Rates of cannabis use by women in early pregnancy shot up 25% early in the COVID-19 pandemic, according to a Kaiser Permanente study of more than 100,000 pregnancies in Northern California.
The study, published yesterday in JAMA, analyzed routine urine tests for cannabis at the first (8-week) prenatal visit for 100,005 pregnancies of 95,412 women from Jan 1, 2019, to Dec 31, 2020. Positive test results were compared with those from the 15 months leading up to the pandemic.
Patients were, on average, 31 years old. About 34% were White, 28% were Hispanic, 26% were Asian or Pacific Islander, 7% were Black, and 5% were multiracial or of unknown race.
State's overall use increased, too
Of the women, 8.14% (95% confidence interval [CI], 7.85% to 8.43%) used cannabis in spring 2020, compared with 6.75% (95% CI, 6.55% to 6.95%) before the pandemic.
Senior study author Lyndsay Avalos, PhD, MPH, said in a Kaiser Permanente news release that cannabis use has been linked with low birth weight and impaired neurodevelopment. "As the pandemic continues it will be important to identify subgroups of women who are most likely to use cannabis during pregnancy so we can provide more targeted interventions," she said.
Lead author Kelly Young-Wolff, PhD, MPH, said that while the study didn't determine the reasons for the increase, the prevalence and frequency of prenatal cannabis use has been creeping up over time. The authors noted that the results are consistent with the increase in overall cannabis sales in California over the same period. State data show that cannabis' quarterly average taxable sales from April to December 2020 was $1.2 billion, whereas the quarterly average of the 15 months' prior was $712 million, a 68.5% increase.
"Pregnant women are more likely to use cannabis if they are depressed, anxious, or have experienced trauma," Young-Wolff said. "It’s very possible that more pregnant women are using cannabis in an attempt to self-medicate these issues during the pandemic."
Clinicians should discuss cannabis use with their pregnant patients, as well as alternative ways to manage issues such as nausea and mood problems early in pregnancy, coauthor Deborah Ansley, MD, said in the release. "Clinicians—and people who work in cannabis dispensaries—need to help educate women that during pregnancy they should abstain from any type of cannabis use because of potential health risks to their babies," she said.
Some don't understand risks to offspring
In a commentary in JAMA Network Open that focuses on a similar study published in that journal in February, Young-Wolff; Lynn Silver, MD, MPH, of Public Health Institute in Oakland, California; and Qiana Brown, PhD, MPH, LCSW, of Rutgers University, said that data on cannabis use in pregnant women are reason for "substantial concern."
They note that the US Surgeon General, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics all recommend that pregnant and breastfeeding women abstain from cannabis use.
"However, pregnant women remain uncertain about the harms of prenatal cannabis use, and many seek out anecdotal advice from peers and online communities supportive of cannabis when choosing whether to use (or continue to use) cannabis during pregnancy," Young-Wolff and colleagues wrote. "Adding to the confusion, many cannabis retailers tout cannabis as a safe, natural, and effective way to manage pregnancy symptoms."
The authors called for more research on whether expanding legalization of recreational cannabis is tied to increasing prevalence, frequency, or intensity of use of the drug before, during, and after pregnancy and whether any methods of ingestion (eg, gummies) are more harmful than others.
"Beyond state cannabis policies, local governments in many states can further regulate retail cannabis sales, for example, by limiting retailer density, banning retailers altogether, by requiring prominent pictorial warnings on prenatal use in stores or on advertising, or by limiting product types allowed to be sold," they wrote.
It is time, according to Young-Wolff and colleagues, to reform policies that criminalize prenatal substance use in favor of protecting the health of mothers and children.
"Improvements in primary prevention and education are vital but also necessary are legal and regulatory policies that protect infants and children, inform women of risks, prohibit health and therapeutic claims for cannabis outside scientific approval processes, and ensure equitable access to supportive and nonpunitive substance use treatment," they concluded.