Short communicationMarijuana use during pregnancy: A comparison of trends and correlates among married and unmarried pregnant women
Introduction
Marijuana is the most commonly used illicit drug among pregnant women in the United States (US; McCabe and Arndt, 2012, Metz and Stickrath, 2015). Prior studies report that about 4% of all pregnant women in the United States use marijuana and that the prevalence of marijuana use has increased during the past decade (Brown et al., 2017, Ko et al., 2012). According to Brown and colleagues (2017), past-month marijuana use prevalence among pregnant women increased from 2.4% in 2002–3.8% in 2014. In light of the legalization of medical marijuana use in many states, legalization of recreational use in some states, as well as more relaxed attitudes towards and lower risk perceptions of marijuana use among adolescents and adults, it seems likely that prenatal marijuana use will continue to increase (Fleming et al., 2016, Keyes et al., 2016, McCarthy, 2016, Salas-Wright et al., 2017c).
Though marijuana is known to have potential therapeutic benefits for pain relief and nausea control, its manifold risks are typically considered to be too great for use during pregnancy (Westfall et al., 2006). In particular, prenatal marijuana use has been found to have immediate impacts on birth outcomes, including preterm delivery (Dekker et al., 2012), fetal growth restriction (Janisse et al., 2014), and still birth (Varner et al., 2014), as well as longer-term adverse developmental impacts on children’s cognitive and behavioral development (Day et al., 2006, Goldschmidt et al., 2004).
Research also suggests that the risks of marijuana use during pregnancy are not equally distributed in the general population. In particular, recent studies suggest that unmarried pregnant women, a population that is younger and more likely to experience individual and social risks (i.e., mental disorders and poverty) than their married counterparts, also faces substantially greater risks of substance use (Kiernan and Pickett, 2006, Waldfogel et al., 2010). Given that roughly two in five births in the United States are to non-married women, substance use among this group and its associated health consequences should be deemed key public-health concerns (Hamilton et al., 2014).
Several recent studies provide insight into what may have influenced changes in marijuana use among the population in general and pregnant women in particular (Fleming et al., 2016, Johnston et al., 2014, Lipari et al., 2014, Salas-Wright et al., 2017a). Keyes et al. (2011) and Salas-Wright et al. (2017b) reported ease of access to marijuana as a key risk factor of marijuana use among adolescents and adults in the United States, respectively. Recent evidence also suggests that disapproval and risk perceptions of marijuana affect marijuana use as protective factors among youth and adult populations in the United States (Keyes et al., 2016, Salas-Wright et al., 2015, Salas-Wright et al., 2016, Schuermeyer et al., 2014). For instance, Salas-Wright and colleagues (2015) reported sizable declines in the proportion of young adults reporting disapproval of marijuana use in recent years, which may have contributed to increasing marijuana use among the group. On the other hand, Keyes and colleagues (2016) found that increases in perceived harm of using marijuana among 8th graders in the United States accounted for up to 33% decreases in their use.
Lastly, well-documented associations between marijuana use and mental health risks among the general population offer important insights on the wellbeing of pregnant women. Epidemiological research makes it clear that marijuana use—and other psychoactive drug use—often co-occurs with a variety of adverse behavioral health outcomes such as driving under the influence and criminal activities/delinquency (e.g., drug selling and theft) (Salas-Wright et al., 2017b). Moreover, longitudinal research has helped to clarify the ways in which marijuana use is related to increased risk of anxiety, depression, and other psychiatric disorders (Caspi et al., 2005, Wittchen et al., 2007). Although evidence suggests that alcohol and tobacco use during pregnancy are related to risks for psychiatric morbidity (Kiernan and Pickett, 2006, Leis et al., 2012, Oh et al., 2017), similar studies of marijuana use are lacking. In addition, adverse influences from potential comorbidity between mental disorders and substance use on the persistence and severity of the disorders (e.g., Brooner et al., 1997, Kessler et al., 1996, Rohde et al., 2004) point to the need to examine comorbidity specific to marijuana use with mental health disorders among at-risk pregnant populations.
Section snippets
The present study
Using public use data from the 2005–2014 National Survey of Drug Use and Health (NSDUH), a population-based study conducted annually in the United States, the present study examined trends and mental health correlates of marijuana use among married and unmarried pregnant women. Specifically, we present prevalence estimates for prenatal marijuana use and marijuana-specific risk/protective factors, assess the degree to which changes in the factors are associated with marijuana use, and examine
Data
The NSDUH provides population estimates for substance use and health-related behaviors in the U.S. general population. NSDUH participants include household residents, civilians residing on military bases, and shelter and group home residents. Due to its compatible research design and identical measures used in the 2005 through 2014 surveys, the 2005–2014 data enable researchers to compare substance use and mental health risks across those years (Substance Abuse and Mental Health Services
Trends in prenatal marijuana use and marijuana-specific protective factors
Fig. 1 and Table 1 display the trends for prevalence estimates and tests of trends for marijuana use among married and unmarried pregnant women. Among unmarried-pregnant women, the prevalence of past-month marijuana use increased significantly from 5.4% in 2005–10.0% in 2014 (AOR = 1.08, 95% CI = 1.02-1.15). This trend increase was significant even when controlling for sociodemographic factors (age, gender, race/ethnicity, family income, health insurance, and urbanicity) and pregnancy trimester.
Discussion
The present study suggests that recent increases in prenatal marijuana use are associated with a higher prevalence of marijuana use among unmarried-pregnant women. While past-month marijuana use prevalence among married-pregnant women continues to remain relatively low at approximately 1.5%, prenatal marijuana use among unmarried women has increased steadily to nearly 10% in 2014. Marijuana use rates among unmarried women raise serious public health concerns, especially since nonmarital births
Contributors
No disclosures to be made.
Role of funding source
This research was supported in part by the National Institute on Drug Abuse at the National Institutes of Health (R25 DA030310; PI: James Anthony).
Conflict of interest
No conflict declared.
Acknowledgements
None.
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