Cannabis Use Was an Independent Predictor of Prenatal Anxiety in 54,000 Nova Scotia Pregnancies

In 53,852 first-time pregnancies in Nova Scotia (2004-2023), reported prenatal anxiety prevalence was 8.9% overall but rose from under 5% to over 20% over the study period. Cannabis use was an independent predictor of prenatal anxiety in multivariable analysis, alongside younger or older age, being unpartnered, lower education, higher BMI, and smoking. These factors collectively explained 17.5% of variance.

Retrospective cohort study using the Nova Scotia Atlee Prenatal Database of 53,852 primigravid persons with singleton pregnancies (2004-2023). Multivariable analysis examined birth year group, age, partner status, education, pre-pregnancy BMI, smoking, and cannabis use as predictors of reported prenatal anxiety.

The dramatic rise in reported prenatal anxiety over two decades (from under 5% to over 20%) is itself concerning. The identification of cannabis use as an independent predictor, after controlling for other risk factors, adds important information for prenatal screening and suggests cannabis use should be assessed as part of comprehensive anxiety screening during pregnancy.

Whether cannabis use causes prenatal anxiety or whether anxious individuals are more likely to use cannabis remains unclear from this observational design. However, the association is clinically relevant regardless of direction: pregnant individuals who use cannabis should be screened for anxiety, and those with anxiety should be asked about cannabis use.

Retrospective database study cannot determine causation. Rising anxiety rates may partly reflect increased recognition and reporting rather than true increases. Cannabis use was self-reported and likely underestimated. Cannot distinguish between recreational and self-medicating use. Only first-time pregnancies included.