Four distinct patterns of substance use in early pregnancy identified in 265,000 pregnancies | Research

The takeaway

Latent class analysis of over 265,000 pregnancies identified four substance use patterns, including a predominantly cannabis group (4.9%) that had elevated rates of depression and anxiety compared to non-users.

Prenatal care providers, substance use screening researchers, and public health professionals focused on maternal health.

265,274 pregnancies; 4.9% classified as predominantly cannabis users

What the researchers found

Four prenatal substance use patterns emerged: predominantly alcohol (9.3%), predominantly cannabis (4.9%), predominantly nicotine with some opioids (1.1%), and high-polysubstance (0.4%). All substance use groups had elevated depression, anxiety, intimate partner violence, and family drug history compared to non-users.

Why it matters

Pregnant people who use cannabis are not a monolithic group. Identifying distinct use patterns and their associated mental health profiles can help clinicians tailor screening and support rather than applying one-size-fits-all approaches.

The numbers in context

265,274 pregnancies. Four substance use groups: alcohol only (9.3%), cannabis only (4.9%), nicotine/opioids (1.1%), polysubstance (0.4%), no use (84.4%). All use groups had elevated behavioral health conditions vs. non-users.

How the study worked

Retrospective observational study of 265,274 pregnancies at Kaiser Permanente Northern California (2012-2019). Substance use screened via self-report and urine toxicology in the first trimester. Latent class analysis identified use patterns. Modified Poisson regression compared behavioral health prevalences.

What this study cannot tell us

Single healthcare system in Northern California. Screening methods may miss underreporting. Cross-sectional substance use data from first trimester only. Cannot determine whether behavioral health conditions preceded or resulted from substance use.

How to read the evidence

Large retrospective cohort with both self-report and biomarker screening. Limited by single system and first-trimester-only assessment.

When this study was published

Published 2023. Data from 2012-2019.

The bigger picture

Prenatal substance use screening often focuses on detecting use rather than understanding patterns. Recognizing that cannabis-only users have a different risk profile than polysubstance users could improve how healthcare systems allocate intervention resources.

Questions still open

Do the different substance use patterns lead to different birth outcomes? Would targeted interventions for cannabis-only users differ from those for polysubstance users?

Common questions

How common is cannabis use during pregnancy?

In this large Kaiser Permanente sample, 4.9% of pregnancies were classified as predominantly cannabis users (without significant other substance use). An additional 0.4% used cannabis as part of a polysubstance pattern. These figures likely underestimate true prevalence despite using both self-report and urine testing.

Are pregnant cannabis users more likely to have mental health conditions?

Yes. In this study, the cannabis-predominant group had higher rates of depression, anxiety, intimate partner violence, and family drug use history compared to non-users. The polysubstance group had the highest rates of all behavioral health conditions.

Read the original research

Patterns of Substance Use During Early Pregnancy and Associations With Behavioral Health Characteristics.

Journal of addiction medicine, 17(3), e141-e147

View on PubMed ↗Publisher’s paper ↗

Citation

Sujan, Ayesha C; Alexeeff, Stacey E; Slama, Natalie; Avalos, Lyndsay A; Adams, Sara R; Conway, Amy; Ansley, Deborah; Young-Wolff, Kelly C. (2023). Patterns of Substance Use During Early Pregnancy and Associations With Behavioral Health Characteristics.. Journal of addiction medicine, 17(3), e141-e147. https://doi.org/10.1097/ADM.0000000000001090