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

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.

Figure 1.. Adjusted Prevalence of Cannabis Use Among 367 403 Pregnancies in the Year Before Pregnancy by Frequency of Use, 2009-2017

Adjusted prevalence estimates (dots) and 95% CIs (error bars) were estimated from Poisson regression models controlling for age group, race/ethnicity, and median neighborhood household income (extracted from the electronic health record [Table 2]). Self-reported cannabis use in the year before pregnancy was assessed via a questionnaire as part of standard prenatal care (at approximately 8 weeks’ gestation).

Figure 2.. Adjusted Prevalence of Cannabis Use Among 367 403 Pregnancies During Pregnancy by Frequency of Use, 2009-2017

Adjusted prevalence estimates (dots) and 95% CIs (error bars) were estimated from Poisson regression models controlling for age group, race/ethnicity, and median neighborhood household income (extracted from the electronic health record [Table 2]). Self-reported cannabis use during pregnancy was assessed via a questionnaire as part of standard prenatal care (at approximately 8 weeks’ gestation).