Background: The use of excessive caffeine, consumption of alcohol, cigarette, and khat during pregnancy can result in adverse health effects on the fetus. The World Health Organization (WHO) recommends as a daily caffeine intake not exceeding 300 mg. Likewise, pregnant women are recommended to avoid alcohol, khat and tobacco use. However, the magnitude of these substances use among pregnant women in Ethiopia has not been well studied. Therefore, this study aimed to determine the magnitudes of excessive caffeine and alcohol consumption, khat chewing, as well as tobacco use during pregnancy and identify factors associated with excessive caffeine consumption.

Methods: We conducted a community based cross-sectional study from April 12 to May 15, 2018 and used a random sampling technique to select 352 pregnant women. We developed a questionnaire adapted from Caffeine Consumption Questionnaire-Revised (CCQ-R), Alcohol Use Disorder Identification Test (AUDIT), and Global Adult Tobacco Survey (GATS) for caffeine, alcohol consumption and tobacco use assessment respectively. We used non-consecutive two days 24-hour recall to assess the habitual intake of caffeine. The collected data were entered using Epi-data version 3.1 Software. Then, the data were exported to Stata 14 for data management and analysis. Prevalence with 95% confidence interval was estimated for excessive caffeine intake per day, alcohol consumption, khat chewing, and passive tobacco smoking. Multivariable binary logistic regression was fitted to identify factors associated with excessive caffeine intake among pregnant women.

Results: About 17.6% (95% CI: 13.9%, 22.0%) of the pregnant women consumed 300 mg and above caffeine per day, exceeding the WHO recommended daily caffeine intake during pregnancy. The prevalence of alcohol consumption and Khat chewing were 10.0% (95% CI: 7.2%, 13.7%) and 35.8% (95% CI: 30.8, 41.0%), respectively. None of the pregnant women were active tobacco smokers. However, 23.2 % (95% CI: 19.0, 28.0%) were passive tobacco smokers. We found that the richest wealth status (AOR=3.66; 95% CI: 1.13, 11.88), and the first trimester of pregnancy (AOR=4.04; 95% CI: 1.26, 13.05) were significantly associated with excessive caffeine consumption.

Conclusions: The study showed a considerable magnitude of substance use among pregnant women in the study area. Therefore, programs and services focusing on pregnant women shall consider addressing substance use exposure.

Keywords: Substance use, Caffeine consumption, Alcohol consumption, Cigarette smoking, Khat chewing, Pregnancy