Cannabis Use During Pregnancy: Risks Greater Than Imagined, Experts Warn

Cannabis use during pregnancy has been on the rise in the United States, raising concerns among experts due to the health risks to both mother and baby. A study analyzed data from more than one million pregnancies between 2015 and 2020 and found that diagnoses of cannabis use disorder (CUD) during pregnancy are still rare, but may be underreported. The researchers highlight the need for more studies and better support for pregnant women who use the substance.

Cannabis use during pregnancy has been on the rise in the United States, raising concerns among public health experts and physicians. This increase is not limited to occasional use of the substance, but also to the development of Cannabis Use Disorder (CUD), a condition characterized by problematic and compulsive use of the substance, even in the face of negative health consequences.

According to researchers at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center, the number of pregnant women who reported using cannabis in the past month more than tripled between 2002 and 2020.

In 2002, about 1.5% of pregnant women reported using the substance, while in 2020 that rate increased to 5.4%. The results of this research were published in the American Journal of Preventive Medicine and warn of the need for more effective diagnostic, support, and intervention policies.

Current medical guidelines recommend that pregnant women avoid using cannabis, as several studies have shown that the substance may be associated with increased risks for both mother and baby.

Potential negative effects include complications during pregnancy, premature birth, and impacts on the child’s neurological development, which may affect their long-term mental health.

To better understand the impact of cannabis use disorder during pregnancy, researchers analyzed data from the Merative MarketScan Commercial Claims and Encounters Database, a medical claims database that contains information on millions of patients in the United States.

The study focused on pregnant women between the ages of 12 and 55 who had continuous health insurance coverage between 2015 and 2020. To identify which of these women had been diagnosed with cannabis use disorder, researchers used codes from the International Classification of Diseases (ICD), a standardized system used by health professionals to classify diseases and medical conditions.

Among the more than 893,000 records of pregnant women analyzed, 1,058,448 pregnancies were identified. Among these pregnancies, the prevalence of Cannabis Use Disorder diagnosis was relatively low: 0.26% overall, with small annual variations. For example, in 2015, 0.22% of pregnant women received the diagnosis, while in 2018 and 2019 this rate rose to 0.27%.

This study stands out for analyzing a large sample of pregnant women with commercial health insurance in different parts of the country. While previous research has generally focused on smaller or geographically limited populations, this new survey used administrative data collected over five years, ensuring a broader view of the reality of cannabis use among pregnant women.

It is worth noting that, in 2020, the medicinal use of cannabis was already permitted in 34 US states and Washington D.C. This may have led some women to use the substance as a form of self-medication to treat symptoms such as nausea and vomiting during pregnancy.

However, the researchers warn that many of these women may meet the criteria for a diagnosis of Cannabis Use Disorder, which requires more medical attention.

Identification and treatment of problematic cannabis use among pregnant women still face significant obstacles. Healthcare professionals who care for pregnant women are in a unique position to detect and intervene in these cases.

However, many clinicians report that they do not have adequate support to make accurate diagnoses and offer effective treatments. In addition, there is an important social factor: some women may avoid reporting cannabis use for fear of legal repercussions or prosecution, which leads to an underestimation of diagnoses.

In addition, the researchers advocate that more studies be conducted to develop effective prevention and intervention strategies. This includes adopting clearer guidelines for screening for cannabis use during prenatal care, expanding psychological support for pregnant women, and raising awareness about the risks of cannabis use during pregnancy.

In summary, this study highlights the urgent need to improve the diagnosis and treatment of problematic cannabis use during pregnancy, ensuring that pregnant women receive appropriate guidance and support to protect their health and that of their babies.

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Cannabis use disorder among insured pregnant women in the U.S., 2015-2020 Priscila Dib Goncalves, Morgan M. Philbin, Weijia Fan, Yongmei Huang, Megan E. Marziali, Emilie Bruzelius, Luis E. Segura, Pia M. Mauro and Silvia S. Martins

American Journal of Preventive Medicine. 2025 Feb 28:S0749-3797(25)00068-6.

DOI: 10.1016/j.amepre.2025.02.011

Abstract:

Cannabis use among pregnant women is a public health issue. Self-reported past-month cannabis use without concurrent alcohol use more than tripled (1.5% to 5.4%) from 2002-2020 among pregnant women in the US.1 Medical guidelines recommend that pregnant women abstain from cannabis, given its associations with an increased risk of adverse maternal and neonatal outcomes2, and concerns regarding long-term effects on mental health.3