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Self-reported Daily, Weekly, and Monthly Cannabis Use Among Women Before and During Pregnancy

Educational ObjectiveTo review if the frequency of cannabis use among pregnant women in the year before and during pregnancy increased in recent years.
1 Credit CME
Key Points

Question  Has the frequency of cannabis use among pregnant women in the year before and during pregnancy increased in recent years?

Findings  In this serial cross-sectional study of 367 403 pregnancies among women in Kaiser Permanente Northern California who were universally screened for self-reported cannabis use as part of standard prenatal care, annual relative rates of daily, weekly, and monthly cannabis use in the year before pregnancy and during pregnancy increased from 2009 to 2017. Relative rates of self-reported daily cannabis use in the year before and during pregnancy increased fastest.

Meaning  Results of this study demonstrate that frequency of cannabis use in the year before pregnancy and during pregnancy has increased among women in Northern California in recent years, with relative rates of daily cannabis use increasing most rapidly.

Abstract

Importance  As the overall prevalence of prenatal cannabis use rises, it is vital to also monitor trends in the frequency of cannabis use in the period leading up to and during pregnancy because more frequent use may confer greater health risks for mothers and their children.

Objective  To examine trends in the frequency of self-reported cannabis use among pregnant women in the year before and during pregnancy.

Design, Setting, and Participants  Cross-sectional study using data from 367 403 pregnancies among 276 991 women 11 years or older who completed a self-administered questionnaire on cannabis use during standard prenatal care in Kaiser Permanente Northern California from January 1, 2009, to December 31, 2017. The annual prevalence of self-reported daily, weekly, and monthly cannabis use among women before and during pregnancy was estimated using Poisson regression with a log link function, adjusting for sociodemographics. Data analyses were conducted from February to May 2019.

Exposures  Calendar year.

Main Outcomes and Measures  Self-reported frequency of cannabis use in the year before pregnancy and during pregnancy assessed as part of standard prenatal care (at approximately 8 weeks’ gestation).

Results  Among the overall sample of 367 403 pregnancies among 276 991 women, 35.9% of the women self-reported white race/ethnicity; 28.0%, Hispanic; 16.6%, Asian; 6.0%, African American; and 13.5%, other. In the sample, 1.2% of the women were aged 11 to 17 years; 15.3%, 18 to 24 years; 61.4%, 25 to 34 years; and 22.0%, older than 34 years. Median (interquartile range) neighborhood household income was $70 472 ($51 583-$92 643). From 2009 to 2017, the adjusted prevalence of cannabis use in the year before pregnancy increased from 6.80% (95% CI, 6.42%-7.18%) to 12.50% (95% CI, 12.01%-12.99%), and the adjusted prevalence of cannabis use during pregnancy increased from 1.95% (95% CI, 1.78%-2.13%) to 3.38% (95% CI, 3.15%-3.60%). Annual relative rates of change in self-reported daily cannabis use (1.115; 95% CI, 1.103-1.128), weekly cannabis use (1.083; 95% CI, 1.071-1.095), and monthly or less cannabis use (1.050; 95% CI, 1.043-1.057) in the year before pregnancy increased significantly, with daily use increasing most rapidly (from 1.17% to 3.05%). Similarly, annual relative rates of change in self-reported daily cannabis use (1.110; 95% CI, 1.089-1.132), weekly cannabis use (1.075; 95% CI, 1.059-1.092) and monthly or less cannabis use (1.044; 95% CI, 1.032-1.057) during pregnancy increased significantly from 2009 to 2017, with daily use increasing most rapidly (from 0.28% to 0.69%).

Conclusions and Relevance  Results of this study demonstrate that frequency of cannabis use in the year before pregnancy and during pregnancy has increased in recent years among pregnant women in Northern California, potentially associated with increasing acceptance of cannabis use and decreasing perceptions of cannabis-associated harms.

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Article Information

Accepted for Publication: May 9, 2019.

Published: July 19, 2019. doi:10.1001/jamanetworkopen.2019.6471

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Young-Wolff KC et al. JAMA Network Open.

Corresponding Author: Kelly C. Young-Wolff, PhD, MPH, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 (kelly.c.young-wolff@kp.org).

Author Contributions: Dr Young-Wolff had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Young-Wolff, Sarovar, Goler.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Young-Wolff, Sarovar.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Young-Wolff, Sarovar, Alexeeff, Armstrong.

Obtained funding: Young-Wolff.

Administrative, technical, or material support: Young-Wolff, Sarovar, Tucker, Conway.

Supervision: Young-Wolff, Goler.

Conflict of Interest Disclosures: Dr Young-Wolff, Mr Tucker, Dr Alexeeff, and Ms Armstrong report receiving grants from National Institutes of Health (NIH) National Institute on Drug Abuse (NIDA) during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by an NIDA K01 Award (DA043604) from the NIH.

Role of the Funder/Sponsor: The funder/sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Agatha Hinman, BA (Kaiser Permanente California), assisted with manuscript preparation. She was not compensated for her contibutions beyond her salary as an administrative professional.

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