Diagnoses and symptoms of anxiety, depression, and trauma are associated with cannabis use in pregnant women, study results published in JAMA Network Open suggest.

The study used data from pregnant women who had live births in the large Kaiser Permanente Northern California integrated health care system. All women included in the study completed a self-reported questionnaire that assessed participants’ substance use. In addition, from 2012 to 2017 all women completed a urine toxicology test at approximately 8 weeks’ gestation. Electronic health records provided information about participants’ depressive, anxiety, and trauma diagnoses and symptoms. At the first prenatal visit, women also completed a self-reported questionnaire that assessed depression symptoms and intimate partner violence.

A total of 196,022 pregnancies were studied (mean maternal age, 30.3±5.4 years). The prevalence of depression symptoms of at least moderate severity was 11%. Compared to women who did not use cannabis, women who did were more likely to have an anxiety disorder (4.7% vs 8.3%, respectively), depressive disorder (4.3% vs 10.6%, respectively), anxiety disorder and comorbid depressive disorder (3.1% vs 8.4%, respectively), depression symptoms that were mild (24.5% vs 32.2%, respectively), moderate (7.0% vs 13.3%, respectively), and moderately severe to severe (3.3% vs 8.3%, respectively). In addition, women who used cannabis were more likely to have a trauma diagnosis (8.3% vs 2.0%) and self-reported intimate partner violence (4.4% vs 1.8%).

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In an analysis adjusted for year, median neighborhood annual household income, age, and self-reported race/ethnicity, women who used cannabis were significantly more likely to have anxiety disorders (adjusted odds ratio [aOR], 1.90; 95% CI, 1.76-2.04), depressive disorders (aOR, 2.25; 95% CI, 2.11-2.41), or both (aOR, 2.65; 95% CI, 2.46-2.86). Increased odds of cannabis use were also observed in women with mild (aOR, 1.60; 95% CI, 1.53-1.67), moderate (aOR, 2.09; 95% CI, 1.96-2.23), and moderately severe to severe depression symptoms (aOR, 2.55; 95% CI, 2.35-2.77) relative to women without depression symptoms.

The study was limited by the inclusion of only women from a single large healthcare system in California, as well as the screening of cannabis use at only 8 weeks’ gestation.

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Considering no amount of cannabis use has been shown to be safe during pregnancy, the researchers suggest that “early screening for prenatal depression, anxiety, and trauma, and linkage to appropriate interventions might mitigate the risk of prenatal cannabis use.”


Young-Wolff KC, Sarovar V, Tucker LY, et al. Association of depression, anxiety, and trauma with cannabis use during pregnancy. JAMA Netw Open. 2020;3(2):e1921333.