Association of Comorbid Behavioral and Medical Conditions With Cannabis Use Disorder in Pregnancy

Abstract

IMPORTANCE Prenatal cannabis use continues to increase, yet studies of the demographic, psychiatric, and medical characteristics associated with cannabis use in pregnancy are limited by size and use of self-report, and often do not consider cannabis use disorder (CUD) or concomitant substance use disorders (SUDs). Understanding the factors associated with CUD in pregnancy is paramount for designing targeted interventions. OBJECTIVE To examine the prevalence of co-occurring psychiatric and medical conditions of US pregnant individuals hospitalized with and without CUD by concomitant SUDs. DESIGN, SETTING, AND PARTICIPANTS The study analyzed restricted hospital discharge data from the 2010 to 2018 Healthcare Cost and Utilization Project State Inpatient Databases in 35 states. Data were analyzed from January to August 2021. Weighted linear regressions tested whether the prevalence of psychiatric and medical conditions differed between individuals with and without a CUD diagnosis at hospitalization. Inpatient hospitalizations of pregnant patients aged 15 to 44 years with a CUD diagnosis were identified. Pregnant patients aged 15 to 44 years without a CUD diagnosis were identified for comparison. Patients were further stratified based on concomitant SUD patterns: (1) other SUDs, including at least 1 controlled substance; (2) other SUDs, excluding controlled substances; and (3) no other SUDs.EXPOSURES CUD in pregnancy. MAIN OUTCOMES AND MEASURESPrevalence of demographic characteristics, psychiatric disorders (eg, depression and anxiety), and medical conditions (eg, epilepsy and vomiting). RESULTSThe sample included 20 914 591 hospitalizations of individuals who were pregnant. The mean (SD) age was 28.24 (5.85) years. Of the total number of hospitalizations, 249 084 (1.19%) involved CUD and 20 665 507 (98.81%) did not. The proportion of prenatal hospitalizations involving CUD increased from 0.008 in 2010 to 0.02 in 2018. Analyses showed significant differences in the prevalence of almost every medical and psychiatric outcome examined between hospitalizations with and without CUD diagnoses, regardless of concomitant SUDs. Elevations were seen in depression (0.089; 95% CI, 0.083-0.095), anxiety (0.072; 95% CI, 0.066-0.076), and nausea (0.036; 95% CI, 0.033-0.040]) among individuals with CUD only at hospitalization compared with individuals with no SUDs at hospitalization. CONCLUSIONS AND RELEVANCE Considerable growth was observed in the prevalence of CUD diagnoses among individuals hospitalized prenatally and in the prevalence of depression, anxiety, nausea, and other conditions in individuals with CUD at hospitalization. This study highlights the need for more screening, prevention, and treatment, particularly in populations with co-occurring CUD and psychiatric disorders. Research on the determinants and outcomes associated with CUD during pregnancy is needed to guide clinicians, policy makers, and patients in making informed decisions.

Impact of Prenatal Cannabis Use Disorder on Perinatal Outcomes

“…Similarly, other recent large systematic reviews have found significant increases in adverse neonatal outcomes among women who used cannabis in pregnancy including small for gestational age, low birth weight, preterm birth, and NICU admissions 14,16,17 . Other studies have reported an association of comorbid behavioral conditions with prenatal cannabis use including increased depression and anxiety, but this was not assessed in our study 45 …”

“…14,16,17 Other studies have reported an association of comorbid behavioral conditions with prenatal cannabis use including increased depression and anxiety, but this was not assessed in our study. 45 Compared with other studies focused on prenatal cannabis use disorder, our study included a sizeable and diverse patient population and also adjusted for confounders including tobacco, alcohol, and substance use. In addition, our study assessed many clinically relevant prenatal and neonatal outcomes, including infant death, which has not been consistently reported.…”

Error in Table and Figure

“…The Original Investigation titled “Association of Comorbid Behavioral and Medical Conditions With Cannabis Use Disorder in Pregnancy,” published on November 3, 2021, was corrected to fix an error in the number of patients with multiple sclerosis and substance use disorder reported in Table 1; the correct number is 69 patients. In addition, there were errors in the quintiles presented in the legend to Figure 2; the correct quintile values are 0 to <0.011, 0.011 to <0.015, 0.015 to <0.019, 0.019 to <0.028, and 0.028 to <0.047.…”