Recreational Cannabis Legalization in the US and Maternal Use during the Preconception, Prenatal, and Postpartum Periods

Abstract

In the United States (US), recreational cannabis use is on the rise. Since 2011, 11 states and the District of Columbia have legalized cannabis for adult recreational use. As additional states consider legalizing, there is an urgent need to assess associations between recreational cannabis legalization and maternal use in the preconception, prenatal, and postpartum periods—all critical windows for maternal and child health. Using cross-sectional data from the 2016 Pregnancy Risk Assessment Monitoring System, we assessed associations between state cannabis legalization and self-reported maternal cannabis use. Using logistic regression, we estimated the adjusted prevalence ratio (PR) of cannabis use during the preconception, prenatal, and postpartum period for women delivering a live-born infant in three states that had legalized recreational cannabis (Alaska, Colorado, and Washington) and three states that had not legalized (Maine, Michigan, and New Hampshire) by 2016. Our final sample size was 7258 women. We utilized 95% confidence intervals (CI) and a significance level of alpha = 0.05. After adjustment for potential confounders, women who resided in states with legalized recreational cannabis were significantly more likely to use cannabis during the preconception (PR 1.52; 95%CI ranging from 1.28–1.80; p < 0.001), prenatal (PR 2.21; 95% CI ranging from 1.67–2.94; p < 0.001), and postpartum (PR 1.73; 95%CI ranging from 1.30–2.30; p < 0.001) periods, compared to women who resided in states without legalized recreational cannabis. Although evidence about the effect of marijuana use during these periods is nascent, these findings show potential for increased incidence of child exposure to cannabis. Longitudinal research is needed to assess immediate and sustained impacts of maternal use before and after state legalization of recreational cannabis.

Women’s cannabis use before, during, and after pregnancy in New Hampshire

“…Estimates of preconception use in this study were higher than other studies using self-reported data. We found that 16.8% of women reported cannabis use prior to pregnancy in New Hampshire ─ a slightly higher prevalence than a recent study that estimated preconception cannabis use to be 14.73% using 2016 PRAMS data from four states ( Skelton et al, 2020 ). In comparison to a recently published study using 2016 PRAMS data from 5 states (not including New Hampshire), we found nearly doubled estimates of preconception use; 8% versus 16%, respectively ( Short et al, 2020 ).…”

“…Increases in cannabis use at the national level make perinatal cannabis use a pressing public health issue, regardless of legality of cannabis at a state level. Yet, much more is known about perinatal cannabis users in states where recreational cannabis is legal ( Akhigbe et al, 2018 , Crume et al, 2018 , Gnofam et al, 2019 , Lee et al, , Metz et al, 2019 , Siega‐Riz et al, 2020 , Skelton et al, 2020 , Young-Wolff et al, 2020 , Young-Wolff et al, 2018 , Young-Wolff et al, 2019a b), compared to those states yet to legalize ( Ko et al, 2020 ). It is important to understand maternal cannabis use prevalence and associated reasons for use for women, including women who reside in states yet to legalize.…”

Association of Recreational Cannabis Legalization With Maternal Cannabis Use in the Preconception, Prenatal, and Postpartum Periods

“…The extent to which changing recreational cannabis policies are associated with maternal cannabis use during critical maternal and child health periods is unclear. A recent cross-sectional study 15 revealed that women residing in states in which recreational cannabis use is legal were significantly more likely to use cannabis during these critical periods compared with women residing in states yet to legalize recreational cannabis. Another recent case study 16 in Colorado revealed that prenatal use increased after recreational use of cannabis had been legalized.…”

Prenatal Cannabinoid Exposure: Emerging Evidence of Physiological and Neuropsychiatric Abnormalities

“…These data are consistent with reports showing that, in the past two decades, the perception that cannabis use poses no risk during pregnancy has increased 3-fold among reproductive-aged women in both clinical settings and across large-scale nationally representative surveys in the US ( 5 , 6 ). In particular, women who reside in areas where recreational cannabis is legalized and those who report regular cannabis use prior to pregnancy perceive far less risk of continued use during pregnancy, possibly owing to a positive perception of therapeutic effects and a lack of communication with health care providers regarding the risks ( 5 , 7 , 8 ). Indeed, in an online survey approximately half of the health care provider participants did not explicitly discourage prenatal cannabis use ( 9 ).…”