University of California, San Francisco, Dept. of Obstetrics, Gynecology, & Reproductive Sciences, 1330 Broadway, Suite 1100, Oakland, CA 94612, United States(1).
Drug Alcohol Depend. 2021 Oct 1;227:108998. doi: 10.1016/j.drugalcdep.2021.108998. Epub 2021 Aug 28.
As cannabis legalization spreads, so do concerns about potential harms from use during pregnancy. Legalization may facilitate improved patient-provider interactions about cannabis use. Yet little is known about pregnant people's discussions of cannabis use with healthcare providers in an environment where recreational cannabis is legal.
In May-August 2019, we conducted semi-structured in-depth interviews with 33 pregnant or postpartum people in California who used cannabis during pregnancy, and explored their discussions with healthcare providers about their cannabis use. We audio-recorded and transcribed interviews, and conducted thematic analysis using inductive and deductive methods.
Participants were diverse by age, race/ethnicity, and socio-economic position. Most reported daily cannabis use, both before and during pregnancy. Most participants did not disclose their cannabis use to their prenatal care providers, due to fears of being reported to child protective services (CPS), or fears of provider judgment. Participants reported that few providers initiated any discussions about cannabis use in pregnancy with them; some participants interpreted this omission as tacit endorsement of cannabis use in pregnancy. When participants and providers did discuss cannabis use in pregnancy, participants heard a wide range of sometimes-conflicting health messages, as well as some legal threats.
This study documents notable deficits in patient-provider interactions about cannabis. Pregnant patients' fears of being reported to CPS and separated from their children for cannabis use persist despite cannabis legalization. Providers' role as potential reporters to CPS appears to pose a significant barrier to comprehensive, compassionate counseling and education on cannabis use in pregnancy.
随着大麻合法化的普及，人们对怀孕期间使用大麻可能带来的危害的担忧也随之增加。合法化可能会促进医患之间就大麻使用问题进行更好的互动。然而，在娱乐用大麻合法化的环境下，人们对孕妇与医疗保健提供者讨论大麻使用的情况知之甚少。
2019 年 5 月至 8 月，我们对加利福尼亚州的 33 名在怀孕期间使用大麻的孕妇或产后妇女进行了半结构化深入访谈，探讨了她们与医疗保健提供者就大麻使用问题进行的讨论。我们对访谈进行了录音和文字记录，并采用归纳法和演绎法进行主题分析。
参与者在年龄、种族/民族和社会经济地位方面存在多样性。大多数人报告说在怀孕前和怀孕期间每天都使用大麻。由于担心被儿童保护服务机构（CPS）报告，或担心提供者的判断，大多数参与者没有向他们的产前保健提供者透露他们的大麻使用情况。参与者报告说，很少有提供者主动与他们讨论怀孕期间的大麻使用问题；一些参与者将这种遗漏解释为对怀孕期间使用大麻的默许。当参与者和提供者确实讨论了怀孕期间的大麻使用问题时，参与者听到了各种有时相互矛盾的健康信息，以及一些法律威胁。
本研究记录了关于大麻使用问题的医患互动方面明显的不足。尽管大麻合法化，但孕妇担心因大麻使用而被 CPS 报告并与子女分离的情况仍然存在。提供者作为潜在的 CPS 报告人，这似乎对全面、同情地咨询和教育孕妇在怀孕期间使用大麻构成了重大障碍。
