In Reply Ericksen et al elegantly outline 2 areas deserving further study. First, they highlight the importance of studying frequency of use during pregnancy. In the combined 2015/2016 data from the National Survey on Drug Use and Health, 21.1% of pregnant white and black women aged 18 to 44 years who used cannabis in the past 30 days reported doing so every day. Furthermore, 11.7% of these women met criteria for cannabis abuse/dependence during the past year. However, when compared with their same-aged counterparts who had used cannabis in the preceding 30 days but were not pregnant, rates of daily use and abuse/dependence were not statistically elevated in pregnant women reporting recent cannabis use (P > .10). About 50% to 60% of the variance in cannabis use disorder is attributable to genetic influences that might be transmitted from parent to offspring,1 thus creating a confound in studies that explore the potential causal effects of prenatal exposure on offspring outcomes.2 Indeed, what might appear to be a direct effect of prenatal exposure to cannabis on, eg, offspring mental health, might also reflect the pleiotropic effects of genes associated with both cannabis use and those mental health outcomes that are inherited by the offspring.
Agrawal A, Grucza RA, Rogers CE. Public Health Implications of Rising Marijuana Use in Pregnancy in an Age of Increasing Legalization—Reply. JAMA Pediatr. 2019;173(6):607. doi:10.1001/jamapediatrics.2019.0618
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