Among 273 pregnant women who had quit tobacco, 14% met criteria for a lifetime cannabis use disorder, with the strongest predictor being a history of multiple psychiatric disorders (36x higher odds).
Healthcare providers caring for pregnant women and anyone interested in co-occurring substance use and mental health disorders.
Multiple psychiatric disorders were associated with 36x higher odds of cannabis use disorder
What the researchers found
Researchers studied 273 pregnant women who had quit smoking tobacco as a result of pregnancy to understand how common cannabis use disorder was in this population and what predicted it.
Overall, 14% met criteria for a lifetime cannabis use disorder. The strongest predictor by far was having a history of multiple psychiatric disorders, which was associated with 36.4 times higher odds. A lifetime alcohol use disorder also increased the odds (3.5x).
Additional predictors included more frequent prior attempts to quit tobacco and lower confidence about managing weight after quitting smoking. The findings suggest that women with co-occurring cannabis and tobacco dependence may need specialized treatment during pregnancy.
Why it matters
Cannabis use during pregnancy is common, and women who struggle with tobacco may also struggle with cannabis. The extremely strong association with multiple psychiatric disorders (OR=36.4) suggests that mental health screening is essential for identifying pregnant women at risk for cannabis use disorder.
The numbers in context
273 pregnant women. 14% met lifetime cannabis use disorder criteria. History of multiple psychiatric disorders: OR 36.44. Lifetime alcohol use disorder: OR 3.54. More quit attempts: OR 1.12. Lower weight management self-efficacy: OR 0.78.
How the study worked
Cross-sectional analysis of 273 pregnant former tobacco smokers enrolled in a randomized controlled trial for postpartum tobacco relapse prevention. Participants completed semi-structured psychiatric interviews and self-report measures during their third trimester.
What this study cannot tell us
The sample was limited to pregnant women who had successfully quit tobacco, which may not represent all pregnant cannabis users. Lifetime (not current) cannabis use disorder was assessed. The very wide confidence interval on the psychiatric disorder odds ratio (5.03-264.27) reflects the small sample. Self-selected trial participants may differ from the general population.
How to read the evidence
This is a cross-sectional study within a clinical trial population, providing preliminary evidence on co-occurring risk factors with a notably wide confidence interval on the key finding.
When this study was published
Published in 2016. Research on substance use in pregnancy continues to evolve.
The bigger picture
This study highlights the clustering of substance use and psychiatric disorders in pregnant women. The finding that multiple psychiatric diagnoses are overwhelmingly the strongest predictor of cannabis use disorder in this population suggests that integrated mental health and substance use treatment during pregnancy could be particularly valuable.
Questions still open
- Are women with cannabis use disorder less likely to quit tobacco during pregnancy? Would integrated psychiatric and substance use treatment improve outcomes for this population?
Common questions
Is cannabis use disorder common among pregnant women?
Why is mental health history such a strong predictor?
Read the original research
Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers.
Addictive behaviors, 54, 52-8
Citation
Emery, Rebecca L; Gregory, Melissa P; Grace, Jennifer L; Levine, Michele D. (2016). Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers.. Addictive behaviors, 54, 52-8. https://doi.org/10.1016/j.addbeh.2015.12.008
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