Cannabis use disorder among insured pregnant women in the US between 2015-2020

Cannabis use has been increasing during pregnancy, according to researchers at Columbia University Mailman School of Public Health and the Columbia University Irving Medical Center. Previous research has observed that past-month cannabis use has more than tripled among pregnant women in the U.S. from 2002-2020 with self-reported cannabis use rising from 1.5 percent to 5.4 percent over the 18 years of tracking data. The findings are published in the American Journal of Preventive Medicine.

Medical guidelines recommend that pregnant women abstain from cannabis because of its link to an increased risk of adverse maternal and neonatal outcomes and concerns regarding long-term effects on mental health.

The researchers investigated cannabis use disorder (CUD) diagnoses during pregnancy using data from the Merative^TM Marketscan^® Commercial Claims and Encounters Database of pregnant women from 2015- 2020 aged 12-55 with continuous insurance enrollment. The researchers used the International Classification of Diseases codes to identify CUD diagnoses.

Their findings show between 2015-2020, 893,430 pregnant women were identified, resulting in 1,058,448 total pregnancies. The cumulative prevalence of CUD diagnosis was 0.26%, yearly prevalence ranged from 0.22 (2015) to 0.27 (2018 and 2019).

“While earlier research analyzed data from a specific geographic sample of pregnant women, this study aimed to examine the prevalence of CUD diagnosis during pregnancy among a large sample of commercially insured women determined from commercial administrative claims data during a five-year period,” observed Priscila Gonçalves, PhD, assistant professor in the Department of Psychiatry, Columbia University Irving Medical Center, and first author.

Cannabis for medical use was legal in 34 states and Washington DC in 2020 (last year of data included in the study). Although women could be self-medicating during pregnancy through the anti-nausea properties of cannabis, it is also possible that many pregnant women meet criteria for CUD. .

Clinicians who regularly meet with pregnant women are well-positioned to intervene in cannabis use and CUD but might lack the structural support to conduct relevant interventions, according to Goncalves. This is in addition to some women’s fear of legal repercussions related to disclosing substance use that could impede the degree of underestimated CUD diagnoses as well as medically appropriate interventions.

“Our results highlight the need to better understand the determinants of CUD among pregnant women, including factors related to CUD diagnosis – from the severity of CUD -- as well as factors contributing to diagnosis and treatment,” noted Silvia Martins, MD, PhD, professor of Epidemiology at Columbia Mailman School, and senior author of the study. “This study makes it clear that additional research is needed to inform prevention and intervention opportunities.”

Co-authors are Morgan Philbin, University of California San Francisco; Weijia Fan, Megan Marziali, Emilie Bruzelius, Luis Segura, Pia Mauro, Columbia Mailman School of Public Health; and Yongmei Huang, Columbia Mailman School and Columbia University Irving Medical Center.^, 

The study reported in this press release was supported by the National Institute on Drug Abuse of the National Institutes of Health, under grant numbers R01DA053745, T32DA031099, K01DA057389, R36DA061635, and K01DA045224. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors have no financial disclosures to report.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.