Abstract
IntroductionPassage of cannabis laws may impact cannabis use and the use of other substances. The suggested association is of particular concern in pregnant women where exposure to substances can cause harm to both the pregnant woman and fetus. The present study contributes to the minimal literature on factors associated with cannabis use during the preconception, prenatal, and postpartum periods including state legalization status, concurrent use of tobacco and e-cigarettes and adequacy of prenatal care.MethodsWe conducted a cross-sectional analysis using combined survey data from the 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS) collected from 36,391 women. Logistic regression was used to estimate the impact of state-legalization, adequacy of prenatal care, and other substance use on cannabis use during the preconception, prenatal, and post-partum periods.ResultsIn the preconception model, residence in a recreationally legal state (OR: 2.37; 95% CI, 2.04–2.75) or medically legal state (OR:3.32; 95% CI, 2.90–3.80) compared to a non-legal state was associated with higher odds of cannabis use. In the prenatal model, residence in a recreationally legal state was associated with higher odds of cannabis use (OR: 1.51; 95% CI, 1.29–1.79) whereas there was no association with residence in a medically legal state. Tobacco use including e-cigarettes and moderate prenatal alcohol use were also significantly associated with cannabis use.ConclusionRecreational cannabis legalization is associated with the use of cannabis prior to, during, and after pregnancy. Renewed clinical and policy efforts may be warranted to update prenatal substance use prevention programs, educational campaigns, and provider education as cannabis legalization evolves.
Highlights
Passage of cannabis laws may impact cannabis use and the use of other substances
This study finds consistent associations of legalization of recreational cannabis is associated with cannabis use throughout the reproductive cycle; medical cannabis legalization was associated with cannabis use, but only in the preconception period
Concurrent use of tobacco products including e-cigarettes was associated with cannabis use in this population. These findings suggested legalization may play a role in cannabis use during pregnancy and providers may want to consider how and when the council pregnant women about substance use in states with legalization
Summary
Passage of cannabis laws may impact cannabis use and the use of other substances. The suggested association is of particular concern in pregnant women where exposure to substances can cause harm to both the pregnant woman and fetus. The present study contributes to the minimal literature on factors associated with cannabis use during the preconception, prenatal, and postpartum periods including state legalization status, concurrent use of tobacco and e-cigarettes and adequacy of prenatal care. Cannabis use during pregnancy may have adverse effects on perinatal and child health outcomes including low infant birth weight and child mental health concerns (Conner et al, 2016; Gunn et al, 2016; Shankaran et al, 2004). The concurrent use of two substances is a potentially dangerous combination since tobacco and cannabis use together is associated with an increased risk of adverse birth outcomes including stillbirth and small-for-gestational age (SGA) when compared to using one substance alone (El Marroun et al, 2016; Gunn et al, 2016)
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