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This study aimed to determine the prevalence and determinants of alcohol, tobacco and illicit drug use before and during pregnancy in Belgium. Methods: An observational study was conducted using data from the longitudinal BELpREG registry. The study included women aged 18 years or older who completed at least one questionnaire on substance use during pregnancy between 2022 and 2024. Data were analyzed using descriptive statistics and logistic regressions. Results: In total, 1441 women were included. Preconception prevalences of alcohol, tobacco and illicit drug use were 82.2%, 10.0% and 4.2%. These self-reported prevalences dropped in the first trimester to 12.9%, 4.1% and 0.6%, respectively. Considering the rates of substance use in pregnancy but before pregnancy awareness, the overall prevalence of alcohol, tobacco and illicit drug use in the first trimester was 41.0%, 6.6% and 1.2%, respectively. Women with a higher education (aOR (adjusted odds ratio), 2.12; 95% CI (confidence interval): 1.14\u20133.96), unplanned pregnancies (aOR, 2.88; 95% CI: 1.77\u20134.67), spontaneous pregnancies (aOR, 2.94; 95% CI: 1.51\u20135.75), cohabitants drinking alcohol daily (aOR, 2.01; 95% CI: 1.09\u20133.70), and those using tobacco in the first trimester (aOR, 5.37; 95% CI: 2.70\u201310.66) were more likely to report alcohol use. In addition, women with a lower education (aOR, 7.67; 95% CI: 3.76\u201315.67), unplanned pregnancies (aOR, 3.31; 95% CI: 1.53\u20137.15), cohabitants using tobacco (aOR, 9.11; 95% CI: 4.48\u201318.52), and those who used alcohol (aOR, 6.67; 95% CI: 3.07\u201314.64) or illicit drugs (aOR, 39.03; 95% CI: 3.72\u2013409.83) in the first trimester were more likely to report tobacco use. Conclusions: Despite a significant reduction in substance use in pregnancy compared to before pregnancy, a relevant portion of women continue to use substances, particularly in the early stages before pregnancy awareness. Targeted public health interventions and (more) awareness among caregivers are needed to further promote substance use cessation before conception.<\/jats:p>","DOI":"10.3390\/jcm14020613","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T10:32:15Z","timestamp":1737369135000},"page":"613","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Alcohol, Tobacco and Illicit Drug Use During Pregnancy in the Longitudinal BELpREG Cohort in Belgium Between 2022 and 2024"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8786-4765","authenticated-orcid":false,"given":"Sien","family":"Lenie","sequence":"first","affiliation":[{"name":"Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7545-2357","authenticated-orcid":false,"given":"Laure","family":"Sillis","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium"},{"name":"Research Foundation Flanders, 1000 Brussels, Belgium"},{"name":"L-C&Y, Child and Youth Institute KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9921-5105","authenticated-orcid":false,"given":"Karel","family":"Allegaert","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium"},{"name":"L-C&Y, Child and Youth Institute KU Leuven, 3000 Leuven, Belgium"},{"name":"Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium"},{"name":"Department of Hospital Pharmacy, Erasmus MC, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2718-4682","authenticated-orcid":false,"given":"Annick","family":"Bogaerts","sequence":"additional","affiliation":[{"name":"L-C&Y, Child and Youth Institute KU Leuven, 3000 Leuven, Belgium"},{"name":"Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium"},{"name":"Faculty of Health, University of Plymouth, Devon PL4 8AA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0710-6698","authenticated-orcid":false,"given":"Anne","family":"Smits","sequence":"additional","affiliation":[{"name":"L-C&Y, Child and Youth Institute KU Leuven, 3000 Leuven, Belgium"},{"name":"Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium"},{"name":"Neonatal Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristel","family":"Van Calsteren","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium"},{"name":"Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7166-7211","authenticated-orcid":false,"given":"Jan Y.","family":"Verbakel","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium"},{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4053-3915","authenticated-orcid":false,"given":"Veerle","family":"Foulon","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium"},{"name":"L-C&Y, Child and Youth Institute KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4130-5869","authenticated-orcid":false,"given":"Michael","family":"Ceulemans","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium"},{"name":"Research Foundation Flanders, 1000 Brussels, Belgium"},{"name":"L-C&Y, Child and Youth Institute KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Avsar, T.S., McLeod, H., and Jackson, L. (2021). Health outcomes of smoking during pregnancy and the postpartum period: An umbrella review. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03729-1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e015410","DOI":"10.1136\/bmjopen-2016-015410","article-title":"Low alcohol consumption and pregnancy and childhood outcomes: Time to change guidelines indicating apparently \u2019safe\u2019 levels of alcohol during pregnancy? A systematic review and meta-analyses","volume":"7","author":"Mamluk","year":"2017","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1001\/jama.2016.18612","article-title":"The Risks of Marijuana Use During Pregnancy","volume":"317","author":"Volkow","year":"2017","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1001\/jama.2019.8734","article-title":"Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes","volume":"322","author":"Corsi","year":"2019","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1159\/000510821","article-title":"Cannabis Use during Pregnancy and Risk of Adverse Birth Outcomes: A Longitudinal Cohort Study","volume":"27","author":"Gabrhelik","year":"2021","journal-title":"Eur. Addict. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e009986","DOI":"10.1136\/bmjopen-2015-009986","article-title":"Prenatal exposure to cannabis and maternal and child health outcomes: A systematic review and meta-analysis","volume":"6","author":"Gunn","year":"2016","journal-title":"BMJ Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1440-1754.2004.00280.x","article-title":"Fetal alcohol syndrome: Diagnosis, epidemiology, and developmental outcomes","volume":"40","year":"2004","journal-title":"J. Paediatr. Child Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1111\/j.1530-0277.2011.01664.x","article-title":"Prenatal alcohol exposure patterns and alcohol-related birth defects and growth deficiencies: A prospective study","volume":"36","author":"Feldman","year":"2012","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Pacho, M., Aymerich, C., Pedruzo, B., Salazar de Pablo, G., Sesma, E., Bordenave, M., Dieguez, R., Lopez-Zorroza, I., Herrero, J., and Laborda, M. (2023). Substance use during pregnancy and risk of postpartum depression: A systematic review and meta-analysis. Front. Psychiatry, 14.","DOI":"10.3389\/fpsyt.2023.1264998"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.jogn.2021.02.008","article-title":"Scoping Review of the Associations Between Perinatal Substance Use and Perinatal Depression and Anxiety","volume":"50","author":"Pentecost","year":"2021","journal-title":"J. Obs. Gynecol. Neonatal. Nurs."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Grzywacz, E., Brzuchalski, B., Smiarowska, M., Malinowski, D., Machoy-Mokrzynska, A., and Bialecka, M.A. (2023). Significance of Selected Environmental and Biological Factors on the Risk of FASD in Women Who Drink Alcohol during Pregnancy. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196185"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1001\/jamapediatrics.2017.0778","article-title":"Association Between Prenatal Alcohol Exposure and Craniofacial Shape of Children at 12 Months of Age","volume":"171","author":"Muggli","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Pielage, M., El Marroun, H., Odendaal, H.J., Willemsen, S.P., Hillegers, M.H.J., Steegers, E.A.P., and Rousian, M. (2023). Alcohol exposure before and during pregnancy is associated with reduced fetal growth: The Safe Passage Study. BMC Med., 21.","DOI":"10.1186\/s12916-023-03020-4"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1186\/1742-4755-11-S3-S6","article-title":"Preconception care: Caffeine, smoking, alcohol, drugs and other environmental chemical\/radiation exposure","volume":"11","author":"Lassi","year":"2014","journal-title":"Reprod Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1001\/jamapediatrics.2021.0291","article-title":"Association of Preconception Paternal Alcohol Consumption With Increased Fetal Birth Defect Risk","volume":"175","author":"Zhou","year":"2021","journal-title":"JAMA Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Corrales-Gutierrez, I., Mendoza, R., Gomez-Baya, D., and Leon-Larios, F. (2019). Pregnant Women\u2019s Risk Perception of the Teratogenic Effects of Alcohol Consumption in Pregnancy. J. Clin. Med., 8.","DOI":"10.3390\/jcm8060907"},{"key":"ref_17","unstructured":"World Health Organization (2014). Guidelines for the Identification and Management of Substance Use Disorders in Pregnancy, World Health Organization."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1002\/pds.4862","article-title":"Health products\u2019 and substance use among pregnant women visiting a tertiary hospital in Belgium: A cross-sectional study","volume":"28","author":"Ceulemans","year":"2019","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sillis, L., Foulon, V., Allegaert, K., Bogaerts, A., De Vos, M., Hompes, T., Smits, A., Van Calsteren, K., Verbakel, J.Y., and Ceulemans, M. (2023). Development and design of the BELpREG registration system for the collection of real-world data on medication use in pregnancy and mother-infant outcomes. Front. Drug. Saf. Regul., 3.","DOI":"10.3389\/fdsfr.2023.1166963"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s40264-023-01291-7","article-title":"Core Data Elements for Pregnancy Pharmacovigilance Studies Using Primary Source Data Collection Methods: Recommendations from the IMI ConcePTION Project","volume":"46","author":"Richardson","year":"2023","journal-title":"Drug. Saf."},{"key":"ref_21","unstructured":"European Medicines Agency (2019). Guideline on Good Pharmacovigilance Practices (GVP) Product- or Population-Specific Considerations III: Pregnant and Breastfeeding Women, EMA\/653036\/2019\u2014Draft for Public Consultation."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e5751","DOI":"10.1002\/pds.5751","article-title":"Letter to the Editor re Davis et al., 2023: BELpREG, the first of its kind real-world data source on medication use in pregnancy in Belgium","volume":"33","author":"Ceulemans","year":"2024","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Skagerstrom, J., Alehagen, S., Haggstrom-Nordin, E., Arestedt, K., and Nilsen, P. (2013). Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: A cross sectional study in Sweden. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-780"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1089\/jwh.2010.2216","article-title":"Predictors of drinking during pregnancy: A systematic review","volume":"20","author":"Skagerstrom","year":"2011","journal-title":"J. Womens Health (Larchmt)"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s00404-013-3056-9","article-title":"Determinants of alcohol cessation, reduction and no reduction during pregnancy","volume":"289","author":"Kitsantas","year":"2014","journal-title":"Arch. Gynecol. Obs."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/acer.13305","article-title":"Prenatal Alcohol Consumption Between Conception and Recognition of Pregnancy","volume":"41","author":"McCormack","year":"2017","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/eurpub\/cky004","article-title":"Prevalence of smoking during pregnancy and associated risk factors: A cross-sectional study in Northern Greece","volume":"28","author":"Tsakiridis","year":"2018","journal-title":"Eur. J. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Smedberg, J., Lupattelli, A., Mardby, A.C., and Nordeng, H. (2014). Characteristics of women who continue smoking during pregnancy: A cross-sectional study of pregnant women and new mothers in 15 European countries. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-213"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12978-019-0740-7","article-title":"Prevalence and predictors of maternal smoking prior to and during pregnancy in a regional Danish population: A cross-sectional study","volume":"16","author":"Backhausen","year":"2019","journal-title":"Reprod Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1111\/add.14135","article-title":"Predictors of smoking cessation during pregnancy: A systematic review and meta-analysis","volume":"113","author":"Riaz","year":"2018","journal-title":"Addiction"},{"key":"ref_32","first-page":"6","article-title":"Maternal factors associated with smoking during gestation and consequences in newborns: Results of an 18-year study","volume":"8","year":"2022","journal-title":"J. Clin. Transl. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1177\/1403494818804417","article-title":"Smoking during pregnancy in Finland\u2014Trends in the MATEX cohort","volume":"47","author":"Rumrich","year":"2019","journal-title":"Scand. J. Public Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s12978-019-0807-5","article-title":"Prevalence and patterns of cigarette smoking before and during early and late pregnancy according to maternal characteristics: The first national data based on the 2003 birth certificate revision, United States, 2016","volume":"16","author":"Kondracki","year":"2019","journal-title":"Reprod Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e006323","DOI":"10.1136\/bmjopen-2014-006323","article-title":"Prevalence and predictors of alcohol use during pregnancy: Findings from international multicentre cohort studies","volume":"5","author":"Kearney","year":"2015","journal-title":"BMJ Open"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1515\/jpm-2013-0323","article-title":"Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women","volume":"43","author":"Kitsantas","year":"2015","journal-title":"J. Perinat. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ypmed.2019.04.027","article-title":"Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017","volume":"124","author":"Shmulewitz","year":"2019","journal-title":"Prev. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.drugalcdep.2019.02.014","article-title":"The interaction of sociodemographic risk factors and measures of nicotine dependence in predicting maternal smoking during pregnancy","volume":"198","author":"Bucholz","year":"2019","journal-title":"Drug Alcohol Depend."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e207","DOI":"10.1016\/j.wombi.2017.01.003","article-title":"Consumption of alcohol during pregnancy-A multinational European study","volume":"30","author":"Mardby","year":"2017","journal-title":"Women Birth"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Corrales-Gutierrez, I., Mendoza, R., Gomez-Baya, D., and Leon-Larios, F. (2020). Understanding the Relationship between Predictors of Alcohol Consumption in Pregnancy: Towards Effective Prevention of FASD. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17041388"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Hamadneh, S., Hamadneh, J., Alhenawi, E., Khurma, R.A., and Hussien, A.G. (2024). Predictive factors and adverse perinatal outcomes associated with maternal smoking status. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-53813-7"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Azagba, S., Ebling, T., and Korkmaz, A. (2024). The Changing Faces of Smoking: Sociodemographic Trends in Cigarette Use in the U.S., 1992\u20132019. Int. J. Ment. Health Addict.","DOI":"10.1007\/s11469-024-01258-4"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Bover Manderski, M.T., Steinberg, M.B., Wackowski, O.A., Singh, B., Young, W.J., and Delnevo, C.D. (2021). Persistent Misperceptions about Nicotine among US Physicians: Results from a Randomized Survey Experiment. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18147713"},{"key":"ref_44","unstructured":"Gisle, L., Demararest, S., and Drieskens, S. (2018). Health Interview Survey 2018: Alcohol Use, Sciensano. D\/2019\/14.440\/56."},{"key":"ref_45","unstructured":"Gisle, L., Demararest, S., and Drieskens, S. (2018). Health Interview Survery 2018: Smoking, Sciensano. D\/2019\/14.440\/57."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"365","DOI":"10.15585\/mmwr.mm6816a1","article-title":"Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18\u201344 Years\u2014United States, 2015\u20132017","volume":"68","author":"Denny","year":"2019","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1007\/s10995-008-0355-z","article-title":"Alcohol and drug use before and during pregnancy: An examination of use patterns and predictors of cessation","volume":"13","author":"Harrison","year":"2009","journal-title":"Matern. Child Health J."},{"key":"ref_48","first-page":"28","article-title":"Substance use and self-medication during pregnancy and associations with socio-demographic data: A cross-sectional survey","volume":"2","author":"Liao","year":"2015","journal-title":"Int. J. Nurs. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"108507","DOI":"10.1016\/j.drugalcdep.2021.108507","article-title":"Frequency of cannabis use during pregnancy and adverse infant outcomes, by cigarette smoking status\u20148 PRAMS states, 2017","volume":"220","author":"Haight","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.drugalcdep.2011.06.011","article-title":"Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence","volume":"120","author":"Cerda","year":"2012","journal-title":"Drug Alcohol Depend."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s10995-019-02840-2","article-title":"Determinants of Alcohol Consumption in Women Before and After Awareness of Conception","volume":"24","author":"Ishitsuka","year":"2020","journal-title":"Matern. Child Health J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1093\/eurpub\/cks044","article-title":"Alcohol consumption and social inequality at the individual and country levels--results from an international study","volume":"23","author":"Grittner","year":"2013","journal-title":"Eur. J. Public Health"},{"key":"ref_53","unstructured":"Goemaes, R., Fomenko, E., Laubach, M., De Coen, K., Roelens, K., and Bogaerts, A. (2024). Perinatal Health in Flenders\u2014Year 2023, Study Center for Perinatal Epidemiology."},{"key":"ref_54","unstructured":"Statistics Flanders (2024, November 13). Population and Society, Available online: https:\/\/www.vlaanderen.be\/statistiek-vlaanderen\/bevolking-en-samenleving."},{"key":"ref_55","unstructured":"Growing Up, and Child and Youth Govermental Agency (2024, November 13). Numerical Report Household Income and Poverty, Available online: https:\/\/www.opgroeien.be\/kennis\/cijfers-en-onderzoek\/gezinsinkomen-en-kansarmoede."},{"key":"ref_56","unstructured":"Statbel (2024, November 13). Employment and Unemployment, Available online: https:\/\/statbel.fgov.be\/en\/themes\/work-training\/labour-market\/employment-and-unemployment."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3109\/13625187.2013.851183","article-title":"Pregnancy planning and lifestyle prior to conception and during early pregnancy among Danish women","volume":"19","author":"Backhausen","year":"2014","journal-title":"Eur. J. Contracept. Reprod Health Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.midw.2017.10.004","article-title":"Preconception lifestyle changes in women with planned pregnancies","volume":"56","author":"Goossens","year":"2018","journal-title":"Midwifery"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.midw.2015.10.012","article-title":"Preconception-related needs of reproductive-aged women","volume":"33","author":"Goossens","year":"2016","journal-title":"Midwifery"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Amuli, K., Decabooter, K., Talrich, F., Renders, A., and Beeckman, K. (2021). Born in Brussels screening tool: The development of a screening tool measuring antenatal psychosocial vulnerability. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-11463-8"},{"key":"ref_61","unstructured":"Born in Belgium Professionals (2024, November 29). Born in Belgium Professionals, Available online: https:\/\/borninbelgiumpro.be\/."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/613\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:31:26Z","timestamp":1759919486000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,18]]},"references-count":61,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020613"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020613","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,18]]}}}