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Whitlock C, Chang C, Onishchenko R, Joassaint M, Madlambayan E, Oshman L, Frank CJ. Perspectives of adolescents and young adults on cannabis use during pregnancy. Addict Behav 2024; 156:108059. [PMID: 38723313 DOI: 10.1016/j.addbeh.2024.108059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE Rates of cannabis use during pregnancy are highest for adolescents and young adults (AYAs). This study aims to understand AYA perspectives regarding the medical and legal consequences of prenatal and parental cannabis use. METHODS This study delivered five open-ended survey questions regarding prenatal cannabis use in May/June 2022 via a text message polling platform to the MyVoice cohort, a cohort of AYA aged 14-24 throughout the United States recruited from social media to target national benchmarks set by the American Community Survey. We used qualitative content analysis to analyze open-ended responses and summarized code frequency and demographic data with descriptive statistics. RESULTS Of 826 AYAs, 666 responded to at least one question (response rate = 80.6 %) and the mean age of respondents was 19.9 years (SD = 2.3). We identified four themes from responses: (1) AYA believe cannabis is harmful during pregnancy, (2) they are divided on whether prenatal cannabis exposure should be considered child abuse or neglect, (3) they have mixed attitudes about safe parenting and regular cannabis use, and (4) they support counseling from health care professionals about prenatal cannabis use. CONCLUSIONS AYAs were concerned about potential risks of prenatal cannabis exposure and want clinicians to counsel about cannabis use during pregnancy. More than one in three AYAs surveyed felt prenatal cannabis use should be classified as child abuse or neglect, in contrast to the declining perception of risk among pregnant people.
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Affiliation(s)
- Christopher Whitlock
- University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI 48109, USA
| | - Claire Chang
- University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI 48109, USA
| | - Regina Onishchenko
- University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI 48109, USA
| | | | | | - Lauren Oshman
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Christopher J Frank
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA.
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Iobst SE, Skelton KR. Reconsidering Breastfeeding Recommendations in the Context of Cannabis Use to Support Health Equity. J Obstet Gynecol Neonatal Nurs 2024; 53:451-458. [PMID: 39151897 DOI: 10.1016/j.jogn.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024] Open
Abstract
The authors offer guidance to perinatal nurses and clinicians on how to assist patients who use cannabis and wish to breastfeed.
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Bhatia D, Rosenberg S, Rees R, Brooks-Russell A. Perinatal Cannabis Use and Cannabis Use during Breastfeeding: the Role of Health Care Workers. Am J Perinatol 2024; 41:e2686-e2695. [PMID: 37527787 DOI: 10.1055/a-2145-7775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE This study aimed to estimate the proportion of perinatal women reporting a health care worker (HCW) discussed cannabis use during pregnancy or breastfeeding with them and to evaluate the association between HCWs' discussions and perinatal cannabis use and cannabis use while breastfeeding. STUDY DESIGN Data from Health eMoms (a longitudinal, state-representative survey of Colorado mothers, collected from 2018 to 2020 [n = 3,193]) were utilized in logistic regressions assessing the relationship between HCW discussions about cannabis and perinatal cannabis use and cannabis use while breastfeeding at two time points postpartum, adjusting for sociodemographic factors. RESULTS A total of 5.8% of the sample reported cannabis use either during their most recent pregnancy or while breastfeeding at 3 to 6 months' postpartum. A total of 67.8% of the sample reported an HCW-discussed cannabis at prenatal visits. Women reporting perinatal use were more likely to report HCW discussing cannabis compared with nonusers (82.2 vs. 65.3%, p < 0.01). There was not a significant association between HCW discussions and cannabis use while breastfeeding at either time point postpartum. Compared with nonusers, women using perinatally were more likely to report cannabis Web sites (28.9 vs. 6.5%), cannabis stores (15.7 vs. 3.8%), or word-of-mouth (28.4 vs. 17.1%) as trusted sources of cannabis-related information. CONCLUSION HCW discussions about cannabis use during pregnancy or breastfeeding are not universally reported. This study highlights the need for further encouragement of universal HCW discussions of cannabis use during pregnancy and breastfeeding, strengthening of messaging around cannabis use during these periods, and improved delivery of reliable cannabis-related health information to this population. KEY POINTS · HCW discussions of perinatal cannabis use are not universally reported by women.. · Women reporting perinatal use were more likely to report HCW discussions of cannabis.. · Women reporting perinatal cannabis use were more likely to trust word-of-mouth or cannabis stores or Web sites..
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Affiliation(s)
- Devika Bhatia
- Department of Psychiatry, Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sophie Rosenberg
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca Rees
- Colorado Department of Public Health and Environment, University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Ashley Brooks-Russell
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Ali MM, Novak P, Maykrantz SA. Trends in cannabis use among parenting women with major depressive episode in the United States. Gen Hosp Psychiatry 2024; 87:159-161. [PMID: 38087751 DOI: 10.1016/j.genhosppsych.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/20/2023] [Accepted: 12/03/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Mir M Ali
- Department of Health Policy and Management, University of Maryland, USA.
| | - Priscilla Novak
- Department of Health Policy and Management, University of Maryland, USA
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Umer A, Garrow J, Nesbitt M, Lilly C, Lefeber C, Breyel J, John C. Prenatal substance use in the rural and Appalachian state: Project WATCH study 2020-2022. J Rural Health 2023; 39:804-815. [PMID: 36823403 DOI: 10.1111/jrh.12752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE To examine the prevalence, patterns, and correlates of prenatal substance use in the rural Appalachian state of West Virginia (WV). METHODS Population-based cohort (Project WATCH) of all women (N = 34,309) who gave birth between February 2020 and June 2022. A composite substance use variable included 9 categories: "no substance use," "opioids," "cannabis," "sedatives/hypnotics," "stimulants," "opioids and cannabis," "opioids and stimulants," "cannabis and stimulants," and "opioids, cannabis, and stimulants." These data were gathered through self-report, medical records, and/or positive drug screen at labor and delivery. FINDINGS 12.4% of women used one or more substances (opioids, cannabis, stimulants, and sedatives/hypnotics) during their current pregnancy. The mean age of women using cannabis was 25.34 (SD = 5.31), stimulants was 28.88 (SD = 5.62), and opioid was 30.19 (SD = 4.78). White women were more likely to use opioids (aOR = 2.19, 95% CI 1.46, 3.28) and less likely to use cannabis (aOR = 0.39, 95% CI 0.34, 0.44) compared to minority racial groups. Women with cannabis use were more likely to live in urban versus rural regions (aOR = 1.47, 95% CI 1.33, 1.62). The odds of using any type of substance(s) were significantly higher in women who smoked (aOR range 4.17-30.85), had Medicaid (aOR range 1.52-7.65), and those receiving inadequate prenatal care (aOR range 1.96-16.83). CONCLUSIONS In this rural Appalachian state, 1 in 8 women used 1 or more substances (opioids, cannabis, stimulants, and/or sedatives/hypnotics) during pregnancy and the type of substance used varied by sociodemographic and health-related factors. These factors should inform state-level strategies and initiatives to address the substance use crisis for this population.
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Affiliation(s)
- Amna Umer
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Jana Garrow
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Makena Nesbitt
- Department of Biochemistry and Molecular Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Christa Lilly
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Candice Lefeber
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Janine Breyel
- West Virginia Perinatal Partnership, Department of Obstetrics and Gynecology, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Collin John
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
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Abstract
OBJECTIVES As the social and legal acceptance of cannabis use grows, health professionals must understand and mitigate the impact of cannabis use in the perinatal period. Here we compare the prevalence of tobacco and cannabis use during and after pregnancy in California, a state that recently legalized cannabis use. METHODS Measures of tobacco and cannabis use during and after pregnancy were obtained from California's Maternal and Infant Health Assessment, an annual population-based survey of California resident women with a live birth. To allow analysis of county-level variation, we pooled data from the 35 counties with the largest numbers of births from 2017 to 2019. RESULTS Cannabis use was more than twice as common as cigarette smoking among pregnant women (4.9% vs. 2.1%) in California. This difference was even more pronounced in some counties; for example, in Los Angeles, cannabis use was four times more prevalent than cigarette use. Either during or soon after birth, 7.3% of women in California reported cannabis use. Of those who smoked tobacco cigarettes prior to pregnancy, 73% quit before their third trimester of pregnancy, though 33.0% of these women reported a post-partum relapse in cigarette use. CONCLUSIONS States that have legalized cannabis must attend to the increasing prevalence of perinatal cannabis use, as well as concurrent use with tobacco and other substances. Efforts to support cannabis cessation should draw from successful public health approaches in tobacco control.
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Young-Wolff KC, Adams SR, Brown QL, Weisner C, Ansley D, Goler N, Skelton KR, Satre DD, Foti TR, Conway A. Modes of cannabis administration in the year prior to conception among patients in Northern California. Addict Behav Rep 2022; 15:100416. [PMID: 35252535 PMCID: PMC8894140 DOI: 10.1016/j.abrep.2022.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 11/26/2022] Open
Abstract
Cannabis use among individuals before and during pregnancy is increasing alongside the proliferation of new products with various modes of administration. Preconception cannabis use is a strong predictor of prenatal cannabis use. Yet little is known about how individuals administer cannabis during the preconception period, particularly in socioeconomically vulnerable populations. This study examined the prevalence and correlates of modes of cannabis administration (smoke, vape, blunts, edible/oral, dabs/wax, lotion/topical) during the year before conception, among patients who self-reported preconception cannabis use during universal screening in prenatal care. Descriptive statistics included sociodemographic characteristics, preconception cannabis use frequency, and modes of administration. Chi-square tests examined whether mode was associated with sociodemographic characteristics and use frequency. The sample (N = 11,936, screened from February 2020-May 2021) was 59.8% non-White and 26.1% were < 26 years old; 50.7% reported monthly or less, 21.8% weekly, and 27.4% daily preconception cannabis use; 69.7% smoked (any method), 34.5% smoked blunts, 53.4% used edibles/oral, 28.2% vaped, 9.9% used lotion/topical; 54.2% reported 1 mode, 30.4% reported 2 modes, 15.4% reported 3+ modes. Smoking was more common among daily users, younger patients, those with greater neighborhood deprivation, and Black and Hispanic patients, while edibles/oral were more common among ≤ monthly users, older patients, those with less neighborhood deprivation, and Asian patients. Use of other modes also varied by sociodemographic characteristics and use frequency. Research is needed to understand preconception cannabis use in vulnerable subpopulations, continuation of use during pregnancy, and whether health risks associated with preconception and prenatal cannabis use differ by administration mode.
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Qiana L Brown
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Deborah Ansley
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kara R Skelton
- Department of Health Sciences, College of Health Professions, Towson University, Towson, MD, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Tara R Foti
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Amy Conway
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
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De Genna NM, Willford JA, Richardson GA. Long-term effects of prenatal cannabis exposure: Pathways to adolescent and adult outcomes. Pharmacol Biochem Behav 2022; 214:173358. [PMID: 35216971 PMCID: PMC8911923 DOI: 10.1016/j.pbb.2022.173358] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 12/09/2022]
Abstract
With the increased prevalence, potency, and acceptability of cannabis use during pregnancy, it is important to understand the developmental effects of prenatal cannabis exposure (PCE). This review discusses methodological considerations for studies of PCE, including the assessment of exposures, covariates, and outcomes, and reviews findings from prospective, longitudinal studies of PCE. There is some evidence for associations between PCE and restricted growth at birth, but not for long-term effects on growth. PCE appears to have subtle yet enduring effects on memory and achievement in children and adolescents. Despite differences in sample demographics and measurement, there are remarkably consistent effects of PCE on externalizing behaviors, such as delinquency and substance use, which persist into adulthood. Longitudinal analyses demonstrate the importance of early cannabis initiation for pathways between PCE and adult functioning, including substance use and abuse, memory deficits, and psychotic symptoms. Animal studies demonstrate direct effects on the development of the brain via activation of endogenous endocannabinoid systems. Cannabis-induced activation of the endocannabinoid system causes alterations in the release of neurotransmitters and the modulation of brain plasticity in neural pathways that underlie cognition, motivation, and behavior regulation. Future research should consider cannabis use before pregnancy, the timing and route of exposure, polysubstance exposures, and inter-generational effects.
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Affiliation(s)
- Natacha M. De Genna
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O’Hara Street, Pittsburgh, PA 15213,Corresponding author:
| | - Jennifer A. Willford
- Slippery Rock University, Department of Psychology, 1 Morrow Way, Slippery Rock, PA 16057
| | - Gale A. Richardson
- University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O’Hara Street, Pittsburgh, PA 15213
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Skelton KR, Young-Wolff KC. Preconception cannabis use: An important but overlooked public health issue. WOMEN'S HEALTH 2022; 18:17455057221124071. [PMID: 36148938 PMCID: PMC9510968 DOI: 10.1177/17455057221124071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cannabis is the most commonly used federally illicit drug among pregnant women in the
United States, and the prevalence and frequency of prenatal cannabis use are increasing.
The preconception period – typically thought of as the 3-12 months immediately preceding
pregnancy – is a distinct and critical period for women’s health that has often been
overlooked when examining prenatal cannabis use. Given that substance use behaviors
typically develop before pregnancy, and risk factors associated with prenatal cannabis use
are often present prior to conception, preventive approaches to addressing prenatal
cannabis use would benefit from focusing on women who use cannabis prior to pregnancy. In
order to ensure preconception cannabis use is brought to the forefront of cannabis
prevention efforts, we recommend additional research, patient education, and clinician
training focused on preconception cannabis use.
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Affiliation(s)
- Kara R Skelton
- Department of Health Sciences, College of Health Professions, Towson University, Towson, MD, USA
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Chernek BA, Skelton KR. Attitudes Toward Cannabis Use During Labor in the United States. WOMEN'S HEALTH REPORTS 2022; 3:124-130. [PMID: 35136884 PMCID: PMC8812495 DOI: 10.1089/whr.2021.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
Objective: Little is known about women's attitudes toward cannabis use during labor. We aim to address this gap by (1) reporting on attitudes toward cannabis use during labor, including cannabis use during most recent childbirth; and (2) examining the extent to which attitudes, willingness to use cannabis during labor, and cannabis use during most recent childbirth vary across state-level cannabis policies. Methods: In Spring 2021, we recruited biological women of reproductive age (18–40 years) for an online survey. We collected sociodemographic information and asked women about their attitudes toward cannabis use during labor, willingness to use cannabis during labor, and prior cannabis use during most recent childbirth. We ran descriptive statistics and used Fisher's exact tests to examine the association between state cannabis policies and attitudes toward cannabis use during labor, including willingness to use cannabis during labor. Results: In our sample (N = 163), most women reported they would either consider using (47.85%) or previously used (3.07%) cannabis during labor. Compared with women who would not use, women who reported willingness to use or prior use of cannabis during labor were more likely to report a lower annual household income (p = 0.001) and education level (p < 0.001). Women willing to consider cannabis use were also more likely to report prenatal cannabis use (p < 0.001) and reside in a state with recreational cannabis legalization (p = 0.003). Women who would not consider using cannabis during labor were more likely to perceive one or more risks of use compared with women who would consider using cannabis during labor (90.00% vs. 72.29%, respectively; p = 0.005). In fully illegal states, 66% of women reported they would be more likely to use cannabis during labor if it were legal. Conclusions: Future research is urgently needed to guide clinical practice. To mitigate adverse health outcomes, prenatal care providers should discuss cannabis use during labor with their patients.
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Affiliation(s)
- Brooke A. Chernek
- Department of Health Sciences, College of Health Professions, Towson, Maryland, USA
| | - Kara R. Skelton
- Department of Health Sciences, College of Health Professions, Towson, Maryland, USA
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