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Original Investigation
November 3, 2021

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

Author Affiliations
  • 1Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
  • 2Community Health Research Division, RTI International, Research Triangle Park, North Carolina
  • 3Department of Epidemiology, Columbia University, New York, New York
  • 4Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, New York
JAMA Psychiatry. 2022;79(1):50-58. doi:10.1001/jamapsychiatry.2021.3193
Key Points

Question  What are the key demographic, psychiatric, and medical conditions associated with cannabis use disorder (CUD) in individuals who are hospitalized prenatally?

Findings  In this cross-sectional study of 20 914 591 female individuals in 35 US states, the proportion of prenatal hospitalizations involving CUD increased substantially between 2010 and 2018. There was a higher prevalence of depression, anxiety, and nausea disorders in prenatal hospitalizations with CUD compared with those without CUD, regardless of concomitant substance use disorders.

Meaning  The high prevalence of co-occurring mental health and medical disorders with CUD in prenatal hospitalizations highlights a critical need for treatment and support in this vulnerable population.


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 Measures  Prevalence of demographic characteristics, psychiatric disorders (eg, depression and anxiety), and medical conditions (eg, epilepsy and vomiting).

Results  The 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.

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    2 Comments for this article
    There are other risks to women who use cannabis while pregnant than mentioned in this study.
    pamela mccoll, BA | Clear The Air Now
    More pregnant and postpartum mothers die because of suicide than die from infection, high blood pressure and hemorrhage combined.
    Both THC and CBD are associated with an increased risk of suicide, depression, and anxiety and far more needs to be done to screen women in their childbearing years for Cannabis Use Disorder, well ahead of starting a family.
    It has been established by scientific clinical trials that the use of CBD is associated with an increased risk of suicide ideation as evidenced by the clinical trials for Epidiolex, the risk listed in the drug side effect profile
    package insert for this synthetic CBD product.
    Suicide attempts among pregnant or postpartum mothers have nearly tripled over the past decade.
    Neurological, Epigenomic and Multigenerational Adverse Outcomes of Prenatal Cannabis Exposure
    Albert Stuart Reece, MD | University of Western Australia
    The paper by Meinhofer is extremely concerning indeed. Examining disorders across three body systems (CNS, gastrointestinal and infectious) they report that all physical and mental disorders were elevated in pregnant CUD patients.
    However this “only” describes disastrous outcomes in one of the two patients in every confinement. Reports from Hawaii (Merz 2007; 70:p7), Colorado (Reece 2019; 58: p1085), Canada (Reece 2020; 14: p_e195) , Australia (Reece 2020; 21: p75) and USA (Reece Psych Times Oct 10th, “Rejoinder, Exposition”) report dozens of congenital anomalies linked with prenatal cannabis use including chromosomal disorders affecting chromosomes 9,12,13,18,21 and X which together account
    for 585 of the 3000MB or 19.5% of the human genome including several common adult and childhood cancers (Reece, Scientific Reports, 2021, 11: 13892).
    Add in adverse reports of neurological outcomes from all longitudinal studies of prenatally exposed infants and children.
    Add in many studies showing widespread alterations of DNA methylation transmitted across generations in rodents and humans; together with altered histone synthesis causing obligatory dysregulation of gene transcription including oncogenesis.
    Add in rising cannabis potency and doubled intensity of daily use.
    The bottom line is a very serious picture of neurological and major genotoxic outcomes for multiple generations together constituting a very high cost indeed.