The Complex Relationship Between Cannabis Use, Mental Health, and Pregnancy: A Comprehensive Examination


Cannabis use has become a subject of increasing concern, especially when it comes to its potential effects on maternal and child health during pregnancy and postpartum.

The American College of Obstetricians and Gynecologists (ACOG), various studies, and public health authorities have consistently warned against cannabis consumption during these critical periods due to the associated risks (ACOG, 2017; Badowski and Smith, 2020; Brown et al., 2016; Calvigioni et al., 2014; Dong et al., 2018; El Marroun et al., 2018; Gabrhelik et al., 2021; Gunn et al., 2016; Haight et al., 2021; Kharbanda et al., 2020; Luke et al., 2019; Marchand et al., 2022; Mark et al., 2021; Meinhofer et al., 2022; Nguyen and Harley, 2022; Ordean and Kim, 2020; Paul et al., 2020; Ryan et al., 2018; U.S. Department of Health and Human Services, 2019; Volkow et al., 2017; Young-Wolff et al., 2020).

In spite of these warnings and recommendations, statistics reveal a concerning trend. The prevalence of cannabis use among pregnant women in the United States has risen by over 110% from 2.37% to 4.98% between 2002 and 2016 (Agrawal et al., 2019; Brown et al., 2017).

Similarly, non-pregnant reproductive-age women have shown a 47% increase in cannabis use, rising from 6.29% to 9.27% between 2002 and 2014 (Brown et al., 2017).

Even more alarming is the surge in prenatal cannabis use disorder (CUD), which has multiplied more than 5-fold from 1993 to 2014, escalating from 18.53 to 93.64 cases per 10,000 pregnancy-related delivery hospitalizations (Shi and Zhong, 2018).

Against this backdrop of increased usage, it’s crucial to explore the underlying motivations for such behavior among pregnant and postpartum women. Several studies indicate that these women might be using cannabis as a means to alleviate stress, anxiety, and cope with mental health symptoms (Barbosa-Leiker et al., 2020; Ko et al., 2020; Vanstone et al., 2021).

This potentially suggests a form of self-medication for mental health conditions. However, the extent and implications of this behavior are not fully understood, particularly when considering nationally representative samples.

Prior research examining the interplay between prenatal cannabis use, CUD, and mental health has been fragmented and limited in scope. Studies have often employed patient-based data, featured small sample sizes, and were confined to specific geographical regions (Chang et al., 2019; Emery et al., 2015; Latuskie et al., 2019; Mark et al., 2021; Meinhofer et al., 2022; Nagel et al., 2021; Young-Wolff et al., 2020). Consequently, extrapolating the findings of these studies to the broader population proves challenging.

Existing nationally representative research has primarily focused on prenatal cannabis use rather than CUD. Furthermore, the utilization of outdated diagnostic criteria and self-reported mental health measures, often limited to anxiety and depression, further constrain the comprehensiveness of these studies (Goodwin et al., 2020; Oh et al., 2017).

The few investigations centered on cannabis use and mental health in the postpartum period have been characterized by their limited sample sizes (Barbosa-Leiker et al., 2020; Vanstone et al., 2021).

Considering these gaps in the current knowledge landscape, a holistic approach is warranted. A comprehensive investigation should encompass both general classes (e.g., any mood disorder) and specific types of DSM-5 mental health disorders (e.g., major depressive disorder, persistent depressive disorder) in relation to cannabis use and CUD among pregnant and postpartum women in the United States.

By examining the nuanced intersections between mental health conditions and cannabis use, it’s possible to uncover associations that might otherwise remain concealed within aggregated data.

Additionally, the rapidly shifting legal landscape surrounding cannabis further emphasizes the urgency of such research. With the majority of states legalizing cannabis for various purposes, the availability and accessibility of the substance have expanded, creating a potential breeding ground for misinformation and misconceptions about its safety during pregnancy (Brown and Hasin, 2019).

To address these complex issues, a pioneering effort was undertaken to bridge the gap in understanding. This study, based on data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), represents the first nationally representative endeavor to delve into the intricate relationships between mental health disorders, cannabis use, and CUD among women who were pregnant within the past year.

By employing the latest DSM-5 criteria and controlling for relevant covariates, this study explores the associations between mood, anxiety, personality, and post-traumatic stress disorders and their links to cannabis use and CUD during pregnancy and postpartum.

In conclusion, the escalating prevalence of cannabis use among pregnant and postpartum women, coupled with the potential for self-medication of mental health symptoms, highlights the pressing need for comprehensive and nationally representative research.

This study represents a pioneering effort in unraveling the intricate connections between mental health disorders, cannabis use, and CUD during these critical periods.

As society grapples with evolving legal frameworks and the widening availability of cannabis, the insights from this study have the potential to inform effective prevention interventions aimed at safeguarding the health and well-being of both mothers and their children.


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