Associations between Cannabis Use, Cannabis Use Disorder and Mental Health Disorders Among Pregnant and Postpartum Women in the US

Background and Purpose: Despite public health recommendations to abstain from cannabis during preconception, pregnancy and lactation due to potential maternal and child health risks, cannabis use is increasing among pregnant and non-pregnant reproductive-age women in the US. It is plausible that this population is using cannabis to self-medicate mental health disorders. However, little is known about the association between mental health disorders, cannabis use and cannabis use disorder (CUD) among pregnant and postpartum women in the US. Extant research among this population uses non-representative samples, is limited in scope, and/or uses older Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria to assess mental health disorders. Given the rapid legalization of cannabis for medical and recreational use across states and the lack of state policy guidance regarding cannabis use among pregnant and postpartum women, nationally representative studies are needed to understand why women are using cannabis during these critical periods of reproductive health. Therefore, this study examined mental health correlates of cannabis use and CUD among a nationally representative sample of women pregnant in the past year (i.e., currently pregnant and recently postpartum women).

Methods: This cross-sectional study (N=1,316) sampled pregnant (n=414) and postpartum women (n=902) 18-44 years old from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Weighted logistic regression models were used to examine associations between cannabis use, DSM-5 CUD and DSM-5 mood, anxiety, personality and post-traumatic stress disorders controlling for sociodemographic characteristics (age, race/ethnicity, education, poverty level, marital status, health insurance status, urbanicity and state medical cannabis laws) and past-year alcohol, tobacco and other drug use excluding cannabis use.

Results: The prevalence of past-year cannabis use and CUD was 9.8% and 3.2%, respectively. The odds of cannabis use (adjusted odds ratio [aORs] range 2.10 to 3.87, p-values<0.01) and CUD (aORs range 2.55 to 10.44, p-values< 0.01) were higher among pregnant and postpartum women with versus without any past-year mood, anxiety or post-traumatic stress disorder or any lifetime personality disorder. The aORs for the association of cannabis use with specific mood, anxiety or personality disorders ranged from 1.95 to 6.00 (p-values<0.05), with associations between bipolar disorder (aOR=6.00, p<0.001) and schizotypal personality disorder (aOR=5.94, p<0.001) being the most salient. The aORs for the association of CUD with specific mood, anxiety or personality disorders ranged from 2.36 to 11.60 (p-values<0.05), with associations between schizotypal (aOR=11.60, p<0.001) and borderline personality disorders (aOR=6.12, p<0.001) being the most salient.

Conclusions and Implications: From pregnancy up to one year postpartum is a critical period where women may be vulnerable to mental health disorders, cannabis use and CUD. Moreover, mental health correlates of cannabis use and CUD among this population differ in type and strength of association, which has implications for tailored treatment and prevention efforts.