Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 3, 2026
Date Accepted: Jun 10, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Web-Based Intervention for Reducing Sexually Transmitted Infections and Substance Use During Pregnancy: A Randomized Controlled Trial
ABSTRACT
Background:
STIs are at a record high in the United States and are a significant health problem for childbearing women. Rates of substance use, particularly cannabis and opioid use, have increased in recent years and are linked to negative health consequences for pregnant women and their infants. Addressing these health concerns together during this vulnerable time is a priority.
Objective:
Objective:
We tested whether an innovative, theory-driven, technology-delivered and fully automated brief intervention (single session plus two booster sessions), the Health Check-up for Expectant Moms (HCEM), reduced condomless sex/STI risk, alcohol, or drug use, compared to a control condition in pregnant women seeking prenatal care.
Methods:
Methods:
We recruited a sample of 176 pregnant women (all were at risk for alcohol/drug use or STIs during pregnancy) from clinics and using social media campaigns (Facebook® and Instagram®) in the state of Michigan and randomized them to the Motivational Interviewing (MI)-consistent HCEM intervention or to an attention, time, and information-matched control condition delivered using the same technology platform. We followed these women at 2- and 6- months after the initial intervention visit. Primary outcomes included self-report assessment of alcohol, drug/cannabis use, and unprotected sexual occasions during pregnancy.
Results:
Results:
A total of 88 women were randomized to the intervention, and 88 to the control condition. Cannabis use was the most prevalent substance reported during pregnancy; a total of 35.2% reported recent use (within the last ninety days) at baseline, with 10.2% reporting use in the month prior to baseline. There were significant reductions in alcohol and cannabis use over time during pregnancy (at 2- and 6-months compared to baseline) in both HCEM and control groups; however, these reductions were not significantly different between conditions (time-by-arm interaction), and most were sustained from spontaneous reductions reported in the month before study enrollment. Moreover, there were no statistically significant differences in the change pattern of condomless sex across the groups at either follow-up.
Conclusions:
Conclusion: There are many potential benefits of a technology-delivered approach to support the behavioral health of pregnant women in a private and convenient way. Our sample was largely low-risk and as such, an intervention effect may have been impossible to observe given substantial self-change. Future trials are needed to examine efficacy in other samples of pregnant women with higher risk of current substance use. Clinical Trial: NCT03826342
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