Psychiatric and Substance Use Disorders Strongly Predict Cannabis Use During Pregnancy | Research

The takeaway

Among nearly 300,000 pregnancies, every psychiatric and substance use disorder examined was associated with elevated cannabis use during pregnancy, with psychotic disorders showing 10x higher odds of cannabis use disorder.

Prenatal mental health providers; addiction specialists working with pregnant patients.

21.99x higher odds of prenatal cannabis use disorder with comorbid stimulant use disorder

What the researchers found

All psychiatric disorders studied were associated with elevated cannabis use and CUD during pregnancy. Strongest associations for any use: bipolar disorder (aOR 2.83) and tobacco use disorder (aOR 4.03). Strongest associations for CUD: psychotic disorders (aOR 10.01) and stimulant use disorder (aOR 21.99). Anxiety, bipolar, and depressive disorders were associated with daily versus monthly cannabis use.

Why it matters

This is the largest study to systematically examine the relationship between mental health conditions and prenatal cannabis use. The finding that virtually every psychiatric and substance use diagnosis increases prenatal cannabis use risk suggests these women may be self-medicating, and that prenatal mental health treatment could indirectly reduce cannabis exposure.

The numbers in context

299,496 pregnancies. 6.8% used cannabis, 0.2% had CUD. Anxiety prevalence: 14.3%. For any cannabis use: bipolar aOR 2.83, PTSD aOR 2.15, ADHD aOR 1.94, depression aOR 1.74, anxiety aOR 1.62. For CUD: psychotic disorders aOR 10.01, stimulant use disorder aOR 21.99, opioid use disorder aOR 15.19, tobacco use disorder aOR 8.21.

How the study worked

Observational study of 299,496 pregnancies from 227,555 individuals screened at Kaiser Permanente Northern California from 2011-2021 (excluding 2020). Psychiatric and substance use disorder diagnoses from electronic health records in the two years prior to pregnancy. Cannabis use measured by self-report and urine toxicology at prenatal care entry.

What this study cannot tell us

Observational design cannot establish whether psychiatric conditions cause cannabis use or vice versa. EHR-based diagnoses may not capture all psychiatric conditions, particularly in mild or undiagnosed cases. Year 2020 was excluded due to pandemic disruptions.

How to read the evidence

Strong: very large population-based study with universal screening, comprehensive psychiatric diagnosis data, and systematic analysis across multiple disorder categories.

When this study was published

2024 study using 2011-2021 data.

The bigger picture

The much stronger associations with substance use disorders than psychiatric disorders suggest that prenatal cannabis use is often part of a broader pattern of substance use rather than isolated self-medication for mental health. This has implications for intervention design: treating one substance in isolation may be insufficient.

Questions still open

Would effective treatment of psychiatric conditions during preconception reduce prenatal cannabis use? Are women with comorbid psychiatric and substance use disorders receiving integrated treatment during pregnancy?

Common questions

Which mental health conditions are most linked to prenatal cannabis use?

Bipolar disorder had the strongest association among psychiatric diagnoses (2.83x higher odds). For cannabis use disorder specifically, psychotic disorders showed 10x higher odds. Among substance use disorders, stimulant use disorder showed the strongest link (22x higher odds of CUD).

Does this mean women use cannabis to cope with mental health issues during pregnancy?

The data suggest this is likely for some women, as anxiety, depression, and bipolar disorder were specifically associated with daily rather than occasional cannabis use. However, the even stronger associations with other substance use disorders suggest prenatal cannabis use is often part of a broader pattern of substance use.

Read the original research

Association of psychiatric and substance use disorders with cannabis use and cannabis use disorder during early pregnancy in northern California.

Addiction (Abingdon, England), 119(11), 1987-1997

View on PubMed ↗Publisher’s paper ↗

Citation

Young-Wolff, Kelly C; Chi, Felicia W; Campbell, Cynthia I; Does, Monique B; Brown, Qiana L; Alexeeff, Stacey E; Ansley, Deborah; Wang, Xiaoming; Lapham, Gwen T. (2024). Association of psychiatric and substance use disorders with cannabis use and cannabis use disorder during early pregnancy in northern California.. Addiction (Abingdon, England), 119(11), 1987-1997. https://doi.org/10.1111/add.16622