Cannabis use, cannabis use disorder and mental health disorders among pregnant and postpartum women in the US: A nationally representative study

Perceived racial discrimination and tobacco and cannabis use in pregnant Black Americans: The mediating role of depressive symptoms

The objective of the current study was to assess the relationships between perceived racial discrimination, symptoms of depression, and tobacco and cannabis use in a sample of pregnant Black Americans. We collected data from 668 pregnant participants, in Atlanta, GA, once at 8- to 14- weeks' gestation and again at 24- to 30-weeks' gestation. We administered the Timeline Follow-back Interview to assess self-reported tobacco and cannabis use and measured metabolites of nicotine (cotinine) and cannabis (11-nor-9-carboxy-Δ9-tetrahydrocannabinol) from urine samples. Participants described depressive symptoms using the Edinburgh Postnatal Depression Scale. They also reported instances of racial discrimination throughout their lifetimes via the Krieger Experiences of Discrimination scale. Self-perceived racial discrimination was significantly related to increased tobacco use and urinary cotinine levels during pregnancy, while controlling for potential confounds. Race-based discrimination also impacted self-reported tobacco and cannabis use later in pregnancy through increased depressive symptoms. To our knowledge, this study is the first to investigate whether depressive symptoms mediate the influence of racial discrimination on substance use among pregnant Black people. Our findings have significant implications for smoking-cessation interventions, which should account for the interconnection between racial stress and mental health.

Psychological, social factors, and smoking behavior mediated the effects of cannabis use on personality disorders: A Mendelian randomization study

Background

Rapid changes in attitudes, legality, and patterns of cannabis use (CU) underscore the importance of understanding its impact on mental health. Although links between CU and personality disorders (PDs) are documented, their causality remains uncertain.

Methods

Employing Genome-Wide Association Studies (GWAS) data, this study investigated the causal relationship between cannabis use disorder (CUD) and lifetime cannabis use (LCU) with 9 types of PD risk through Mendelian randomization (MR) analysis. The primary method was the inverse variance weighted (IVW) method, supplemented by multivariable MR to assess direct effects independent of mental, social, and substance use factors, and mediation MR to explore mediating factors.

Results

Corrections for the false discovery rate revealed significant causal associations between CUD and an increased risk of emotionally unstable PD (EUPD; ORIVW = 1.228, 95% CI 1.069-1.411), overall PD (ORIVW = 1.186, 95% CI 1.065-1.321), and schizoid PD (SPD; ORIVW = 1.644, 95% CI 1.131-2.390). Mediation analysis identified schizophrenia (SCZ), major depressive disorder (MDD), neuroticism, and smoking initiation (SmkInit) as shared mediating factors between CUD and both EUPD and overall PD, with an additional mediating factor, household income (HI), specific to the CUD-to-overall PD pathway. In contrast, no mediating factors were found between CUD and SPD. Notably, a bidirectional causal relationship was observed between overall PD and CUD (ORIVW = 1.399, 95% CI 1.033-1.895). Suggestive evidence indicated a causal link between lifetime cannabis use (LCU) and overall PD risk (ORIVW = 1.074, 95% CI 1.008-1.146).

Conclusion

This study offers new insights into the potential impact of CU on the development and progression of various PDs, laying the groundwork for targeted interventions to mitigate its effects on mental health.

High Stakes: Exploring the Impact of Cannabis Use in Pregnancy and Lactation

Cannabis is the most commonly used federally illicit substance during pregnancy in the United States, with an estimated prevalence of 3% to 30%. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics discourage cannabis use during pregnancy and breastfeeding due to safety concerns for the fetus and infant. Despite these recommendations, nearly half of active cannabis users continue use in pregnancy. In this review, we summarize cannabis pharmacology and metabolism with a focus on delta-9-tetrahydrocannabinol, the psychoactive component of the cannabis plant, highlighting its significance in quantifying exposure and the impact on outcomes studies. We also provide a concise review of current evidence on the effects of perinatal cannabis use and pregnancy, infant, and childhood outcomes, acknowledging the limitations of this evidence. Additionally, we provide targeted counseling recommendations for harm reduction strategies and lactation considerations for birthing parents who use cannabis.

Substance use and use disorders during pregnancy and the postpartum period

Substance use and substance use disorders among pregnant and postpartum individuals have risen dramatically, necessitating enhanced clinician education and intervention strategies. This expert review offers obstetricians and gynecologists a comprehensive overview of substance use during the prenatal and postpartum periods. We discuss the epidemiology, maternal and fetal adverse effects, as well as treatment approaches for major substances: nicotine, cannabis, alcohol, benzodiazepines, stimulants, and opioids. Additionally, we address the ethical and legal implications of substance use during pregnancy and emphasize the importance of equitable and nonstigmatizing care. By integrating evidence-based practices, we aim to support obstetricians and gynecologists in providing optimal care for pregnant and postpartum individuals affected by substance use disorders.

Maternal cannabis use disorder and offspring behavioral outcomes: findings from a linked data cohort study

Few studies have explored the association between maternal gestational cannabis use and disruptive behavioural disorders (DBDs) in offspring, often relying on self-reported data and small samples. This study aimed to assess the relationship between maternal cannabis use disorder (CUD) during pregnancy and postpartum periods and the risk of disruptive behaviours in offspring. We conducted a population-based retrospective cohort study using linked health data from New South Wales, Australia, for live births between 2003 and 2005. Mothers with CUD were compared to those without, and the risk of DBDs in offspring was estimated. Both CUD and disruptive behavioural disorders were identified using the International Classification of Disease (ICD) codes. Generalised Linear Models (GLMs) with log-binomial regression were fitted to estimate disruptive behavioural disorder risk in children. Statistical significance was set at p < 0.05. After adjusting for key confounders, this study revealed significantly higher risks of disruptive behavioural disorders in children of mothers with CUD during the antenatal [risk ratio (RR) = 3.56, 95 % CI 2.42-5.05], perinatal [RR = 3.55, 95 % CI 2.45-4.98], and postnatal [RR = 2.95, 95 % CI 1.23-6.16] periods compared to non-exposed counterparts. These findings underscore the importance of preconception, antenatal, and postnatal counselling on maternal cannabis use to mitigate neurobehavioral risks in children.

Predictors of Participation in Prenatal Substance Use Assessment, Counseling, and Treatment Among Pregnant Individuals in Prenatal Settings Who Use Cannabis

OBJECTIVES

Assessment and counseling are recommended for individuals with prenatal cannabis use. We examined characteristics that predict prenatal substance use assessment and counseling among individuals who screened positive for prenatal cannabis use in prenatal settings.

METHODS

Electronic health record data from Kaiser Permanente Northern California's Early Start perinatal substance use screening, assessment, and counseling program was used to identify individuals with ≥1 pregnancies positive for prenatal cannabis use. Outcomes included completion of a substance use assessment and among those assessed, attendance in Early Start counseling only or Addiction Medicine Recovery Services (AMRS) treatment. Predictors included demographics and past-year psychiatric and substance use disorder diagnoses evaluated with GEE multinomial logistic regression.

RESULTS

The sample included 17,782 individuals with 20,398 pregnancies positive for cannabis use (1/2011-12/2021). Most pregnancies (80.3%) had an assessment. Individuals with Medicaid, anxiety, depression and tobacco use disorders, compared to those without, had higher odds and those with greater parity, older age (≥35) and in later trimesters, had lower odds of assessment. Among 64% (n = 10,469) pregnancies needing intervention based on assessment, most (88%) attended Early Start counseling only or AMRS (with or without Early Start). Greater parity and later trimester assessment was associated with lower odds, while Medicaid was associated with higher odds of Early Start counseling. Nearly all diagnosed psychiatric and substance use disorders were associated with higher odds of AMRS treatment.

CONCLUSIONS

A comprehensive prenatal substance use program engaged most pregnant individuals with prenatal cannabis use in substance use assessment and counseling. Opportunities to improve care gaps remain.

Exploring Peripartum Cannabis Use Among Young Sexual Minority People: A Qualitative Study

INTRODUCTION

Young childbearing sexual minority (SM) people are more likely to use cannabis and to have an unintended pregnancy than their heterosexual peers; however, little is known about their perceptions and experiences of peripartum cannabis use. This qualitative study explores the relationships young pregnant and parenting SM people have with cannabis, as well as their feelings and opinions about prenatal cannabis use.

METHOD

Participants who identified as SM from baseline surveys of the YoungMoms study were recruited for semi-structured qualitative interviews (n = 13). Interviews focused on cannabis use experiences before and during pregnancy. Data were analyzed using thematic analysis.

RESULTS

Data analysis revealed 3 key themes. Participants described the contextual adaptivity of their cannabis use, discussing how their use changed based on social context, mental health, and stress but was not directly related to their sexuality. Pregnancy was identified as a potential turning point for cannabis use as participants described trying to reduce or abstain during pregnancy, although some struggled to do so or continued use to address pregnancy symptoms. Facilitating factors of prenatal cannabis reduction were described, including focusing on the financial toll, social environment changes, access to health-related guidance, and replacement hobbies.

CONCLUSIONS

This study provides novel information about a public health concern among a pregnant population that is often overlooked in prenatal substance use research. Similar to their heterosexual peers, pregnancy may serve as an opportune time for intervention among young SM people who use cannabis, but consideration of unique factors that contribute to their cannabis use is needed.

Use of cannabis to manage symptoms of mental and physical health conditions during pregnancy: analysis of a pro-cannabis pregnancy forum

Introduction

Rates of prenatal cannabis use (PCU) have increased in recent years. Despite evidence of developmental health consequences to offspring and birthing person, there has been a reduction in the perception of PCU-related harms. Due to the stigma and risk of legal consequences associated with disclosing PCU, individuals are often cautious to seek information from their healthcare providers. Thus, pregnant people are more likely to seek information from anonymous sources, such as online support forums. Information garnered from these anonymous online forums can shed light on the patterns and motives for cannabis use among this population. These insights can help to better inform prevention efforts aimed at reducing potential harms of PCU and improve intervention efforts.

Methods

Posts (N = 120) from an online pro-cannabis pregnancy forum called "Ganja Mamas" on WhattoExpect.com were randomly selected and analyzed if they covered topics related to PCU. A qualitative coding structure based on the existing PCU literature was created and refined to include other emergent topics. The coding structure was used to apply thematic analysis to posts; associated codes were grouped into themes. Codes specific to symptom management for physical and mental health were subsequently subjected to further conceptual analysis for the current study.

Results

Four themes related to symptom management during pregnancy were identified: 1) cannabis use and impacts of use for a variety of mental health symptoms, including depression and anxiety; 2) cannabis use for physical health symptoms and conditions, such as nausea and pain; 3) use of cannabis to achieve homeostasis and manage stress; 4) decision-making about using cannabis for symptom management, such as using cannabis instead of prescription medications. Most discussions in this pro-cannabis forum reflected perceptions that cannabis was effective in treating the conditions for which it was used; however, limitations of cannabis' efficacy were also mentioned.

Discussion

There is need for reduced stigma and open communication between pregnant persons who use cannabis and their providers in discussing how to manage their mental and physical health symptoms. Understanding the various symptoms for which individuals use cannabis during pregnancy to self-treat can inform these conversations and the expansion of harm reduction strategies.

Association of psychiatric and substance use disorders with cannabis use and cannabis use disorder during early pregnancy in northern California

AIMS

To estimate the strength of association between psychiatric disorders and substance use disorders (SUD), and cannabis use and cannabis use disorder (CUD) during early pregnancy.

DESIGN

Observational study.

SETTING

Kaiser Permanente Northern California, USA.

PARTICIPANTS

299 496 pregnancies from 227 555 individuals screened for cannabis use by self-report and a urine toxicology test at entrance to prenatal care in Kaiser Permanente Northern California during January 2011-December 2021 (excepting year 2020). The sample was 62.5% non-White, with a mean (standard deviation) age of 31.1 (5.5) years; 6.8% used cannabis; 0.2% had a CUD.

MEASUREMENTS

Exposure variables included electronic health record-based psychiatric diagnoses of attention deficit hyperactivity, anxiety, bipolar, depressive, personality, posttraumatic stress and psychotic disorders; and alcohol, opioid, stimulant and tobacco use disorders, during the two years prior to pregnancy up to the day before the prenatal substance use screening date. Outcome variables were any cannabis use, frequency of self-reported cannabis use and CUD during early pregnancy.

FINDINGS

Psychiatric disorder prevalence ranged from 0.2% (psychotic) to 14.3% (anxiety), and SUD ranged from 0.3% (stimulant/opioid) to 3.8% (tobacco). Psychiatric disorders were associated with cannabis use and CUD, with the strongest association for any use found for bipolar disorder (adjusted odds ratio [aOR] = 2.83; 95% confidence interval [CI] = 2.53-3.17) and the strongest association for CUD found for psychotic disorders (aOR = 10.01, 95% CI = 6.52-15.37). SUDs were associated with cannabis use and CUD, with the strongest association for any use found for tobacco use disorder (aOR = 4.03, 95% CI = 3.82-4.24) and the strongest association for CUD found for stimulant use disorder (aOR = 21.99, 95% CI = 16.53-29.26). Anxiety, bipolar, depressive disorders and tobacco use disorder were associated with greater odds of daily than monthly or less cannabis use.

CONCLUSIONS

Psychiatric disorders and substance use disorders appear to be associated with elevated odds of any and frequent cannabis use as well as cannabis use disorder during early pregnancy. In most cases, the associations with cannabis outcomes were stronger for substance use disorders than other psychiatric disorders.

Reasons pregnant people use cannabis to self-treat health conditions during pregnancy: Results from a US population-based survey

INTRODUCTION

Little is known about reasons pregnant people self-treat health conditions and pregnancy-related symptoms with cannabis.

METHODS

We administered a cross-sectional survey to 3571 pregnant and recently pregnant people from US population-based panels. Participants who used cannabis at some point during pregnancy were asked which health conditions or symptoms they used cannabis to treat and reasons they used cannabis for self-treatment. We explored differences in reasons for self-treatment by sociodemographics.

RESULTS

Nine-hundred forty-six participants indicated they used cannabis during pregnancy. Fifty-seven percent (n = 578) of those who used cannabis during pregnancy indicated they used cannabis exclusively for health purposes; 39% (n = 347) indicated they used cannabis for health and recreation. The most common reasons for self-treatment were believing cannabis was safer and more effective than other medications or treatments. Some participants reported not having health insurance or a health care provider as reasons for self-treatment. Black and Hispanic people, and people with household income under $25,000, were more likely than White people and people with household income between $25,000-$49,999 to report barriers to other medications or treatments as reasons for self-treatment. People with high school education were more likely than people with more education to report viewing cannabis as safe and effective for self-treatment.

DISCUSSION AND CONCLUSIONS

Most pregnant people self-treating health conditions or symptoms with cannabis are doing so because they consider it safer and more effective than other medications or treatments. Some people, particularly people of colour and low-income people, may also self-treat because they face barriers to other treatments.

Reconsidering Breastfeeding Recommendations in the Context of Cannabis Use to Support Health Equity

The authors offer guidance to perinatal nurses and clinicians on how to assist patients who use cannabis and wish to breastfeed.

Herbal Cannabis and Depression: A Review of Findings Published over the Last Three Years

Public perception contrasts scientific findings on the depression-related effects of cannabis. However, earlier studies were performed when cannabis was predominantly illegal, its production was mostly uncontrolled, and the idea of medical cannabis was incipient only. We hypothesized that recent changes in attitudes and legislations may have favorably affected research. In addition, publication bias against cannabis may have also decreased. To investigate this hypothesis, we conducted a review of research studies published over the last three years. We found 156 relevant research articles. In most cross-sectional studies, depression was higher in those who consumed cannabis than in those who did not. An increase in cannabis consumption was typically followed by an increase in depression, whereas withdrawal from cannabis ameliorated depression in most cases. Although medical cannabis reduced depression in most studies, none of these were placebo-controlled. In clinical studies published in the same period, the placebo also ameliorated depression and, in addition, the average effect size of the placebo was larger than the average effect size of medical cannabis. We also investigated the plausibility of the antidepressant effects of cannabis by reviewing molecular and pharmacological studies. Taken together, the reviewed findings do not support the antidepressant effects of herbal cannabis.

Understanding cannabis use and mental health difficulties in context with women's experiences of stressful events and social health issues in pregnancy: The Aboriginal Families Study

BACKGROUND

Few population-based data sources fully recognise the intersections between stressful events, social health issues, and cannabis use in pregnancy, and little is known about sequelae for women's mental health.

METHODS

We draw on two waves of population-based data for 344 families participating in the Aboriginal Families Study longitudinal cohort. We examine women's mental health in the first year postpartum and when children were aged 5-9 years in context with life experiences and use of cannabis in pregnancy.

OUTCOMES

One in five women (19·5%) used cannabis during pregnancy (with or without co-use of tobacco). Within this group of women, 88·3% experienced 3 or more (3+) stressful events or social health issues. Psychological distress (Kessler-5 scale, K-5) in the year postpartum was substantially higher amongst women who had used cannabis or experienced 3+ stressful events or social health issues. High proportions of women met criteria for support and referral for depression and/or anxiety (52·5% of women who had used cannabis compared to 20·9% amongst women who had neither used cannabis nor tobacco; 43·2% of women who had experienced 3+ stressful events or social health issues compared to 15·6% amongst women who had not indicated these experiences). Similar patterns of psychological distress, depressive (9-item adapted Personal Health Questionnaire, aPHQ-9) and anxiety symptoms (7-item Generalised Anxiety Disorder score, GAD-7) were evident when the study children were aged 5-9 years.

INTERPRETATION

Amongst women who had used cannabis in pregnancy, a high burden of psychological distress, depression, and anxiety is evident in the postpartum period and as their children turn 5-9 years. The overlay of stressful events and social health issues and the high proportion of women meeting criteria for referral for mental health assessment and support indicate an urgent need to offer women opportunities for safe disclosure of cannabis use and opportunities to access sustained holistic services. Reducing the harms of cannabis use on Aboriginal and Torres Strait Islander families must be coupled with culturally safe ways of addressing the social, historical, and structural determinants of mental health distress and harmful use of substances.

Immigration status-related exclusive e-cigarette use and cannabis use and their dual use disparities associated with mental health disorder symptoms

INTRODUCTION

E-cigarette and cannabis use has been linked to various health risks, including respiratory and cardiovascular conditions. Yet, extant knowledge about the risk factors for exclusive and dual use of e-cigarettes and cannabis is limited, especially among immigrants. We examined exclusive e-cigarette and cannabis use and their dual use associated with mental health disorders among immigrants and U.S.-born.

METHODS

We analyzed national cross-sectional data collected between May 13, 2021, and January 9, 2022, among adults aged >18 years (n= 4766) living in U.S. Multinomial logistic regression analyses were conducted to model the associations of exclusivity and dual-use (reference group= non-use) with anxiety/depression.

RESULTS

The dual-use prevalence was higher than exclusive e-cigarette and cannabis use, especially among U.S.-born (dual use= 14.79% vs. cannabis use= 13.53% vs. e-cigarette use= 7.11%) compared to immigrants (dual use= 8.23% vs. cannabis use= 5.03% vs. e-cigarette use= 6.31%). Immigrants had lower risks of exclusive cannabis and dual use compared to U.S.-born. Anxiety/depression was associated with higher risks of exclusive cannabis use and dual use across immigration status, but was associated with exclusive e-cigarette use among only immigrants. While effect sizes of dual-use associated with anxiety/depression were higher among U.S.-born, the effect sizes of exclusive e-cigarette and cannabis use associated with anxiety/depression were higher among immigrants.

CONCLUSIONS

The findings revealed significant mental health risks for e-cigarette, cannabis, and their dual use among immigrants and U.S.-born, especially among U.S.-born. These findings highlight the need for public health research and interventions to consider immigration status-related disparities in substance use.