Constantino-Pettit Anna, Tillman Rebecca, Wilson Jillian, Lashley-Simms Nicole, Vatan Naazanene, Atkinson Azaria, Leverett Shelby D, Lenze Shannon, Smyser Christopher D, Bogdan Ryan, Rogers Cynthia, Agrawal Arpana
Department of Psychiatry, Washington University in St Louis, School of Medicine, St Louis, Missouri.
Washington University in St Louis School of Medicine, St Louis, Missouri.
JAMA Netw Open. 2024 Dec 2;7(12):e2451597. doi: 10.1001/jamanetworkopen.2024.51597.
Cannabis use among pregnant individuals has increased. Depression and stress are frequently reported motives for cannabis use that may prolong using cannabis during pregnancy.
To examine associations between changes in depression, stress, and self-reported prenatal cannabis use (PCU), to examine motives for PCU, and to examine whether trajectories of depression and stress vary across individuals who report using cannabis to cope with mental health symptoms and/or stress, those who use cannabis for other reasons, and those who do not report PCU.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study recruited pregnant individuals at an obstetric clinic at an academic hospital between July 2019 and January 2024 and followed them during pregnancy. Pregnant individuals with a history of lifetime cannabis use were included. Individuals reporting heavy episodic alcohol use or with other illicit drug use were excluded.
Self-reported PCU.
The primary outcomes were self-reported depression (Edinburgh Postnatal Depression Scale), stress (Cohen Perceived Stress Scale), and cannabis use at each trimester during pregnancy, as well as motives for cannabis use during the first trimester (T1). Stability and changes in depression and stress scores and categorical self-reported prenatal cannabis use from T1 to the third trimester (T3) were estimated using individual linear growth curve models.
In this sample of 504 patients (all identified as women; median [IQR] age, 26 [18-40] years), 236 individuals (46.8%) reported PCU after pregnancy knowledge. Depression, stress, and PCU decreased from T1 to T3 (all slope estimates less than -0.29; SEs, 0.23-0.7; all P < .001). There were positive associations between depression and PCU at T1 (r = 0.17; P = .004) and in their rate of change (r = 0.18; P = .01). Only T1 stress and PCU were correlated (r = 0.14; P = .004). Participants reporting PCU for mental health reasons (137 participants [58.1%]) had the highest depression scores at each trimester; however, their rate of change in depression was statistically equivalent to those who did not use cannabis.
In this cohort study of PCU, participants who used cannabis did not experience a more significant decline in stress or depression symptoms compared with those who did not use cannabis. Individuals who used cannabis for mental health reasons did not hasten a decrease in their symptoms. Health care professionals are encouraged to enhance prenatal individuals' access to empirically supported treatments for depression and stress.
孕妇群体中使用大麻的情况有所增加。抑郁和压力是经常被提及的使用大麻的动机，这可能会导致孕期持续使用大麻。
研究抑郁、压力变化与自我报告的产前大麻使用（PCU）之间的关联，探究PCU的动机，并研究抑郁和压力轨迹在报告使用大麻来应对心理健康症状和/或压力的人群、因其他原因使用大麻的人群以及未报告PCU的人群中是否存在差异。
设计、设置和参与者：这项队列研究于2019年7月至2024年1月在一家学术医院的产科诊所招募孕妇，并在孕期对她们进行跟踪。纳入有终生大麻使用史的孕妇。排除报告有大量饮酒发作史或使用其他非法药物的个体。
自我报告的PCU。
主要结局包括自我报告的抑郁（爱丁堡产后抑郁量表）、压力（科恩感知压力量表）以及孕期各 trimester 的大麻使用情况，还有孕早期（T1）使用大麻的动机。使用个体线性生长曲线模型估计从T1到孕晚期（T3）抑郁和压力评分的稳定性和变化以及分类的自我报告产前大麻使用情况。
在这个包含504名患者的样本中（均为女性；年龄中位数[四分位间距]为26[18 - 40]岁），236名个体（46.8%）在知晓怀孕后报告了PCU。从T1到T3，抑郁、压力和PCU均有所下降（所有斜率估计值均小于 -0.29；标准误为0.23 - 0.7；所有P < 0.001）。T1时抑郁与PCU之间（r = 0.17；P = 0.004）及其变化率之间（r = 0.18；P = 0.01）存在正相关。仅T1时的压力与PCU相关（r = 0.14；P = 0.004）。因心理健康原因报告PCU的参与者（137名参与者[58.1%]）在各 trimester 的抑郁得分最高；然而，他们抑郁的变化率在统计学上与未使用大麻的人相当。
在这项关于PCU的队列研究中，与未使用大麻的参与者相比，使用大麻的参与者在压力或抑郁症状方面并未出现更显著的下降。因心理健康原因使用大麻的个体并未加速其症状的减轻。鼓励医疗保健专业人员增加产前个体获得经实证支持的抑郁和压力治疗的机会。
