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Smoking is most common method of cannabis use in pregnancy

Kaiser Permanente researchers find nearly a third of those with prenatal cannabis use it in multiple forms

A new study finds about 71% of people who use cannabis during pregnancy smoke it, and about a third use an edible version. Nearly a third use cannabis in multiple forms.

The study, published in the journal Drug and Alcohol Dependence, is part of a larger body of research meant to better understand pregnant patients’ use of cannabis and any potential health risks associated with it. Current medical advice is to avoid cannabis during pregnancy because of evidence it may increase the risk of medical problems for both the mother and child.

Kelly Young-Wolff, PhD, MPH

“Understanding how patients use cannabis during pregnancy enables clinicians to provide more tailored guidance, helping to support a healthier and safer pregnancy,” said lead author Kelly Young-Wolff, PhD, MPH, a research scientist and clinical psychologist with the Kaiser Permanente Division of Research. “Pregnant individuals who use cannabis tend to prefer methods they perceive as safer, more familiar, accessible, and effective for quick symptom relief. They also express a strong desire for evidence-based information on the relative risks associated with different modes of use.”

The study included 3,454 pregnant individuals who self-reported cannabis use during early pregnancy in 2021 and 2022 on universal screening surveys that are part of standard prenatal care. These patients represented 3.9% of all pregnancies studied. Pregnant individuals were asked to specify their mode of cannabis use, selecting from options such as smoking, edibles, vaping, dabs (heating and inhaling highly concentrated cannabis extracts), or using topicals.

Smoking was most common at 71%, followed by edibles (32.6%), vaping (22.2%), dabbing (9.9%), and topicals (4.6%). Also, 29.9% of the patients reported use of multiple modes.

“The health risks of different modes of cannabis administration may vary,” Young-Wolff explained. Smoking cannabis poses significant risks due to exposure to carbon monoxide and other harmful smoke byproducts. Vaping may have similar but distinct effects. Edible cannabis products carry their own risks; the delayed onset of THC effects can lead users to underestimate the impact and consume more than intended. Dabbing may have the greatest risks, and more than half of those who reported dabbing said they used daily during early pregnancy.

Importantly, the relative risks of different modes of cannabis use during pregnancy remain poorly understood. Young-Wolff emphasized that addressing this critical gap is a priority for their future research on the health impacts of cannabis use for pregnant individuals and their infants.

Sociodemographic factors examined

The researchers also analyzed cannabis use by sociodemographic factors, noting that this information is crucial for identifying potential disparities in health outcomes among specific subgroups. Understanding these patterns can shed light on how prenatal cannabis use may contribute to and exacerbate existing health inequities.

They found smoking was more common among young adults, Black patients, and those living in more deprived neighborhoods. Edible use was less common among these groups. Vaping and dabbing were more common among Hispanic patients and less common among Black individuals.

Qiana Brown, PhD, MPH, LCSW

“To better understand and reduce disparities in prenatal cannabis use and modes of use, researchers, practitioners, and policymakers need to understand people and their environments,” said senior author Qiana L. Brown, PhD, MPH, LCSW, assistant professor at the Rutgers University School of Social Work. “For example, we need to know why pregnant individuals are using cannabis and why they choose specific modes of use. We also need to understand and address environmental factors, like access to cannabis via dispensaries or other means, as well as access to quality health care, both of which are associated with health behaviors.

Brown also noted the role of mandatory reporting laws in several states that require health care providers to report prenatal substance use, including prenatal cannabis use, to child protective service agencies. “Pregnant individuals should feel safe enough to disclose prenatal cannabis use to health care providers without fear of punitive action,” Brown added. “Through this deeper understanding and concerted effort to prioritize treatment over punishment, we can begin to meet pregnant individuals where they are and reduce disparities in prenatal cannabis use and harmful modes of use.”

The study was funded by the National Institute on Drug Abuse.

Additional co-authors were Catherine A. Cortez, MPH, Joshua R. Nugent, PhD, Sara R. Adams, MPH, Natalie E. Slama, MPH, Monique B. Does, MPH, and Cynthia I. Campbell, PhD, of the Division of Research; Deborah Ansley, MD, and Carley Castellanos, LMFT, of Kaiser Permanente Northern California; Alisa A. Padon, PhD, and Aurash J. Soroosh, MSPH, of the Public Health Institute; and Judith J. Prochaska, PhD, MPH, of Stanford University.

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About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.

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