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Training needed for physicians with pregnant patients who use marijuana

When patients disclose during their first prenatal visits that they use marijuana, health care providers respond with counseling less than half of the time, and when counseling is given, clinicians typically focus on the legal and procedural, rather than medical, consequences, according to data published in Obstetrics and Gynecology.

“Marijuana is the most commonly used drug during pregnancy in the United States,” Cynthia L. Holland, MPH, of the department of obstetrics, gynecology and reproductive sciences at the Magee-Women’s Research Institute, in Pittsburgh, and colleagues wrote. “In the National Survey on Drug Use and Health report, 4.6% of women reported they used marijuana during pregnancy, whereas population-based studies using biochemical testing noted rates as high as 12%. Our previous work found 29% of pregnant patients were users of marijuana during pregnancy. … Perinatal marijuana use is associated with negative pregnancy, infant and child outcomes.”

To examine obstetric health care providers’ responses during initial prenatal encounters to disclosures of marijuana use among patients, the researchers analyzed audio recordings of 468 visits across five urban outpatient clinics in Pittsburgh.

Among the recorded visits, 90 patients (19%) disclosed marijuana use to 47 health care providers.

According to the researchers, 48% of the health care providers involved in those cases failed offer counseling, or otherwise did not respond to the disclosure. In addition, when the disclosure was met with counseling, clinicians focused on general statements, avoiding specific information on the risks and outcomes associated with marijuana use during pregnancy. When counseling was offered, the two most common strategies involved either putative, in 33 cases, or supportive, in 34 cases, statements. Among punitive statements, clinicians evenly split their discussions informing patients they would undergo toxicology testing upon delivery or the current visit, and that if the test was positive for marijuana at delivery, child protective services would be contacted. Among supportive counseling, statements affirming the clinician’s belief in the patient’s ability or motivation to quit were most common.

“Counseling should address the potential medical risks for both mother and fetus and strategies to assist the patient in quitting,” Holland and colleagues wrote. “Furthermore, studies are needed to better understand the beliefs, perspectives, knowledge and concerns of both pregnant patients and obstetric health care providers to develop and tailor effective communication resources and training interventions on perinatal marijuana that address the specific needs and concerns of health care providers and patients in the varying regions across the nation.” – by Jason Laday