Among 604 pregnant women, those who continued using cannabis throughout pregnancy were significantly more likely to have elevated anxiety and depression scores compared to non-users, with depression predicting continued use over quitting.
Obstetricians, prenatal care providers, pregnant individuals, and anyone interested in the intersection of cannabis use and mental health during pregnancy.
2.75x higher odds of elevated depression scores in continued cannabis users
What the researchers found
Women who continued cannabis use had significantly higher odds of elevated GAD scores (2.55, 95% CI 1.31-4.99) and EPDS depression scores (2.75, 95% CI 1.43-5.28) compared to non-users. Women with higher depression scores had 2.70 times the odds of continuing use rather than quitting.
Why it matters
Cannabis use during pregnancy is common (36.3% tested positive at care initiation in this sample), and mental health symptoms may drive continued use. Understanding this bidirectional relationship is important for designing interventions that address both issues simultaneously.
The numbers in context
604 women; 221 (36.3%) positive for cannabis at care initiation; continued use: GAD OR 2.55, EPDS OR 2.75 vs non-users; higher depression scores: 2.70x odds of continuing vs quitting
How the study worked
Retrospective cohort at a single site evaluated urine toxicology for cannabis at two time points to categorize 604 women as never-used, quit, or continued. Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder scores were compared using multinomial logistic regression.
What this study cannot tell us
Single site, retrospective design. Urine testing has a limited detection window. Cannot determine whether cannabis use caused mood symptoms or vice versa. No data on cannabis use patterns, amounts, or products.
How to read the evidence
Moderate sample size with objective toxicology confirmation and validated screening tools, but single-site retrospective design limits causal inference.
When this study was published
Published in 2021.
The bigger picture
The finding that depression predicted continued cannabis use during pregnancy suggests some women may be self-medicating. Simply advising cessation without addressing underlying mental health needs may be ineffective.
Questions still open
- Would treating depression and anxiety reduce cannabis use during pregnancy? Are women using cannabis to manage mood symptoms, and if so, what alternatives could be offered? Do these associations persist postpartum?
Common questions
Did quitting cannabis during pregnancy help with mood symptoms?
How common was cannabis use in this study?
Read the original research
Association between continued cannabis use during pregnancy and symptoms of anxiety and depression.
International review of psychiatry (Abingdon, England), 33(6), 528-533
Citation
Mark, Katrina; Otieno, Linda; Moore, Ellen; Zehra, Amna; Mitchell, Mary. (2021). Association between continued cannabis use during pregnancy and symptoms of anxiety and depression.. International review of psychiatry (Abingdon, England), 33(6), 528-533. https://doi.org/10.1080/09540261.2021.1898348
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