Cannabis use disorder among insured pregnant women in the US between 2015–2020

Cannabis use has been increasing during pregnancy, according to researchers at Columbia University Mailman School of Public Health and the Columbia University Irving Medical Center. Previous research has observed that past-month cannabis use has more than tripled among pregnant women in the U.S. from 2002–2020, with self-reported cannabis use rising from 1.5% to 5.4% over the 18 years of tracking data.

The findings are published in the American Journal of Preventive Medicine.

Medical guidelines recommend that pregnant women abstain from cannabis because of its link to an increased risk of adverse maternal and neonatal outcomes and concerns regarding long-term effects on mental health.

The researchers investigated cannabis use disorder (CUD) diagnoses during pregnancy using data from the Merative Marketscan Commercial Claims and Encounters Database of pregnant women from 2015–2020 aged 12–55 with continuous insurance enrollment. The researchers used the International Classification of Diseases codes to identify CUD diagnoses.

Their findings show between 2015–2020, 893,430 pregnant women were identified, resulting in 1,058,448 total pregnancies. The cumulative prevalence of CUD diagnosis was 0.26%; yearly prevalence ranged from 0.22 (2015) to 0.27 (2018 and 2019).

“While earlier research analyzed data from a specific geographic sample of pregnant women, this study aimed to examine the prevalence of CUD diagnosis during pregnancy among a large sample of commercially insured women determined from commercial administrative claims data during a five-year period,” observed Priscila Gonçalves, Ph.D., assistant professor in the Department of Psychiatry, Columbia University Irving Medical Center, and first author.

Cannabis for medical use was legal in 34 states and Washington DC in 2020 (last year of data included in the study). Although women could be self-medicating during pregnancy through the anti-nausea properties of cannabis, it is also possible that many pregnant women meet the criteria for CUD.

Clinicians who regularly meet with pregnant women are well-positioned to intervene in cannabis use and CUD but might lack the structural support to conduct relevant interventions, according to Goncalves. This is in addition to some women’s fear of legal repercussions related to disclosing substance use that could impede the degree of underestimated CUD diagnoses as well as medically appropriate interventions.

“Our results highlight the need to better understand the determinants of CUD among pregnant women, including factors related to CUD diagnosis—from the severity of CUD—as well as factors contributing to diagnosis and treatment,” noted Silvia Martins, MD, Ph.D., professor of Epidemiology at Columbia Mailman School, and senior author of the study.

“This study makes it clear that additional research is needed to inform prevention and intervention opportunities.”