Department of Communication, University of Massachusetts, Amherst, Massachusetts.
Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan.
J Midwifery Womens Health. 2021 Jan;66(1):96-100. doi: 10.1111/jmwh.13205. Epub 2021 Feb 3.
Cannabis is the most commonly used drug during pregnancy in the United States and Canada, and the American College of Obstetricians and Gynecologists recommends that all pregnant individuals be screened for cannabis use and counseled regarding potential adverse health impacts of use. However, those considering or using cannabis during pregnancy report experiencing stigma and lack of information from health care providers and, thus, frequently rely on friends, family, and the internet for information. This article describes 3 types of decisions individuals may be making about cannabis use during pregnancy and suggests approaches health care providers may take to minimize judgment and provide optimal support for informed cannabis use decisions among pregnant individuals. Desistance decisions involve consideration of whether and how to reduce or stop using during pregnancy. Self-treatment decisions are made by those exploring cannabis to help alleviate troublesome symptoms such as nausea or anxiety. Substitution decisions entail weighing whether to use cannabis instead of another substance with greater perceived harms. Health care providers should be able to recognize the various types of cannabis use decisions that are being made in pregnancy and be ready to have a supportive conversation to provide current and evidence-based information to individuals making desistance, self-treatment, and substitution decisions. Individuals making desistance decisions may require support with potential adverse consequences such as withdrawal or return of symptoms for which cannabis was being used, as well as potentially navigating social situations during which cannabis use is expected. Those making self-treatment decisions should be helped to fully explore treatment options for their symptoms, including evidence on risks and benefits. Regarding substitution decisions, health care providers should endeavor to help pregnant individuals understand the available evidence regarding risks and benefits of available options and be open to revisiting the topic over time.
大麻是美国和加拿大孕期最常使用的药物，美国妇产科医师学会建议对所有孕妇进行大麻使用筛查，并对使用大麻的潜在健康影响进行咨询。然而，那些考虑或在孕期使用大麻的人报告说，他们会受到污名化，且缺乏来自医疗保健提供者的信息，因此，他们经常依赖朋友、家人和互联网获取信息。本文描述了个人在孕期可能做出的 3 种关于大麻使用的决策，并提出了医疗保健提供者可以采取的方法，以尽量减少评判，并为孕妇做出知情的大麻使用决策提供最佳支持。戒除决策涉及到考虑是否以及如何减少或停止孕期使用大麻。自我治疗决策是由那些探索大麻以帮助缓解恶心或焦虑等麻烦症状的人做出的。替代决策涉及权衡是否使用大麻代替其他危害更大的物质。医疗保健提供者应该能够识别在孕期做出的各种类型的大麻使用决策，并准备好进行支持性对话，为正在做出戒除、自我治疗和替代决策的个人提供最新的、基于证据的信息。正在做出戒除决策的个人可能需要支持，以应对可能的不良后果，如戒断或因使用大麻而出现的症状复发，以及可能需要在社交场合应对大麻使用的问题。正在做出自我治疗决策的个人应该帮助他们充分探索治疗症状的选择，包括关于风险和益处的证据。对于替代决策，医疗保健提供者应努力帮助孕妇了解可用选项的风险和益处的现有证据，并愿意随着时间的推移重新讨论这个话题。
