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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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Boerner Z, Natha C, Baker T, Garner CD. Perceptions of Cannabis Use and Its Benefits and Risks Among Breastfeeding Mothers. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:412-423. [PMID: 39035146 PMCID: PMC11257130 DOI: 10.1089/whr.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 07/23/2024]
Abstract
Background Approximately 5% of breastfeeding women report using cannabis. Little is understood about perceived benefits and risks of cannabis use; thus, this study aimed to fill this gap. Methods An anonymous online survey was conducted from 2018 to 2019 among breastfeeding women (n = 1516) who used cannabis. Data collected included demographics, frequency and timing of cannabis use, perceived effects in infants, and repercussions experienced. Analyses included descriptive statistics; chi-square and t-tests were used to test differences between groups (SPSSv28). A subset (n = 413) left open-text responses about cannabis and its perceived risks and benefits. Content analysis and ATLAS.ti were used for open-ended responses. Results Two-thirds (67%) of participants were "not at all" concerned that cannabis use while breastfeeding affected their baby. Only 3% attributed symptoms in their infants to cannabis use; symptoms were perceived as positive or negative. Interestingly, 45% (n = 603) altered timing of cannabis use relative to breastfeeding to avoid exposing their infant to cannabis. Most mothers (85.8%) reported no changes in their breast milk supply. Few respondents were investigated by Child Protective Services (6.9%) or arrested (3.8%) for cannabis use. In open-ended responses, three themes emerged about the perceptions of cannabis use while breastfeeding: (1) cannabis preferred to address medical concerns, (2) positive impact of cannabis on quality of life for mothers and their children, and (3) concerns about negative consequences. Conclusion Breastfeeding mothers who used cannabis reported positive perceptions of cannabis as a safer alternative to medications, yet concerns existed about legal repercussions. Understanding maternal perceptions may be useful in developing successful approaches to counseling mothers about cannabis use.
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Affiliation(s)
- Zane Boerner
- School of Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Cristina Natha
- Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Teresa Baker
- Department of Obstetrics and Gynecology, Texas Tech Health Sciences Center, Lubbock, Texas, USA
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Christine D. Garner
- Department of Obstetrics and Gynecology, Texas Tech Health Sciences Center, Lubbock, Texas, USA
- InfantRisk Center, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
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Gould EE, Ganesh SS, Nguyen RM, Breton CV, Bastain TM, Dunton GF, Ceasar RC. The unseen patient: competing priorities between patients and providers when cannabis is used in pregnancy, a qualitative study. Front Glob Womens Health 2024; 5:1355375. [PMID: 38699460 PMCID: PMC11063236 DOI: 10.3389/fgwh.2024.1355375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives This study aimed to explore competing priorities when cannabis is used during pregnancy from the perspective of providers and Black and Latina people. Maternal cannabis use is increasingly common, but patients and providers alike struggle to navigate it. Methods This pilot used qualitative, constructivist ground theory methods to conduct semi-structured, remote interviews between 16 November 2021, and 7 February 2022 with 7 Black and Latina people who used cannabis during pregnancy, and 10 providers between 15 March 2022, and 6 April 2022, all of who were in Southern California, U.S. Results We identified three main findings: (1) Providers reported barriers to caregiving and relationship building with patients due to maternal cannabis use stigma, (2) Providers prioritized the fetus despite patients' current health system challenges that drove cannabis use, and (3) Both patients and providers engaged in personal research beyond the healthcare system to better understand maternal cannabis use. Discussion Our findings indicate that challenges exist between people who use cannabis during pregnancy and providers. Both groups need accurate, sociocultural sensitive information about maternal cannabis use via a harm reduction lens.
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Affiliation(s)
- Erin E. Gould
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Young-Wolff KC, Green A, Iturralde E, Altschuler A, Does MB, Jackson-Morris M, Adams SR, Ansley D, Conway A, Goler N, Skelton K, Foti TR. Intentions to Use Cannabis Postpartum: A Qualitative Study of Pregnant Individuals Who Used Cannabis During Early Pregnancy. J Womens Health (Larchmt) 2024; 33:435-445. [PMID: 38407822 PMCID: PMC11238839 DOI: 10.1089/jwh.2023.0066] [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] [Indexed: 02/27/2024] Open
Abstract
Objective: To examine plans for postpartum cannabis use among pregnant individuals who used cannabis during early pregnancy. Materials and Methods: Eighteen virtual focus groups were conducted from November 17, 2021, to December 17, 2021, with 23 Black and 30 White pregnant adults in Kaiser Permanente Northern California, who self-reported prenatal cannabis use during early pregnancy. Focus groups were recorded, transcribed, and analyzed using thematic analysis. Results: The sample (N = 53) had a mean age of 30.3 years (standard deviation = 5.2) at recruitment; 70% reported daily, 25% weekly, and 6% ≤ monthly cannabis use at entrance to prenatal care. Some participants viewed cannabis as critical for coping with postpartum mental and physical health challenges, while others questioned whether cannabis use would fit with their parental lifestyle, and some planned to abstain altogether. Most planned to use cannabis postpartum, but with lower frequency than before pregnancy, and in ways consistent with harm reduction (e.g., smoking outside to avoid secondhand or thirdhand smoke exposure). Many were motivated to abstain from cannabis while breastfeeding, and some desired more data on the safety of cannabis and breastfeeding, or intended to "pump and dump," believing it would reduce potential transfer of Δ9-tetrahydrocannabinol (THC) to their infant. Responses from Black and White participants were generally similar, but White participants were more likely to report plans to use cannabis while breastfeeding and to want information about cannabis and breastfeeding. Conclusions: Pregnant individuals with prenatal cannabis use had varied plans for cannabis use postpartum. Many were motivated to abstain or use cannabis less frequently than pre-pregnancy, especially during lactation.
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Affiliation(s)
- Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Andrea Green
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, California, USA
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Monique B. Does
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Sara R. Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Deborah Ansley
- Regional Offices, Kaiser Permanente Northern California, Oakland, California, USA
| | - Amy Conway
- Regional Offices, Kaiser Permanente Northern California, Oakland, California, USA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kara Skelton
- Department of Health Sciences, College of Health Professions, Towson, Maryland, USA
| | - Tara R. Foti
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Torres J, Miller C, Apostol M, Gross J, Maxwell JR. The impact of recreational cannabinoid legalization on utilization in a pregnant population. Front Public Health 2024; 12:1278834. [PMID: 38444440 PMCID: PMC10912290 DOI: 10.3389/fpubh.2024.1278834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
Background Marijuana potency and utilization both continue to increase across the United States. While the overall prevalence of cannabinoid utilization during pregnancy has been surveyed in various studies, the direct impact of changing governmental policies on pregnancy use is less characterized. Thus, we aimed to investigate how the legalization of recreational cannabinoid products impacted use during pregnancy in the state of New Mexico. Methods Participants who had a live birth during two study epochs were included: pre-legalization (Epoch 1: 1 January 2019-31 March 2021) and post-legalization (Epoch 2: 1 November 2021-30 November 2022). Participants were further divided into case group [prenatal cannabinoid exposure (PCE)] vs. control (no PCE), with cases being identified by documented self-report or a positive laboratory toxicology test for cannabinoid use during pregnancy. Results A total of 1,191 maternal/infant dyads were included in Epoch 1, and 378 maternal/infant dyads were included in Epoch 2. In Epoch 1, 788 dyads were controls with 403 cases, while Epoch 2 had 292 controls and 86 cases. Interestingly there was a significant decrease in self-report or positive laboratory toxicology tests in Epoch 2 compared to Epoch 1. Infants born following PCE in both Epoch groups were more commonly born via Cesarean section, had significantly smaller birth weight, length, and head circumference as well as significantly lower Apgar scores at 1 and 5 min. Conclusion The finding of decreased reported cannabinoid use in the post-legalization group is contradictory to previous studies which have shown increased rates of cannabinoid use after legalization. This could be due to multiple factors including changes in screening practices, the COVID-19 pandemic, and lack of commercialization of THC products. Additional studies are needed to further characterize how changing governmental policies impacts utilization during pregnancy.
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Affiliation(s)
- Jacob Torres
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Colton Miller
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Michael Apostol
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Jessica Gross
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, NM, United States
| | - Jessie R. Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
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Smith CB, Schmidt J, Holdsworth EA, Caffé B, Brooks O, Williams JE, Gang DR, McGuire MA, McGuire MK, Barbosa-Leiker C, Meehan CL. Cannabis use, decision making, and perceptions of risk among breastfeeding individuals: the Lactation and Cannabis (LAC) Study. J Cannabis Res 2024; 6:6. [PMID: 38365778 PMCID: PMC10870434 DOI: 10.1186/s42238-023-00212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/13/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE Our primary objective was to understand breastfeeding individuals' decisions to use cannabis. Specifically, we investigated reasons for cannabis use, experiences with healthcare providers regarding use, and potential concerns about cannabis use. METHODS We collected survey data from twenty breastfeeding participants from Washington and Oregon who used cannabis at least once weekly. We documented individuals' cannabis use and analyzed factors associated with their decisions to use cannabis during lactation. Qualitative description was used to assess responses to an open-ended question about potential concerns. RESULTS Fifty-five percent of participants (n = 11) reported using cannabis to treat or manage health conditions, mostly related to mental health. Eighty percent of participants (n = 16) reported very few or no concerns about using cannabis while breastfeeding, although participants who used cannabis for medical purposes had significantly more concerns. Most participants (n = 18, 90%) reported receiving either no or unhelpful advice from healthcare providers. Four themes arose through qualitative analysis, indicating that breastfeeding individuals are: 1) identifying research gaps and collecting evidence; 2) monitoring their child's health and development; 3) monitoring and titrating their cannabis use; and 4) comparing risks between cannabis and other controlled substances. CONCLUSIONS Breastfeeding individuals reported cannabis for medical and non-medical reasons and few had concerns about cannabis use during breastfeeding. Breastfeeding individuals reported using a variety of strategies and resources in their assessment of risk or lack thereof when deciding to use cannabis. Most participants reported receiving no helpful guidance from healthcare providers.
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Affiliation(s)
- Caroline B Smith
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Jenna Schmidt
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | | | - Beatrice Caffé
- Department of Anthropology, Washington State University, Pullman, WA, USA
| | - Olivia Brooks
- College of Nursing, Washington State University Health Sciences Spokane, Spokane, WA, USA
| | - Janet E Williams
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID, USA
| | - David R Gang
- Institute of Biological Chemistry, Washington State University, Pullman, WA, USA
| | - Mark A McGuire
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID, USA
| | - Michelle K McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, USA
| | | | - Courtney L Meehan
- Department of Anthropology, Washington State University, Pullman, WA, USA.
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Chang PW, Goyal NK, Chung EK. Marijuana Use and Breastfeeding: A Survey of Newborn Nurseries. Pediatrics 2024; 153:e2023063682. [PMID: 38247374 DOI: 10.1542/peds.2023-063682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Marijuana use has increased nationally and is the most common federally illicit substance used during pregnancy. This study aimed to describe hospital practices and nursery director knowledge and attitudes regarding marijuana use and breastfeeding and assess the association between breastfeeding restrictions and provider knowledge, geographic region, and state marijuana legalization status. We hypothesized that there would be associations between geography and/or state legalization and hospital practices regarding breastfeeding with perinatal marijuana use. METHODS A cross-sectional, 31-question survey was sent electronically to the 110 US hospital members of the Academic Pediatric Association's Better Outcomes through Research for Newborns (BORN) network. Survey responses were analyzed using descriptive statistics to report frequencies. For comparisons, χ2 and Fisher exact tests were used to determine statistical significance. RESULTS Sixty-nine (63%) BORN nursery directors across 38 states completed the survey. For mothers with a positive cannabinoid screen at delivery, 16% of hospitals universally or selectively restrict breastfeeding. Most (96%) nursery directors reported that marijuana use while breastfeeding is "somewhat" (70%) or "very harmful" (26%). The majority was aware of the potential negative impact of prenatal marijuana use on learning and behavior. There were no consistent statistical associations between breastfeeding restrictions and provider marijuana knowledge, geographic region, or state marijuana legalization status. CONCLUSIONS BORN newborn clinicians report highly variable and unpredictable breastfeeding support practices for mothers with perinatal marijuana use. Further studies are needed to establish evidence-based practices and to promote consistent, equitable care of newborns with perinatal marijuana exposure.
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Affiliation(s)
- Pearl W Chang
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Neera K Goyal
- Department of Pediatrics, Sidney Kimmel College of Medicine and Nemours Children's Health, Philadelphia, Pennsylvania
| | - Esther K Chung
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
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Kirby J, Naren T. Cannabinoid hyperemesis syndrome in pregnancy: Challenges and opportunities. Aust N Z J Obstet Gynaecol 2023; 63:746-752. [PMID: 37259610 DOI: 10.1111/ajo.13714] [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: 02/25/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
Antenatal cannabis consumption is common and associated with adverse perinatal outcomes, including low birthweight, pre-term birth and increased rates of admission to neonatal intensive care. Cannabinoid hyperemesis syndrome (CHS) comprises severe, cyclical episodes of vomiting, intractable nausea and abdominal pain observed in chronic cannabis users. CHS, particularly during pregnancy, poses a diagnostic dilemma with a tendency to be ineffectively managed secondary to reduced clinician awareness and a scarcity of available therapies. This clinical perspective explores the current literature on CHS in pregnancy, available pharmacotherapeutics, and recognises the current barriers to improving clinical care.
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Affiliation(s)
- Jordan Kirby
- Obstetrics & Gynaecology Resident, Department of Obstetrics & Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Thileepan Naren
- Addiction Medicine Advanced Trainee, Drug Health Services, Western Health, Melbourne, Victoria, Australia
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Foti TR, Green A, Altschuler A, Iturralde E, Does MB, Jackson-Morris M, Adams SR, Goler N, Ansley D, Conway A, Young-Wolff KC. Patient Perceptions of Prenatal Cannabis Use and Implications for Clinicians. Obstet Gynecol 2023; 142:1153-1161. [PMID: 37562055 PMCID: PMC10592503 DOI: 10.1097/aog.0000000000005295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/08/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To understand pregnant patients' reasons for prenatal cannabis use and perceptions of safety, desired and undesirable health care experiences, and desired information about prenatal cannabis use and secondarily to understand racial differences in these perceptions and preferences. METHODS We conducted a qualitative study including 18 semi-structured, race-concordant virtual focus groups with pregnant individuals who self-reported cannabis use at prenatal care entry in a large integrated health care system in Northern California from November 2021 to December 2021. The focus groups included semi-structured questions that were recorded, transcribed, and coded by the research team. Thematic analysis was used to analyze the data. RESULTS Overall, 53 participants were included; 30 self-identified, as White and 23 self-identified as Black. Participants averaged 30.3 years of age (SD 5.2 years) and were on average at 20.9 weeks of gestation at study enrollment; 69.8% reported daily cannabis use, 24.5% reported weekly cannabis use, and 5.7% reported monthly or less cannabis use at entrance to prenatal care. Although some participants quit cannabis use in early pregnancy because of concerns about potential health risks, many perceived a lack of scientific evidence or believed that prenatal cannabis use was safe. Many preferred cannabis to over-the-counter or prescription medications for treating mood, morning sickness, pain, and sleep. Participants valued open interactions with obstetricians that acknowledged their motivations for use, and they desired information about potential risks through conversations and educational materials. White and Black participants' perspectives were generally similar, but a few Black participants uniquely described concerns about racial bias related to their prenatal cannabis use. CONCLUSION Pregnant patients used cannabis to manage mood and medical symptoms, and many believed that prenatal cannabis use was safer than the use of prescription medications. Obstetrician-initiated, patient-centered conversations around prenatal cannabis use, advice to discontinue cannabis use during pregnancy, and exploration of willingness to switch to medically recommended interventions for pregnancy-related symptoms may benefit patients.
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Affiliation(s)
- Tara R Foti
- Division of Research and the Regional Offices, Kaiser Permanente Northern California, Oakland, the Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, and the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California
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Taneja S, Panday J, Popoola A, Greyson D, McDonald SD, Patel T, Vanstone M. Making informed choices about cannabis use during pregnancy and lactation: A qualitative study of information use. Birth 2023; 50:504-512. [PMID: 35848512 DOI: 10.1111/birt.12668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cannabis use during pregnancy and lactation continues to increase as some perceive cannabis to be helpful for symptom management and coping. As such, pregnant and lactating people are faced with challenging decisions, weighing benefits against the potential risks of cannabis use. To help clinicians facilitate informed choices, we explored the self-identified information needs of pregnant and lactating people who are deciding whether or not to use cannabis. We aimed to describe the modes and sources of their information-seeking and their satisfaction with the information they found. METHODS We interviewed 52 people in Canada who made the decision to start, stop, or continue using cannabis during pregnancy and lactation. Participants were recruited from advertisements in prenatal clinics and on social media. We utilized an inductive approach to analysis focused on information used in decision-making about cannabis use, including the process of seeking and evaluating that information. RESULTS Participants were deliberate in their search for information, most commonly seeking information on risks of use. Information sources were mainly online material or people in their social networks. Clinicians were not commonly described as a knowledgeable or supportive source of information. Overwhelmingly, participants described the information they found as insufficient and emphasized the need for more comprehensive and trustworthy sources of information. CONCLUSIONS Participants identified distinct and unmet information needs associated with their decision to use cannabis. They described a desire for clear evidence about the impact of cannabis use, including information about how to balance the benefits they perceived from cannabis use with the risks of harm.
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Affiliation(s)
- Shipra Taneja
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Janelle Panday
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anuoluwa Popoola
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tejal Patel
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Ceasar RC, Gould E, Stal J, Laughter J, Tran M, Wang SD, Granacki J, Ziltzer RS, Santos JJ. Legislation has Changed But Issues Remain: Provider Perceptions of Caring for People Who Use Cannabis During Pregnancy in Safety Net Health Settings, a Qualitative Pilot Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:400-408. [PMID: 37529758 PMCID: PMC10389248 DOI: 10.1089/whr.2023.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/03/2023]
Abstract
Objective To identify perceptions of cannabis use and risk among maternal health providers who provide care for people who use cannabis during pregnancy in safety-net health settings. Methods Using qualitative, constructivist ground theory methods, we conducted semistructured remote interviews with 10 providers (2 midwives, 6 OB/GYN physicians, and 2 OB/GYN residents) in Southern California, United States, between March 15, 2022, and April 6, 2022. We selected participants through selective sampling using a convenience sample and snowball approach. Providers were eligible for the study if they self-reported via survey to being a maternal health provider (e.g., physician, doula, midwife, and so on) providing care in a safety-net health setting and had cared for people who used cannabis during pregnancy in the last year. Analysis drew upon grounded theory methods to document the socio-structural contexts that contribute to provider perceptions about cannabis. This study was approved by the University of Southern California Institutional Review Board (UP-21-00282-AM009). Results We identified three categories of provider perceptions of cannabis use and risk during pregnancy: (1) Relying on self-education, (2) Taking a case-by-case approach, and (3) Avoiding cannabis discussions to maintain an alliance with patients. Findings indicate that provider reluctance to counsel patients about cannabis in favor of preserving a therapeutic relationship can overlook the lack of resources and access to health care alternatives available to low-income patients that can shape self-medicating. Conclusions Nonpunitive policies and training on cannabis use are critical steps for supporting providers to counsel patients who use cannabis during pregnancy, alongside a harm reduction approach that acknowledges the broader socio-structural contexts and barriers facing patients who disclose use.
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Affiliation(s)
- Rachel Carmen Ceasar
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Erin Gould
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Julia Stal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jen Laughter
- Department of Sociology, California State University, Fullerton, Fullerton, California, USA
| | - Michelle Tran
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shirlene D. Wang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jordan Granacki
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ryan S. Ziltzer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jasmeen Joy Santos
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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12
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Prewitt KC, Hayer S, Garg B, Benson AE, Hedges MA, Caughey AB, Lo JO. Impact of Prenatal Cannabis Use Disorder on Perinatal Outcomes. J Addict Med 2023; 17:e192-e198. [PMID: 37267181 PMCID: PMC10248186 DOI: 10.1097/adm.0000000000001123] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES With legislative changes to cannabis legalization and increasing prevalence of use, cannabis is the most commonly used federally illicit drug in pregnancy. Our study aims to assess the perinatal outcomes associated with prenatal cannabis use disorder. METHODS We conducted a retrospective cohort study using California linked hospital discharge-vital statistics data and included singleton, nonanomalous births occurring between 23 and 42 weeks of gestational age. χ 2 Test and multivariable logistic regression were used for statistical analyses. RESULTS A total of 2,380,446 patients were included, and 9144 (0.38%) were identified as using cannabis during pregnancy. There was a significantly increased risk for adverse birthing person outcomes, including gestational hypertension (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.06-1.34; P = 0.004), preeclampsia (AOR, 1.16; 95% CI, 1.0-1.28; P = 0.006), preterm delivery (AOR, 1.45; 95% CI, 1.35-1.55; P < 0.001), and severe maternal morbidity (AOR, 1.22; 95% CI, 1.02-1.47; P = 0.033). Prenatal cannabis use disorder was also associated with an increased risk of neonatal outcomes including respiratory distress syndrome (AOR, 1.16; 95% CI, 1.07-1.27; P < 0.001), small for gestational age (AOR, 1.47; 95% CI, 1.38-1.56; P < 0.001), neonatal intensive care unit admission (AOR, 1.24; 95% CI, 1.16-1.33; P < 0.001), and infant death (AOR, 1.86; 95% CI, 1.44-2.41; P < 0.001). There was no statistically significant difference in stillbirth (AOR, 0.96; 95% CI, 0.69-1.34; P = 0.80) and hypoglycemia (AOR, 1.22; 95% CI, 1.00-1.49; P = 0.045). CONCLUSIONS Our study suggests that prenatal cannabis use disorder is associated with increased maternal and neonatal morbidity and mortality. As cannabis use disorder in pregnancy is becoming more prevalent, our findings can help guide preconception and prenatal counseling.
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Affiliation(s)
- Kristin C Prewitt
- From the Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR (KCP, SH, BG, AEB, ABC, JOL); and Department of Pediatrics, Oregon Health & Science University, Portland, OR (MAH)
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Popoola A, Panday J, Taneja S, Greyson D, McDonald SD, Patel T, Darling E, Vanstone M. Pregnant and lactating people's strategies to mitigate the risk of cannabis consumption. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231202406. [PMID: 37776037 PMCID: PMC10541750 DOI: 10.1177/17455057231202406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Multiple studies have demonstrated that pregnant and lactating people who use cannabis perceive a variety of benefits from that use, offering some explanation of why rates of use continue to increase. OBJECTIVES The aim of this study was to explore pregnant and lactating people's perceptions of the risks of cannabis use and understand what steps, if any, they take to mitigate these risks. DESIGN Qualitative description. METHODS We analyzed semi-structured interviews with 52 Canadians who made the decision to start, stop, or continue using cannabis during pregnancy or lactation between 2019 and 2021. Data collection iterated with analysis. We used a conventional (inductive) approach to content analysis. RESULTS Perception of risk was found to be an essential component of decision-making about cannabis use. We identified a cycle of "risk identification," "management," and "observation" of effects. First, the pregnant or lactating person assesses the risks and weighs them against the perceived benefits of cannabis use. Second, they take action to minimize risks, with some choosing abstinence. Others, often those who were using cannabis to manage symptoms, continued cannabis use but devised a variety of other risk mitigation strategies such as, decreasing the amount or frequency of their use, changing the form of cannabis, and strategically timing their use with caregiving responsibilities. The final stage of the cycle involves seeking information about whether or not the initial perceived risk has manifested after implementing mitigation strategies, through observations and clinical information about the pregnancy or child. CONCLUSION Participants consistently engaged in deliberation about the risks and benefits associated with their perinatal cannabis use. Nearly all implemented strategies intended to minimize risk. Our results highlight the need for more research to inform clear public health messaging about risk mitigation to minimize the potential harms of perinatal cannabis use. This work informs clinicians about patient-perceived risks and mitigation strategies which could in turn help inform shared decision-making conversations.
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Affiliation(s)
- Anuoluwa Popoola
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Janelle Panday
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Shipra Taneja
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Devon Greyson
- Department of Communication, University of Massachusetts Amherst, Amherst, MA, USA
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sarah D. McDonald
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Tejal Patel
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Darling
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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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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Kiel L, Hsu C, Wartko PD, Albertson-Junkans L, Ewing J, Lapham GT. Perspectives from women who engaged in prenatal and postpartum cannabis use in a U.S. State with legal non-medical use. Prev Med Rep 2022; 31:102075. [PMID: 36820379 PMCID: PMC9938312 DOI: 10.1016/j.pmedr.2022.102075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
Evidence suggests fetal risks are associated with cannabis use during pregnancy. Yet, insights into women's decision-making and cannabis use during pregnancy are limited. This study explored these concepts with postpartum women who used cannabis during and after pregnancy. We conducted interviews with 15 women (4 self-identifying a race other than White and 4 self-identifying Hispanic ethnicity) who: 1) lived in the Puget Sound region of Washington State, 2) reported past-year cannabis use on a routine screen, and 3) had documented pregnancy and delivery March 2015-May 2017. Semi-structured interviews asked about decision-making and cannabis use during pregnancy and postpartum. We used template analysis for coding and analysis. The key findings included that women: 1) gathered information about cannabis use during pregnancy primarily through internet searches and discussions with peers; 2) were reluctant to talk with health care providers about cannabis; 3) used cannabis while pregnant to treat health issues, including morning sickness, pain, and mental health conditions; 4) were comfortable with their decision to use cannabis while pregnant, but had questions about long-term effects; and 5) tried to mitigate transmission through breastmilk. Women decided about cannabis during pregnancy based on their experience, health symptoms, and information gathered from the internet and peers, often without guidance from their health care provider. Results point to opportunities for providers to become informed about and engage in discussion with patients about cannabis use during preconception, pregnancy, and postpartum.
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Affiliation(s)
- Linda Kiel
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States,Corresponding author.
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States
| | - Paige D. Wartko
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States
| | - Ladia Albertson-Junkans
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States
| | - John Ewing
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States
| | - Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States,Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Fourth Floor, Seattle, WA 98195, United States
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Vanstone M, Taneja S, Popoola A, Panday J, Greyson D, Lennox R, McDonald SD. Reasons for cannabis use during pregnancy and lactation: a qualitative study. CMAJ 2021; 193:E1906-E1914. [PMID: 34930765 PMCID: PMC8687504 DOI: 10.1503/cmaj.211236] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cannabis use among pregnant and lactating people is increasing, despite clinical evidence showing that cannabis use may be associated with low birth weight and childhood developmental deficits. Our objective was to understand why pregnant and lactating people use cannabis and how these motivations change across perinatal stages. METHODS Using qualitative, constructivist grounded theory methodology, we conducted telephone and virtual interviews with 52 individuals from across Canada. We selected participants using maximum variation and theoretical sampling. They were eligible if they had been pregnant or lactating within the past year and had decided to continue, cease or decrease their cannabis use during the perinatal period. RESULTS We identified 3 categories of reasons that people use cannabis during pregnancy and lactation: sensation-seeking for fun and enjoyment; symptom management of chronic conditions and conditions related to pregnancy; and coping with the unpleasant, but nonpathologized, experiences of life. Before pregnancy, participants endorsed reasons for using cannabis in these 3 categories in similar proportions, with many offering multiple reasons for use. During pregnancy, reasons for use shifted primarily to symptom management. During lactation, reasons returned to resemble those expressed before pregnancy. INTERPRETATION In this study, we showed that pregnant and lactating people use cannabis for many reasons, particularly for symptom management. Reasons for cannabis use changed across reproductive stages. The dynamic nature of the reasons for use across stages speaks to participant perception of benefits and risks, and perhaps a desire to cast cannabis use during pregnancy as therapeutic because of perceived stigma.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine (Vanstone, Taneja, Popoola, Panday, Lennox), McMaster University, Hamilton, Ont.; Department of Communication (Greyson), University of Massachusetts Amherst, Amherst, Mass.; School of Population and Public Health (Greyson), University of British Columbia, Vancouver, BC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact (McDonald), McMaster University, Hamilton, Ont.
| | - Shipra Taneja
- Department of Family Medicine (Vanstone, Taneja, Popoola, Panday, Lennox), McMaster University, Hamilton, Ont.; Department of Communication (Greyson), University of Massachusetts Amherst, Amherst, Mass.; School of Population and Public Health (Greyson), University of British Columbia, Vancouver, BC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact (McDonald), McMaster University, Hamilton, Ont
| | - Anuoluwa Popoola
- Department of Family Medicine (Vanstone, Taneja, Popoola, Panday, Lennox), McMaster University, Hamilton, Ont.; Department of Communication (Greyson), University of Massachusetts Amherst, Amherst, Mass.; School of Population and Public Health (Greyson), University of British Columbia, Vancouver, BC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact (McDonald), McMaster University, Hamilton, Ont
| | - Janelle Panday
- Department of Family Medicine (Vanstone, Taneja, Popoola, Panday, Lennox), McMaster University, Hamilton, Ont.; Department of Communication (Greyson), University of Massachusetts Amherst, Amherst, Mass.; School of Population and Public Health (Greyson), University of British Columbia, Vancouver, BC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact (McDonald), McMaster University, Hamilton, Ont
| | - Devon Greyson
- Department of Family Medicine (Vanstone, Taneja, Popoola, Panday, Lennox), McMaster University, Hamilton, Ont.; Department of Communication (Greyson), University of Massachusetts Amherst, Amherst, Mass.; School of Population and Public Health (Greyson), University of British Columbia, Vancouver, BC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact (McDonald), McMaster University, Hamilton, Ont
| | - Robin Lennox
- Department of Family Medicine (Vanstone, Taneja, Popoola, Panday, Lennox), McMaster University, Hamilton, Ont.; Department of Communication (Greyson), University of Massachusetts Amherst, Amherst, Mass.; School of Population and Public Health (Greyson), University of British Columbia, Vancouver, BC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact (McDonald), McMaster University, Hamilton, Ont
| | - Sarah D McDonald
- Department of Family Medicine (Vanstone, Taneja, Popoola, Panday, Lennox), McMaster University, Hamilton, Ont.; Department of Communication (Greyson), University of Massachusetts Amherst, Amherst, Mass.; School of Population and Public Health (Greyson), University of British Columbia, Vancouver, BC; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Radiology and Health Research Methods, Evidence & Impact (McDonald), McMaster University, Hamilton, Ont
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