Characteristics of Marijuana Use During Pregnancy — Eight States, Pregnancy Risk Assessment Monitoring System, 2017

Abstract

Marijuana is the most commonly used illicit substance under federal law in the United States (1); however, many states have legalized medical and adult nonmedical use. Evidence regarding the safety and health effects of cannabis use during pregnancy is largely inconclusive (2). Potential adverse health effects to exposed infants (e.g., lower birthweight) have been documented (2). To provide population-based estimates of use surrounding pregnancy, identify reasons for and mode of use, and understand characteristics of women who continue versus cease marijuana use during pregnancy, CDC analyzed data from eight states participating in the 2017 Pregnancy Risk Assessment Monitoring System (PRAMS) marijuana supplement. Overall, 9.8% of women self-reported marijuana use before pregnancy, 4.2% during pregnancy, and 5.5% after pregnancy. The most common reasons for use during pregnancy were to relieve stress or anxiety, nausea or vomiting, and pain. Smoking was the most common mode of use. In multivariable models that included age, race/ethnicity, marital status, education, insurance status, parity, trimester of entry into prenatal care, and cigarette and e-cigarette use during pregnancy, women who continued versus ceased marijuana use during pregnancy were more likely to be non-Hispanic white or other race/ethnicity than non-Hispanic black, be unmarried, have ≤12 years of education, and use cigarettes during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recommend refraining from marijuana use during pregnancy and lactation (3,4). Given the increasing number of states legalizing medical and adult nonmedical marijuana use, surveillance of perinatal marijuana use can inform clinical guidance, provider and patient education, and public health programs to support evidence-based approaches to addressing substance use. PRAMS is a state-specific, population-based surveillance system designed to monitor self-reported behaviors and experiences before, during, and after pregnancy among women who have had a recent live birth. In each participating state, a monthly stratified systematic sample of women with recent live births is selected from birth certificate records and surveyed by mail or telephone 2-6 months after delivery.* Supplementary questions about marijuana use were asked in eight states included in this analysis: Alaska, Illinois, Maine, each state had a response rate ≥55%. Data were weighted to adjust for noncoverage and nonresponse and represent the total population of women with a live birth in each state in 2017. Women were asked "At any time during the 3 months before you got pregnant or during your most recent pregnancy, did you use marijuana or hash in any form?" Use before pregnancy was identified as a frequency greater than "never" to the follow-up question "During the 3 months before you got pregnant, about how often did you use marijuana products in an average month?" Use during pregnancy was identified the same way, from the question "During your most recent pregnancy, about how often did you use marijuana products in an average month?" Women who indicated marijuana use in both periods were defined as having continued use, whereas those who used before pregnancy and ceased during pregnancy were defined as having ceased use. Women who indicated "yes" to the question "Since your new baby was born, have you used marijuana or hash in any form?" were defined as using marijuana after pregnancy. Women who self-reported use during pregnancy indicated the reason or reasons (to relieve nausea or vomiting; stress or anxiety; symptoms of a chronic condition; pain; to have fun or relax; and other) and mode or modes (smoking; eating; drinking; vaporizing; dabbing; or other) of using marijuana during pregnancy. More than one option could be chosen. Qualitative thematic coding categorized "other" responses; written responses of mental health conditions were recoded as relieving stress or anxiety and written responses of poor appetite or weight loss were recoded as relieving nausea or vomiting. Remaining responses were retained as other. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated overall and by state using SUDAAN (version 11.0; RTI International). Among women who used marijuana in the 3 months before pregnancy, chi-squared tests were used to compare characteristics of women who continued versus ceased marijuana use during pregnancy, including age, race/ethnicity, marital status, education, insurance status, parity, trimester of entry into prenatal care, and cigarette and e-cigarette use during pregnancy. Adjusted prevalence ratios (aPRs) were calculated to describe associations between continued versus ceased use in pregnancy and maternal characteristics. P-values <0.05 were considered significant. Among 7,688 women, 6,236 (81.1%) had any information on marijuana use before, during, or after pregnancy. Prevalences of self-reported marijuana use before, during,