Prenatal cannabis use (PCU) is not associated with significantly decreased stress or depression symptoms, according to a recent study published in JAMA Network Open.¹

An increase in cannabis use has been observed worldwide, alongside a decrease of individuals perceiving PCU as risky. Pregnant individuals may use cannabis because of nausea concerns or to manage mental health conditions. However, data has indicated an increased risk of mental health issues from lifetime cannabis use.

Approximately 10% to 20% of pregnant patients are impacted by depression and stress.² This may lead to cannabis use to cope with these mental health problems, causing questions about trends in PCU and the efficacy of cannabis for reducing depression and stress.¹

To evaluate the association between PCU with pregnancy and offspring outcomes, investigators conducted the Cannabis Use During Early Life and Development study. Participants included pregnant individuals with a lifetime history of cannabis use before their current pregnancy presenting at an obstetric clinic between July 2019 and January 2024.

Patients who were incarcerated, aged under 18 years, with active psychosis, mania, or suicidal ideation, multifetal pregnancy, or using assisted reproductive technology were excluded from the analysis. Self-reported race and ethnicity data was obtained to determine the cohort’s sociodemographic variability.

The Edinburgh Postnatal Depression Scale was used to measure prenatal depression each trimester. Scores ranged from 0 to 28, and higher scores indicated increased symptom burden. Similarly, the Cohen Perceived Stress Scale, ranging from 0 to 40, was used to measure stress.

Participant self-reports were used to identify PCU, alongside corroboration with urine drug screens each trimester. Cannabis use responses included never, monthly or less, 2 to 4 times a month, 2 to 3 times a week, and 4 or more times a week.

Patients reporting cannabis use were asked their reasons for the use of marijuana during pregnancy, with reasons including nausea, sleep aid, stress management, mental health treatment, enjoyment, pain management, difficulty to stop using, and other. Electronic health records were assessed to identify prior or current mental health diagnoses.

There were 504 participants aged a median 26 years included in the analysis, 46.8% of whom reported PCU while 53.2% reported no PCU. First trimester PCU was linked to increased second trimester depression and third trimester stress. Age, race, mental health history, and psychotropic medication use did not differ based on PCU.

Active psychotropic medication prescriptions were not common during the first trimester study visit. Twenty patients with a prescription reported PCU for mental health, 3 PCU for other reasons, and 26 no PCU. Participants primarily reported PCU for nausea and appetite, but 58.1% endorsed cannabis use for mental health symptom relief.

The odds of second trimester PCU were increased over 2-fold among patients with first trimester PCU. Additionally, the odds of prior mental health conditions among patients with PCU for mental health vs those without PCU were 60.5% vs 45.6%, respectively.

A decrease in depression, stress, and cannabis use was noted across trimesters. However, no association was reported between PCU and change in depression or stress. Additionally, a significant reduction in depression and stress was only found in the second trimester when compared to the first trimester.

While the estimated PCU slope was linked to the depression slope, an association was not found for the decline in depression during pregnancy. However, depression and stress influenced each other during pregnancy.

These results indicated no relief in mental health symptom burden from PCU. Investigators recommended increased access for effective alternatives to cannabis during pregnancy, especially for patients using cannabis to cope with mental health symptoms.

References

1. Constantino-Pettit A, Tillman R, Wilson J, et al. Cannabis use and trajectories of depression and stress across the prenatal period. JAMA Netw Open. 2024;7(12):e2451597. doi:10.1001/jamanetworkopen.2024.51597
2. Pearson RM, Carnegie RE, Cree C, et al. Prevalence of prenatal depression symptoms among 2 generations of pregnant mothers: the Avon Longitudinal Study of Parents and Children.JAMA Netw Open. 2018;1(3):e180725. doi:10.1001/jamanetworkopen.2018.0725