society of Obstetricians and Gynaecologists of Canada (SOGC)