Background- Passage of cannabis laws may impact the rate of use for other substances. The suggested association is of particular concern in pregnant women where exposure to substances can cause harm to both the pregnant woman and fetus. This study adds to the minimal literature on the impact of cannabis legalization on use of other substances during pregnancy and factors associated with cannabis use during the preconception, prenatal, and postpartum periods.
Methods This cross-sectional observational study used combined data from the 2009-2018 Pregnancy Risk Assessment Monitoring System (PRAMS). Difference-in-differences (D-I-D) models and logistic regression were used to compare alcohol and tobacco use among pregnant women living in states categorized by cannabis legalization status: recreational (any recreational or medical), medical (only medical since 2013), and non-legal (no legalization). Logistic regression was used to estimate the impact of state-legalization, adequacy of prenatal care, and other substance use on cannabis use during the preconception, prenatal, and post-partum periods.
Results Alcohol use during the last three months of pregnancy increased significantly in recreational states compared to non-legal states(OR=1.14; 95% CI: 1.03-1.27). Heavy alcohol use before pregnancy decreased across all groups but at a lower rate for states that passed recreational legalization after January 2013. Reductions in smoking during pregnancy occurred at slower rates in states that recently allowed cannabis legalization of any type when compared to states without any cannabis legalization. In the preconception model, residence in a recreationally legal state (OR: 2.37; 95% CI, 2.04-2.75) or medically legal state (OR:3.32; 95% CI, 2.90-3.80) compared to a non-legal state was associated with higher odds of cannabis use. Other covariates associated with higher odds of use were: age 18-19 years compared to 25 to 29 years; identifying as black non-Hispanic or Native American/Alaskan; using tobacco prior to pregnancy and reporting heavy alcohol use prior to pregnancy (Table 4).
In the prenatal model, residence in a recreationally legal state was associated with higher odds of cannabis use (OR: 1.51; 95% CI, 1.29-1.79) whereas residence in a medically legal state was not associated. Tobacco and heavy prenatal alcohol use were again associated with cannabis use.
Discussion Both medical and recreational cannabis legalization are associated with the use of alcohol and tobacco by pregnant women. Renewed clinical and policy efforts may be warranted to update prenatal substance use prevention programs, educational campaigns, and provider education as cannabis legalization evolves. Further surveillance may be required for alcohol use behaviors among pregnant women in cannabis legal states over time and as more states pass recreational legalization.
|Advisor:||Bell, Janice F.|
|Commitee:||Drake, Christiana, Adams, Susan L.|
|School:||University of California, Davis|
|School Location:||United States -- California|
|Source:||DAI-B 82/2(E), Dissertation Abstracts International|
|Subjects:||Public health, Health sciences, Obstetrics|
|Keywords:||Alcohol, Cannabis, Cannabis Legalization, Health Policy, Tobacco, Women's Health|
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