Pregnant cannabis users report perceived impact of cannabis legalization

Pregnant people who self-reported cannabis use perceived benefits of cannabis legalization, but also reported worries about the implications for the involvement of Child Protective Services, according to data published in JAMA Network Open.

As of Feb. 3, medical cannabis use is legal in 37 states and Washington, D.C., and, as of Nov. 9, recreational cannabis use is legal in 21 states and Washington, D.C., according to the National Conference of State Legislatures.

“Existing studies provide inconclusive evidence about whether state adult-use cannabis legalization is associated with changes in prenatal cannabis use,” Kelly C. Young-Wolff, PhD, MPH, a licensed clinical psychologist and research scientist at the Kaiser Permanente Northern California Division of Research in Oakland, and colleagues wrote. “However, some cannabis retailer staff (sometimes called budtenders) promote cannabis as safe and effective for managing pregnancy symptoms, and greater cannabis retailer density around pregnant individuals’ homes is associated with higher odds of prenatal cannabis use.”

Young-Wolff and colleagues enrolled 53 pregnant people who self-reported cannabis use when they began prenatal care to participate in one of 18 90-minute focus groups. There were 23 non-Hispanic Black participants in eight groups and 30 non-Hispanic white participants in 10 groups.

Focus group meetings were conducted from Nov. 17 to Dec. 17, 2021, using Microsoft Teams’ video conferencing platform. In each semi-structured meeting, participants discussed reasons for prenatal cannabis use, the benefits and detriments of prenatal cannabis use, changes in use during pregnancy, modes of administration and communication with clinicians about use. Meeting transcripts were compared to identify themes and subthemes.

Daily prenatal cannabis use was reported by 37 (70%) participants, weekly use was reported by 13 (25%) participants and monthly or less use was reported by three (6%) participants. However, 37 (70%) participants reported stopping cannabis use once they were recruited for the study.

There were three themes identified by participants: greater access and exposure to cannabis, increased acceptance and trust in cannabis retailers. These did not differ by race.

Access, exposure

Participants expressed that people they knew had increasingly been using cannabis during pregnancy in recent years due to legalization. Many participants said that cannabis was just as accessible as alcohol or cigarettes were, and that delivery options for cannabis products contributed to increased use in pregnancy. They noted that delivery was “convenient, more discreet and safer than buying cannabis outside the legal marketplace.”

Additionally, there were mixed feelings about cannabis advertising. Participants who had quit or cut back during pregnancy reported that seeing advertisements made them feel like they were missing out, while those who continued use reported ads had little impact on their cannabis use.

Acceptance

Participants commonly reported reduced stigmatization of general and prenatal cannabis use following legalization, which may have increased use prenatally. However, some participants said that prenatal use may not have increased, suggesting instead that pregnant people are able to talk more openly about their cannabis use.

Legalization also increased pregnant patients’ confidence and willingness to discuss cannabis with their providers, according to many participants. They also said their providers seemed more understanding of their cannabis use following legalization.

“One participant reported that she was willing to disclose and honestly discuss her use of cannabis with her obstetrician because cannabis is legal, which resulted in her ultimately quitting use during pregnancy,” Young-Wolff and colleagues wrote.

However, participants reported mixed concerns about the involvement of Child Protective Services (CPS). Although some participants reported reduced concerns about CPS involvement following legalization, others still had strong concerns about potential involvement.

Trust in retailers

Many participants reported increased confidence in their cannabis products due to the prevalence of retailers. Specifically, they said knowing how their cannabis is produced and warnings about health risks on product labels made them more comfortable in their safety while using cannabis.

Participants also appreciated the knowledge, care and nonjudgment that retail staff presented them. Many reported “feeling connected with their budtenders” and trusted them to help choose products that would alleviate pregnancy symptoms.

Finally, participants reported that the diversity of products available through retailers made prenatal cannabis use more accessible to people who do not necessarily want to smoke, which could increase prenatal use.

“These findings suggest that pregnant individuals who use cannabis perceive that legalization of cannabis for adult use has contributed to increases in prenatal cannabis use and created new challenges and opportunities for supporting the health of pregnant individuals,” Young-Wolff and colleagues wrote.

References:

• National Conference of State Legislatures. State medical cannabis laws. ncsl.org/research/health/state-medical-marijuana-laws.aspx. Updated Nov. 9, 2022. Accessed Dec. 20, 2022.
• Young-Wolff KC, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.46912.