Depression During Pregnancy Doubles Risk of Cannabis Use in Colorado Birthing Individuals

Research study background

Recreational cannabis use among individuals of reproductive age has increased in Colorado since legalization in 2012 and retail sales began in 2014, echoing national trends. Despite warnings about the risks of perinatal cannabis use on offspring from the American Academy of Pediatrics and other leading health organizations, there are reports indicating many pregnant individuals perceive legal status implies safety.

Experts at Children’s Hospital Colorado have conducted numerous studies investigating the prevalence of use and impact of legalization on Colorado birthing individuals and their children, including documenting a two-fold increase in cannabis-involved hospitalizations during pregnancy and uncovering that THC can remain in breast milk for six weeks.

While other research has linked increased perinatal substance use with serious mental health conditions, reasons for use and its association with depression during pregnancy in the context of legalization have not been well defined. In this study, neonatal and perinatal experts at Children’s Colorado evaluated predictors of perinatal cannabis use and its independent association with self-reported prenatal depression. The team analyzed a weighted sample of 117,465 Colorado birthing individuals using data from Health eMoms surveys (1.1 and 1.2) collected between 2018 and 2021, as part of a statewide perinatal longitudinal electronic surveillance system.

Among respondents, 13.3% reported using cannabis during the perinatal period, which is higher than previous study findings. Of those who used, the prevalence was lowest during pregnancy (35.5%) but use increased during the post-partum period (87.3% overall).

Survey questions about cannabis consumption allowed participants to select any/all of the options provided as reasons for use. In those who self-reported depressive symptoms and used cannabis while pregnant, 96.4% used for medical purposes (nausea, vomiting or pain relief), 96.4% used for stress and anxiety relief and 16.5% used for recreational reasons. Those who were not depressed were less likely to consume cannabis for medical reasons (87.9%) and stress or anxiety (70.8%) and reported higher rates of recreational use (21.9%) during the perinatal period. Additionally, the study’s multivariate model revealed that the odds of cannabis use were more than twice as high among individuals who reported depression during pregnancy compared to those without depression.

“This study highlights how common cannabis use is during the perinatal period in Colorado, especially during a time when mental health challenges such as depression are also prevalent,” says Stephanie Bourque, MD, contributing study author and neonatologist at Children’s Colorado.

Study data uncovered significant demographic differences in perinatal cannabis users, with higher usage rates reported by those who were younger, who did not complete high school and who were not married. It also identified a critical gap in care. When surveyed about healthcare provider counseling on perinatal cannabis use, 38% of respondents were advised against use, 27% were not asked or counseled about use and 1.1% received recommendations to use cannabis.

Relevance to practice

This research underscores the urgency for healthcare providers to conduct comprehensive mental health and substance use screenings throughout the perinatal period and improve evidence-based patient education and support. This is especially important in states where legalization may influence perceptions of cannabis safety.