Tags:  Pregnancy; Cannabis use; Addiction; Mental Health; Depression; Mood; Anxiety; Trauma.

 

Thumbnail: Pregnant women with concurrent mental disorders such as depression, anxiety or a history of trauma appear to have an increased rate of cannabis consumption during pregnancy.

 

The problem: Qualitative studies have determined that there is an increasing trend of cannabis use, especially among patients with co-existing mood or anxiety disorders. However, no quantitative studies have examined this.

 

The study: Clinical records at a large private health system were reviewed from 2012 through 2017. Pregnant patients who completed a self-reported cannabis consumption questionnaire as well as a urine toxicology screen at 8 weeks gestation, were included in the study.

 

Demographic information, as well as past medical history information, were collected. Patients with depression, anxiety, and trauma disorder were identified by International Classification of Diseases (ICD) – 9th edition codes. Self-reported depression symptoms were also collected (Patient Health Questionnaire 95).

 

Main results:

• A total of 196,022 patients were included in the study.

• 6% of patients (n=11,681) screened positive for prenatal cannabis use.

• Demographic factors associated with increased cannabis use:

  • Younger age

  • Lower household incomes

  • African American or Hispanic

• Comorbidities associated with increased cannabis use - adjusted OR (95% CI):

  • Anxiety Disorder – 1.90 (1.76-2.04)

  • Depressive Disorder – 2.25 (2.11-2.41)

  • Anxiety and Depressive Disorder – 2.65 (2.46-2.86)

  • History of trauma – 2.82 (2.59-3.06)

  • Self-reported intimate partner violence – 1.94 (1.74-2.15)

  • Severity of depressive symptoms (self-reported)

    • Mild – 1.60 (1.53-1.67)

    • Moderate – 2.09 (1.96-2.23)

    • Moderately Severe-Severe – 2.55 (2.35-2.77)

 

 

Conclusions:  A significant proportion of women used cannabis during pregnancy. Depression, anxiety, history of trauma and intimate partner violence were associated with increased odds of cannabis consumption.

 

Why this is a good study:

• This study provides evidence that cannabis consumption during pregnancy is common.

• Large sample size, enough to determine strong associations as well as a dose-response association (higher odds of consumption with higher severity of symptoms).

 

Why this isn’t a perfect study:

• Cannabis use is associated with several mental disorders, including anxiety and depression. The direction of this association can’t be determined, requiring further studies to asses the possibility of cannabis worsening these conditions during pregnancy.

• Even though this study has a large sample size, it involves a single healthcare system in a single state. We do not know if the results are reproducible in other parts of the country/world.  

• Cannabis screening was performed at early stages of the pregnancy (8 weeks), patients could have been unaware of pregnancy at the time of cannabis consumption.

 

What this study adds:

• This study provides qualitative evidence that cannabis consumption is prevalent, albeit only in a single health system. Further studies are warranted to confirm this finding.

 

What it doesn’t:

• Even though the study proves an association between cannabis use and certain mental disorders, it can not prove the direction of this association with certainty.

 

Funder:  This study was supported by National Institutes of Health National Institute on Drug Abuse K01 Awards DA043604 and R01 DA047405 and National Institutes of Mental Health K01 Award MH 103444

 

Author conflicts:  None reported.