Abstract
As the overall prevalence of prenatal cannabis use rises, it is vital to also monitor trends in the frequency of cannabis use in the period leading up to and during pregnancy because more frequent use may confer greater health risks for mothers and their children. To examine trends in the frequency of self-reported cannabis use among pregnant women in the year before and during pregnancy. Cross-sectional study using data from 367 403 pregnancies among 276 991 women 11 years or older who completed a self-administered questionnaire on cannabis use during standard prenatal care in Kaiser Permanente Northern California from January 1, 2009, to December 31, 2017. The annual prevalence of self-reported daily, weekly, and monthly cannabis use among women before and during pregnancy was estimated using Poisson regression with a log link function, adjusting for sociodemographics. Data analyses were conducted from February to May 2019. Calendar year. Self-reported frequency of cannabis use in the year before pregnancy and during pregnancy assessed as part of standard prenatal care (at approximately 8 weeks' gestation). Among the overall sample of 367 403 pregnancies among 276 991 women, 35.9% of the women self-reported white race/ethnicity; 28.0%, Hispanic; 16.6%, Asian; 6.0%, African American; and 13.5%, other. In the sample, 1.2% of the women were aged 11 to 17 years; 15.3%, 18 to 24 years; 61.4%, 25 to 34 years; and 22.0%, older than 34 years. Median (interquartile range) neighborhood household income was $70 472 ($51 583-$92 643). From 2009 to 2017, the adjusted prevalence of cannabis use in the year before pregnancy increased from 6.80% (95% CI, 6.42%-7.18%) to 12.50% (95% CI, 12.01%-12.99%), and the adjusted prevalence of cannabis use during pregnancy increased from 1.95% (95% CI, 1.78%-2.13%) to 3.38% (95% CI, 3.15%-3.60%). Annual relative rates of change in self-reported daily cannabis use (1.115; 95% CI, 1.103-1.128), weekly cannabis use (1.083; 95% CI, 1.071-1.095), and monthly or less cannabis use (1.050; 95% CI, 1.043-1.057) in the year before pregnancy increased significantly, with daily use increasing most rapidly (from 1.17% to 3.05%). Similarly, annual relative rates of change in self-reported daily cannabis use (1.110; 95% CI, 1.089-1.132), weekly cannabis use (1.075; 95% CI, 1.059-1.092) and monthly or less cannabis use (1.044; 95% CI, 1.032-1.057) during pregnancy increased significantly from 2009 to 2017, with daily use increasing most rapidly (from 0.28% to 0.69%). Results of this study demonstrate that frequency of cannabis use in the year before pregnancy and during pregnancy has increased in recent years among pregnant women in Northern California, potentially associated with increasing acceptance of cannabis use and decreasing perceptions of cannabis-associated harms.
Highlights
Cannabis use during pregnancy may adversely affect the health of pregnant mothers and the developing fetus
Meaning Results of this study demonstrate that frequency of cannabis use in the year before pregnancy and during pregnancy has increased among women in Northern California in recent years, with relative rates of daily cannabis use increasing most rapidly
Results of this study demonstrate that frequency of cannabis use in the year before pregnancy and during pregnancy has increased in recent years among pregnant women in Northern California, potentially associated with increasing acceptance of cannabis use and decreasing perceptions of cannabis-associated harms
Summary
Cannabis use during pregnancy may adversely affect the health of pregnant mothers and the developing fetus. A growing body of literature suggests that prenatal cannabis use is associated with lower offspring birthweight, and there is evidence of possible adverse effects on other fetal and neonatal outcomes, as well as worse neuropsychological functioning among children exposed to cannabis in utero.[1,2,3,4,5] While much is still unknown, national guidelines recommend that pregnant women abstain from cannabis use in the perinatal period owing to concerns about the negative health outcomes of cannabis use in pregnancy.[3]. Cannabis use among pregnant women has increased during recent years.[6,7] This use has increased with general acceptance and accessibility of cannabis,[8,9] and many women who are pregnant and cannabis users believe there is slight or no risk to using cannabis.[10,11] Studies suggest that obstetric health care professionals often do not respond or provide counseling to women who disclose cannabis use during pregnancy,[12] and women report dissatisfaction with the quality of information about the harms of prenatal cannabis use.[10,13] This leaves patients to turn to online resources, social media, friends, and family where they frequently receive incomplete information suggesting that cannabis use in pregnancy is safe and effective in treating pregnancy-related symptoms.[13,14,15,16]
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