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- Title
Association of Recreational Cannabis Legalization With Maternal Cannabis Use in the Preconception, Prenatal, and Postpartum Periods.
- Authors
Skelton, Kara R.; Hecht, Amelie A.; Benjamin-Neelon, Sara E.
- Abstract
This cross-sectional study examines the association between state legalization of recreational cannabis and prevalence of maternal cannabis use during the preconception, prenatal, and postpartum periods. Key Points: Question: Is there an association between recreational cannabis legalization and prevalence of maternal cannabis use during the preconception, prenatal, and postpartum periods? Findings: In this cross-sectional study of 73 551 women, cannabis use increased significantly among women before pregnancy and after pregnancy but not during pregnancy in states that had legalized recreational cannabis compared with states that had not legalized cannabis. Meaning: These findings suggest the need for interdisciplinary research to better understand how recreational cannabis policies are associated with maternal cannabis use. Importance: Recent studies have revealed increases in population-level cannabis use after legalization of recreational cannabis. However, the association of cannabis legalization with maternal cannabis use during important life stages remains unknown. Objective: To investigate the association of legalization of recreational cannabis with maternal cannabis use during the preconception, prenatal, and postpartum periods. Design, Setting, and Participants: This repeated cross-sectional study used state-level data on women who delivered live-born infants in the US from the Pregnancy Risk Assessment Monitoring System from January 2004 to December 2018. Data from 2 states that had legalized recreational cannabis (Alaska and Maine) and 2 states that had not legalized recreational cannabis (New Hampshire and Vermont) were used. Women completed surveys 2 to 6 months after delivery, reporting preconception, prenatal, and postpartum cannabis use. Exposure: State recreational cannabis legalization. Main Outcomes and Measures: The 3 primary outcomes were self-reported cannabis use during the 12 months before pregnancy (preconception), during pregnancy (prenatal), and the 2 to 6 months after pregnancy (postpartum). A difference-in-differences analysis was used to compare changes in the prevalence of maternal cannabis use during each period before and after state legalization of recreational cannabis, controlling for maternal characteristics (age, race/ethnicity, educational level, income, cigarette smoking, and breastfeeding) and state fixed effects. State-specific survey weights were used. Results: The analytic sample included 23 082 women in the preconception period, 23 859 in the prenatal period, and 26 610 in the postpartum period. In each analysis, most women were married (range among all groups, 63.9%-64.8%), aged 25 to 34 years (preconception, 55.4%; prenatal, 55.9%; postpartum, 56.1%), and had an annual household income less than $50 000 (preconception, 55.7%; prenatal, 56.3%; postpartum, 55.5%). In adjusted analyses, preconception and postpartum cannabis use increased significantly in states that had legalized recreational cannabis compared with states that had not legalized it (preconception risk difference, 0.0457 [95% CI, 0.0013-0.0900]; P =.04; postpartum risk difference, 0.0539 [95% CI, 0.0259-0.0818]; P <.001). The risk difference for prenatal cannabis use was not significant (0.0070; 95% CI, −0.0120 to 0.0260; P =.47). Conclusions and Relevance: In this repeated cross-sectional study, recreational cannabis legalization was associated with changes in maternal cannabis use before and after pregnancy. The findings suggest that future studies should undertake an interdisciplinary approach to maximize benefit and application of findings to future public health, health care, and policy sectors.
- Subjects
CANNABIS (Genus); CONFIDENCE intervals; CROSS-sectional method; SELF-evaluation; DRUG abuse; MOTHERHOOD; PARENTING; RISK assessment; COMPARATIVE studies; PREGNANCY outcomes; SOCIOECONOMIC factors; PUERPERIUM; DESCRIPTIVE statistics; DATA analysis software; ODDS ratio
- Publication
JAMA Network Open, 2021, Vol 4, Issue 2, pe210138
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.0138