February 19, 2020
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Depression, anxiety, trauma linked to cannabis use in pregnancy

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Women with anxiety, depression and trauma were more likely to use cannabis during pregnancy, according to research published in JAMA Network Open.

“Although the health effects of prenatal cannabis use are complex and may vary with frequency of use and mode of administration (e.g., smoking vs. vaping), no amount of cannabis has been shown to be safe during pregnancy,” Kelly C. Young-Wolff, PhD, MPH, research scientist at the Kaiser Permanente Northern California Division of Research, told Healio Primary Care.

Last year, health officials in the United States reported that cannabis use doubled among pregnant women between 2002 and 2017. It was one of several alarming trends that led to the U.S. Surgeon General’s 2019 advisory reminding the public about the harms associated with the drug.

For the study, Young-Wolff and colleagues compared demographic and mental health characteristics in women with and without cannabis use during pregnancy who gave birth at centers in the Kaiser Permanente Northern California system between 2012 and 2017.

Researchers used electronic health records to identify diagnoses of depressive, anxiety and trauma disorders during pregnancy. Information collected from a questionnaire conducted during the first prenatal meeting — at about 8 weeks’ gestation — was used to determine the severity of symptoms, intimate partner violence and prenatal substance use. Women also underwent urine testing during the first prenatal visit.

Among the 196,022 pregnancies evaluated in the study, researchers found that 6% screened positive for prenatal cannabis. Of these women, 1.9% self-reported intimate partner violence, 5% had an anxiety disorder, 4.7% had a depressive disorder, and 11% had depressive symptoms that were at least moderate in severity.

Researchers determined that the odds of cannabis use during pregnancy were greater among women with anxiety disorders (adjusted OR = 1.9; 95% CI, 1.76-2.04), depressive disorders (adjusted OR = 2.25; 95% CI, 2.11-2.41), or both (adjusted OR = 2.65; 95% CI, 2.46-2.86) compared with women without those disorders.

Compared with women without depression symptoms, the odds of cannabis use were greater among those with depression symptoms that were mild (adjusted OR = 1.6; 95% CI, 1.53-1.67), moderate (adjusted OR = 2.09; 95% CI, 1.96-2.23) and moderately severe to severe (adjusted OR = 2.55; 95% CI, 2.35-2.77), according to Young-Wolff and colleagues.

In addition, the odds of cannabis use during pregnancy were greater among women with a trauma diagnosis (adjusted OR = 2.82; 95% CI, 2.59-3.06) and in those with self-reported intimate partner violence (adjusted OR = 1.94; 95% CI, 1.74-2.15).

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Researchers noted that the increased odds of cannabis use with more severe depression symptoms and with having both anxiety and depressive disorders could indicate a dose-response relationship. However, they explained that additional research is needed to determine the direction of the association because cannabis could cause or worsen mental health issues during pregnancy.

“It is important that clinicians screen for mental health symptoms early in pregnancy and connect pregnant women with depression, anxiety and stress with safe and effective medically-recommended interventions,” Young-Wolff said. “Further, clinicians can reduce potential harms through awareness of the rising prevalence and frequency of prenatal cannabis use, patient education, and advice to all patients to avoid or discontinue cannabis use during pregnancy.”– by Erin Michael

Disclosures: The authors report no relevant financial disclosures.