Researchers aimed to address the associations between prenatal cannabis use and maternal health outcomes over a 9-year period.
Prenatal patients who used cannabis were at a significantly higher risk of developing multiple pregnancy-related complications, totally independent on frequency of use. Although researchers also found a decreased risk of gestational diabetes, their findings support the fact that more research needs to be completed to get a better understanding of health outcomes for prenatal cannabis users.
“Rates of prenatal cannabis use in the US have increased in recent years, corresponding with spreading legalization and rising perceptions of safety. Pregnant individuals report using cannabis to help with sleep, depression, stress, morning sickness, and pain during pregnancy, and many perceive cannabis to be a safer alternative to prescription medications,” wrote authors of the study published in JAMA Internal Medicine.1
Feelings toward cannabis use in the US have changed drastically throughout the years. According to the Harris Poll’s report on the state of marijuana, 40% of American adults use marijuana and 25% use it at least once a week or more.2
As researchers work to understand the overall risks and benefits associated with cannabis use, they are further scrambling to understand the effects of cannabis use on patients who are pregnant. Similar to researchers’ previous findings that cannabis is primarily used to help with sleep, depression, and stress, the Harris Poll also found that 64% of users say that marijuana helps them “relax and unwind.”1,2
However, as sentiments toward cannabis use become less stigmatized, it’s important to understand how it affects the outcomes for pregnant patients, as prenatal cannabis use also increases along with overall use amongst the general public.
As part of the study, researchers analyzed data from 250,221 pregnant individuals (26.5% Asian/Pacific Islander; 37.4% White; mean age, 30.6 years) screened for prenatal cannabis use from January 2011 to December 2019 across 316,722 pregnancies.
“Prenatal cannabis use was defined as any self-reported use during early pregnancy or a positive toxicology test result based on universal screening at entrance to prenatal care (approximately 8-10 weeks’ gestation). Self-reported frequency of use (daily, weekly, monthly or less, never, unknown), use defined only by self-report, and use defined only by toxicology test results were examined,” investigators wrote.1
Before assessing study results, researchers listed the outcomes they observed within prenatal cannabis users, including gestational hypertension, preeclampsia, eclampsia, gestational diabetes, gestational weight gain greater and less than guidelines, placenta previa, placental abruption, placenta accreta, and severe maternal morbidity.
Among the cohort of 316,722 pregnancies, only 20,053 individuals (6.3%) tested positive for prenatal cannabis; 2.9% of these positives were self-reported, 5.3% were identified through positive toxicology testing, and 1.8% were reported through both reporting methods.
Prenatal cannabis use was associated with a higher risk of gestational hypertension, preeclampsia, weight gain less than and greater than guidelines, and placental abruption, according to authors of the study.1 Several negative outcomes were observed in this retrospective cohort study; however, researchers also found that patients had a reduced risk of gestational diabetes. Amidst varying risk reductions and the need for more research into prenatal cannabis use, the authors defined the relationship between prenatal cannabis use and maternal health as “complex.”
“In this and our prior studies, we have documented low sensitivity of self-reported prenatal cannabis use. There are real and perceived risks of disclosing prenatal substance use. Prenatal cannabis use can have greater consequences for individuals from disadvantaged backgrounds due to inequities in who gets tested and reported to child protective services and law enforcement, and some individuals may avoid prenatal care due to these concerns,” researchers wrote.1
As stigmatization of cannabis use has lessened, the same cannot be said about prenatal use of the controlled substance. According to the American College of Obstetricians and Gynecologists, cannabis use among pregnant individuals is discouraged.3 And although ongoing studies are still aiming to truly define the overall effects cannabis has on regular individuals, much more research is needed before health care providers consider encouraging cannabis use in this patient population.
“The findings suggest a complex association between prenatal cannabis use and maternal health and highlight the need for continued research to understand the mechanisms through which prenatal cannabis use is associated with the health of pregnant individuals. Prenatal cannabis use is a risk factor for adverse neonatal outcomes. As we continue to learn about the potential harms and benefits of prenatal cannabis use, clinicians must provide coordinated, nonstigmatizing care and education to support pregnant individuals in making informed decisions about cannabis use,” concluded the authors.1
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