Four distinct patterns of substance use in early pregnancy identified in 265,000 pregnancies
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?Do the different substance use patterns lead to different birth outcomes?
- ?Would targeted interventions for cannabis-only users differ from those for polysubstance users?
Trust & Context
- Key Stat:
- 265,274 pregnancies; 4.9% classified as predominantly cannabis users
- Evidence Grade:
- Large retrospective cohort with both self-report and biomarker screening. Limited by single system and first-trimester-only assessment.
- Study Age:
- Published 2023. Data from 2012-2019.
- Original Title:
- Patterns of Substance Use During Early Pregnancy and Associations With Behavioral Health Characteristics.
- Published In:
- Journal of addiction medicine, 17(3), e141-e147 (2023)
- Authors:
- Sujan, Ayesha C(2), Alexeeff, Stacey E(19), Slama, Natalie, Avalos, Lyndsay A, Adams, Sara R, Conway, Amy, Ansley, Deborah, Young-Wolff, Kelly C
- Database ID:
- RTHC-04966
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked 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 More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-04966APA
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
MLA
Sujan, Ayesha C, et al. "Patterns of Substance Use During Early Pregnancy and Associations With Behavioral Health Characteristics.." Journal of addiction medicine, 2023. https://doi.org/10.1097/ADM.0000000000001090
RethinkTHC
RethinkTHC Research Database. "Patterns of Substance Use During Early Pregnancy and Associa..." RTHC-04966. Retrieved from https://rethinkthc.com/research/sujan-2023-patterns-of-substance-use
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.