Cannabis Use Disorder among Insured Pregnant Women in the U.S.

Rates of cannabis use during pregnancy are rising as more states legalize the drug, according to an analysis of commercial claims data by researchers at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. The findings are published in the American Journal of Preventive Medicine.

Medical guidelines recommend that pregnant people 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 examined cannabis use disorder (CUD) rates between 2015 and 2020 among 893,430 pregnant women and 1,058,448 total pregnancies. The cumulative prevalence of CUD diagnosis was 0.26 percent, and yearly prevalence ranged from 0.22 (2015) to 0.27 (2018 and 2019). Previous research has observed that past-month self-reported cannabis use has more than tripled among pregnant women in the U.S. from 2002-2020, rising from 1.5 percent to 5.4 percent over 18 years of tracking data.

The researchers investigated CUD diagnoses during pregnancy using data from the MerativeTM 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.

“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 D.C., in 2020 (the 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 met the 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 (grants DA053745, DA031099, DA057389, DA061635, DA045224).

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.