Among 34,309 births in rural Appalachian West Virginia, prenatal substance use was prevalent with cannabis appearing as a standalone category and in multiple polysubstance combinations with opioids and stimulants.
Rural health providers, prenatal care teams in Appalachia, substance use epidemiologists, and maternal health policymakers.
34,309 births; cannabis appeared in multiple prenatal substance use patterns
What the researchers found
Cannabis was identified as both a standalone prenatal exposure category and a component of multiple polysubstance patterns (cannabis alone, opioids+cannabis, cannabis+stimulants, opioids+cannabis+stimulants) in a population-based birth cohort from West Virginia.
Why it matters
Rural Appalachian populations face disproportionate substance use challenges. Understanding the specific patterns, including where cannabis fits, is essential for designing appropriate prenatal interventions in underserved regions.
The numbers in context
34,309 births in West Virginia (2020-2022). Nine substance use categories: no use, opioids, cannabis, sedatives/hypnotics, stimulants, opioids+cannabis, opioids+stimulants, cannabis+stimulants, opioids+cannabis+stimulants.
How the study worked
Population-based cohort (Project WATCH) of all 34,309 women who gave birth in West Virginia between February 2020 and June 2022. Substance use identified through self-report, medical records, and drug screening. Nine substance use categories defined.
What this study cannot tell us
Single-state data from a region with unique substance use dynamics. Screening methods may miss some use. Short time window (2020-2022) overlapping with COVID-19 pandemic. Does not assess pregnancy outcomes associated with different substance use patterns.
How to read the evidence
Population-based cohort with multiple screening methods. Strong for prevalence estimation but limited to one state and does not assess outcomes.
When this study was published
Published 2023. Data from February 2020 to June 2022.
The bigger picture
Appalachian communities have been at the center of the opioid crisis, but cannabis use during pregnancy is part of a more complex substance use landscape that includes multiple overlapping patterns. Population-level data like this helps map the full picture.
Questions still open
- How do different prenatal substance use combinations affect birth outcomes in this population? Would universal screening with comprehensive substance panels improve identification rates?
Common questions
How common is cannabis use during pregnancy in Appalachia?
Why study prenatal substance use in West Virginia specifically?
Read the original research
Prenatal substance use in the rural and Appalachian state: Project WATCH study 2020-2022.
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 39(4), 804-815
Citation
Umer, Amna; Garrow, Jana; Nesbitt, Makena; Lilly, Christa; Lefeber, Candice; Breyel, Janine; John, Collin. (2023). Prenatal substance use in the rural and Appalachian state: Project WATCH study 2020-2022.. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 39(4), 804-815. https://doi.org/10.1111/jrh.12752
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