Adverse Childhood Experiences and Mental Health Among Pregnant Women Who Use Cannabis

Cannabis is the most commonly used psychoactive substance during pregnancy, with self-reported use around 5% and up to 28% among socioeconomically disadvantaged groups. Actual use is likely higher, as specimen-based drug tests detect cannabis use at nearly double the rate of self-report, likely due to stigma and fear of legal consequences. As cannabis becomes more legally and socially accepted among adults, perceptions of risk are decreasing, and prenatal use is rising.

Understanding factors that contribute to prenatal cannabis use is essential for early intervention. Adverse Childhood Experiences (ACEs)—potentially traumatic events before age 18—are linked to chronic health issues, poor mental health, and substance use in adulthood. Emerging research shows a strong association between ACEs and cannabis use during pregnancy. Individuals with higher ACE scores are more likely to report using cannabis to manage health conditions and to test positive during prenatal visits or delivery. They also face greater risks of poor mental health and substance use.

This study explores the relationship between ACEs, prenatal cannabis use, and mental health among a small sample of pregnant women who used cannabis during their current pregnancy.

Methods

From August 2023 to January 2024, participants were recruited through prenatal clinics at an academic medical center serving urban, suburban, and predominantly rural/Appalachian communities in central STATE. Eligible participants were English-speaking, aged 18–45, receiving prenatal care at recruitment sites, and self-reported cannabis use during their current pregnancy (including before pregnancy recognition). Recruitment occurred during routine prenatal visits, where interested patients were screened, consented, and provided a survey link.

Participants completed a cross-sectional survey (115 items with skip logic). Of the 63 who enrolled, 60 began the survey, and 59 completed most measures. Each received a $25 incentive. Data were analyzed using SAS 9.4. Descriptive statistics were generated; GAD-7 and ACE scores were summed. Among those completing the ACE measure (n=57), missing data were minimal and low risk for bias; listwise deletion was used. Demographics and substance use descriptives are based on the full sample (n=59).

Results

Rates of any reported ACE were high, with 84.2% reporting at least one ACE. Four or more ACEs were reported by 49.1% of the sample. he binary logistic regression modeling significantly predicted whether participants endorsed past 30-day cannabis use (Chi-square = 8.02, df = 3, p = .0457). Among the predictors, neither maternal age nor anxiety were significant predictors of past 30-day cannabis use; however, the odds of reporting past 30-day cannabis use rose 27% with each additional ACE (OR 1.27, 95% CI (1.002- 1.616)

Implications

The link between ACEs and prenatal cannabis use underscores the need for integrated mental health and substance use care in prenatal settings. As cannabis risk perception declines, especially in legal-use areas, public health messaging should clearly communicate risks—particularly to those with trauma histories. Policymakers should invest in trauma-informed, maternal behavioral health programs that address social determinants and improve outcomes for mothers and infants.