Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Health Sciences, Towson University College of Health Professions, Towson, Maryland.
JAMA Netw Open. 2021 Feb 1;4(2):e210138. doi: 10.1001/jamanetworkopen.2021.0138.
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.
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.
State recreational cannabis legalization.
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.
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).
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.
最近的研究表明，在娱乐用大麻合法化后，人群水平的大麻使用有所增加。然而，大麻合法化与孕妇在重要生命阶段使用大麻之间的关联仍不清楚。
调查娱乐用大麻合法化与孕妇在受孕前、孕期和产后使用大麻之间的关联。
设计、设置和参与者：本重复横断面研究使用了美国妊娠风险评估监测系统从 2004 年 1 月至 2018 年 12 月期间的活产婴儿的州级数据。使用了 2 个已经使娱乐用大麻合法化的州（阿拉斯加和缅因州）和 2 个尚未使娱乐用大麻合法化的州（新罕布什尔州和佛蒙特州）的数据。妇女在分娩后 2 至 6 个月完成调查，报告受孕前、孕期和产后的大麻使用情况。
州娱乐用大麻合法化。
3 个主要结局是自我报告的受孕前 12 个月（受孕前）、孕期（孕期）和产后 2 至 6 个月（产后）的大麻使用情况。采用差异差异分析比较了在州娱乐用大麻合法化前后每个时期孕妇大麻使用情况的变化，同时控制了产妇特征（年龄、种族/民族、教育水平、收入、吸烟和母乳喂养）和州固定效应。使用了州特定的调查权重。
分析样本包括受孕前 23082 名女性、受孕后 23859 名女性和产后 26610 名女性。在每项分析中，大多数女性已婚（各组中，63.9%-64.8%），年龄在 25 至 34 岁（受孕前，55.4%；孕期，55.9%；产后，56.1%），年收入低于 50000 美元（受孕前，55.7%；孕期，56.3%；产后，55.5%）。在调整后的分析中，与未合法化的州相比，已经合法化娱乐用大麻的州的受孕前和产后大麻使用显著增加（受孕前风险差异，0.0457 [95%CI，0.0013-0.0900]；P=0.04；产后风险差异，0.0539 [95%CI，0.0259-0.0818]；P<0.001）。孕期大麻使用的风险差异无统计学意义（0.0070；95%CI，-0.0120 至 0.0260；P=0.47）。
在这项重复的横断面研究中，娱乐用大麻合法化与怀孕前后孕妇大麻使用的变化有关。研究结果表明，未来的研究应该采用跨学科的方法，以最大限度地提高研究结果对未来公共卫生、医疗保健和政策领域的利益和应用。
