Intentions to Use Cannabis Postpartum: A Qualitative Study of Pregnant Individuals Who Used Cannabis During Early Pregnancy
Publication: Journal of Women's Health
Volume 33, Issue Number 4
Abstract
Objective: To examine plans for postpartum cannabis use among pregnant individuals who used cannabis during early pregnancy.
Materials and Methods: Eighteen virtual focus groups were conducted from November 17, 2021, to December 17, 2021, with 23 Black and 30 White pregnant adults in Kaiser Permanente Northern California, who self-reported prenatal cannabis use during early pregnancy. Focus groups were recorded, transcribed, and analyzed using thematic analysis.
Results: The sample (N = 53) had a mean age of 30.3 years (standard deviation = 5.2) at recruitment; 70% reported daily, 25% weekly, and 6% ≤ monthly cannabis use at entrance to prenatal care. Some participants viewed cannabis as critical for coping with postpartum mental and physical health challenges, while others questioned whether cannabis use would fit with their parental lifestyle, and some planned to abstain altogether. Most planned to use cannabis postpartum, but with lower frequency than before pregnancy, and in ways consistent with harm reduction (e.g., smoking outside to avoid secondhand or thirdhand smoke exposure). Many were motivated to abstain from cannabis while breastfeeding, and some desired more data on the safety of cannabis and breastfeeding, or intended to “pump and dump,” believing it would reduce potential transfer of Δ9-tetrahydrocannabinol (THC) to their infant. Responses from Black and White participants were generally similar, but White participants were more likely to report plans to use cannabis while breastfeeding and to want information about cannabis and breastfeeding.
Conclusions: Pregnant individuals with prenatal cannabis use had varied plans for cannabis use postpartum. Many were motivated to abstain or use cannabis less frequently than pre-pregnancy, especially during lactation.
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Disclaimer
The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the article; or decision to submit the article for publication.
References
1. Volkow ND, Han B, Compton WM, et al. Self-reported medical and nonmedical cannabis use among pregnant women in the United States. JAMA 2019;322(2):167–169;
2. Young-Wolff KC, Sarovar V, Tucker LY, et al. Self-reported daily, weekly, and monthly cannabis use among women before and during pregnancy. JAMA Netw Open 2019;2(7):e196471;
3. Metz TD, Allshouse AA, Hogue CJ, et al. Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. Am J Obstet Gynecol 2017;217(4):478 e1–e478 e8;
4. Committee on Obstetric Practice. Committee Opinion No. 722: Marijuana use during pregnancy and lactation. Obstet Gynecol 2017;130(4):e205–e209;
5. National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids. The Current State of Evidence and Recommendations for Research [Internet]. National Academies Press: Washington, DC; 2017.
6. Paul SE, Hatoum AS, Fine JD, et al. Associations between prenatal cannabis exposure and childhood outcomes: Results from the ABCD Study. JAMA Psychiatry 2021;78(1):64–76;
7. Ryan SA, Ammerman SD, O'Connor ME, et al. Marijuana use during pregnancy and breastfeeding: Implications for neonatal and childhood outcomes. Pediatrics 2018;142(3):e20181889;
8. Sharapova SR, Phillips E, Sirocco K, et al. Effects of prenatal marijuana exposure on neuropsychological outcomes in children aged 1–11years: A systematic review. Paediatr Perinat Epidemiol 2018;32(6):512–532;
9. Chang JC, Tarr JA, Holland CL, et al. Beliefs and attitudes regarding prenatal marijuana use: perspectives of pregnant women who report use. Drug Alcohol Depend 2019;196:14–20;
10. Skelton KR, Hecht AA, Benjamin-Neelon SE. Women's cannabis use before, during, and after pregnancy in New Hampshire. Prev Med Rep 2020;20:101262;
11. Crawford KA, Gardner JA, Meyer EA, et al. Current marijuana use and alcohol consumption among adults following the legalization of nonmedical retail marijuana sales - Colorado, 2015–2019. MMWR Morb Mortal Wkly Rep 2021;70(43):1505–1508;
12. Ko JY, Farr SL, Tong VT, et al. Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age. Am J Obstet Gynecol 2015;213(2):201 e1–e201 e10;
13. Singh S, Filion KB, Abenhaim HA, et al. Prevalence and outcomes of prenatal recreational cannabis use in high-income countries: A scoping review. BJOG 2020;127(1):8–16;
14. Astley SJ, Little RE. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol 1990;12(2):161–168;
15. Crume TL, Juhl AL, Brooks-Russell A, et al. Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: The association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. J Pediatr 2018;197:90–96;
16. Moss MJ, Bushlin I, Kazmierczak S, et al. Cannabis use and measurement of cannabinoids in plasma and breast milk of breastfeeding mothers. Pediatr Res 2021;90(4):861–868;
17. Ordean A, Kim G. Cannabis use during lactation: Literature review and clinical recommendations. J Obstet Gynaecol Can 2020;42(10):1248–1253;
18. Colorado Department of Public Health & Environment. Marijuana: Health Care Provider Resources; 2019. Available from: https://cdphe.colorado.gov/marijuana-health-care-provider-resources#:~:text=An%20evidence-based%20clinical%20resource%20document%20for%20health%20care,training%20available%20www.CO.Train.org%20and%20select%20course%20ID%3A%201065030 [Last accessed: June 1, 2023].
19. Weisbeck SJ, Bright KS, Ginn CS, et al. Perceptions about cannabis use during pregnancy: A rapid best-framework qualitative synthesis. Can J Public Health 2021;112(1):49–59;
20. Ayisire OE, Okobi OE, Adaralegbe NJ, et al. The use of cannabis and its effects on postpartum depression. Cureus 2022;14(8):e27926;
21. Vanstone M, Taneja S, Popoola A, et al. Reasons for cannabis use during pregnancy and lactation: a qualitative study. CMAJ 2021;193(50):E1906–E1914;
22. Davis E, Lee T, Weber JT, et al. Cannabis use in pregnancy and breastfeeding: The pharmacist's role. Can Pharm J (Ott) 2020;153(2):95–100;
23. Baker T, Datta P, Rewers-Felkins K, et al. Transfer of inhaled cannabis into human breast milk. Obstet Gynecol 2018;131(5):783–788;
24. Bertrand KA, Hanan NJ, Honerkamp-Smith G, et al. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics 2018;142(3):e20181076;
25. Marchei E, Escuder D, Pallas CR, et al. Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal 2011;55(2):309–316;
26. Perez-Reyes M, Wall ME. Presence of delta9-tetrahydrocannabinol in human milk. N Engl J Med 1982;307(13):819–820;
27. Hale TW, Rowe HE. Medications & Mothers' Milk. Springer: New York; 2017.
28. Metz TD, Borgelt LM. Marijuana use in pregnancy and while breastfeeding. Obstet Gynecol 2018;132(5):1198–1210;
29. Josan C, Shiplo S, Fusch G, et al. Cannabis use during lactation may alter the composition of human breast milk. Pediatr Res 2023;93(7):1958–1965;
30. Gordon NP. Similarity of adult Kaiser Permanente members to the adult population in Kaiser Permanente's Northern California Service Area: Comparisons based on the 2017/2018 cycle of the California Health Interview Survey. Report prepared for the Kaiser Permanente Division of Research: Oakland, CA; 2020.
31. Young-Wolff KC, Sarovar V, Tucker LY, et al. Trends in cannabis polysubstance use during early pregnancy among patients in a large healthcare system in Northern California. JAMA Netw Open 2022;5(6):e2215418;
32. Leask J, Hawe P, Chapman S. Focus group composition: A comparison between natural and constructed groups. Aust N Z J Public Health 2001;25(2):152–154;
33. Greenwood N, Ellmers T, Holley J. The influence of ethnic group composition on focus group discussions. BMC Med Res Methodol 2014;14:107;
34. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77–101.
35. Nowell LS, Norris JM, White DE, et al. Thematic analysis: Striving to meet the trustworthiness criteria. Int J Qual Methods 2017;16(1):1609406917733847;
36. Hennink MM, Kaiser BN, Marconi VC. Code saturation versus meaning saturation: How many interviews are enough? Qual Health Res 2017;27(4):591–608;
37. Vasileiou K, Barnett J, Thorpe S, et al. Characterising and justifying sample size sufficiency in interview-based studies: Systematic analysis of qualitative health research over a 15-year period. BMC Med Res Methodol 2018;18(1):148;
38. Young-Wolff KC, Foti TR, Green A, et al. Perceptions about cannabis following legalization among pregnant individuals with prenatal cannabis use in California. JAMA Netw Open 2022;5(12):e2246912;
39. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19(6):349–357;
40. Young-Wolff KC, Foti TR, Green A, et al. Pregnant women's lived experience of cannabis use during the COVID-19 pandemic: A qualitative study. Front Psychiatry 2023;14:1161137;
41. Barbosa-Leiker C, Burduli E, Smith CL, et al. Daily cannabis use during pregnancy and postpartum in a state with legalized recreational cannabis. J Addict Med 2020;14(6):467–474;
42. Kiel L, Hsu C, Wartko PD, et al. Perspectives from women who engaged in prenatal and postpartum cannabis use in a U.S. State with legal non-medical use. Prev Med Rep 2023;31:102075;
43. Panday J, Taneja S, Popoola A, et al. Clinician responses to cannabis use during pregnancy and lactation: A systematic review and integrative mixed-methods research synthesis. Fam Pract 2022;39(3):504–514;
44. Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers 2007;4(8):1770–1804;
45. Badowski S, Smith G. Cannabis use during pregnancy and postpartum. Can Fam Physician 2020;66(2):98–103.
46. Tennes K, Avitable N, Blackard C, et al. Marijuana: Prenatal and postnatal exposure in the human. NIDA Res Monogr 1985;59(48–60
47. U. S. Department of Justice, Office of Justice Programs. Quarterly Report Potency Monitoring Project, Report 104, December 16, 2008 thru March 15, 2009; 2009.
48. Meek JY, Noble L, Section on Breastfeeding. Policy statement: Breastfeeding and the use of human milk. Pediatrics 2022;150(1):e2022057988;
49. Coy KC, Haight SC, Anstey E, et al. Postpartum marijuana use, perceptions of safety, and breastfeeding initiation and duration: An analysis of PRAMS data from seven states, 2017. J Hum Lact 2021;37(4):803–812;
50. Safon CB, Heeren TC, Kerr SM, et al. Disparities in breastfeeding among U.S. Black mothers: Identification of mechanisms. Breastfeed Med 2021;16(2):140–149;
51. Nidey N, Hoyt-Austin A, Chen MJ, et al. Racial inequities in breastfeeding counseling among pregnant people who use cannabis. Obstet Gynecol 2022;140(5):878–881;
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Copyright 2024, Mary Ann Liebert, Inc., publishers.
History
Published online: 23 April 2024
Published in print: April 2024
Published ahead of print: 24 February 2024
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No competing financial interests exist.
Funding Information
This study was supported by an NIH NIDA K01 Award (Grant No. DA043604; K.C.Y.-W.), a Kaiser Permanente Northern California Division of Research Health Equity Supplement (K.C.Y.-W), and The Permanente Medical Group (TPMG) Delivery Science Fellowship Program (T.F.). The funding sources were not involved in data collection, analysis, interpretation, writing, or decision to submit the article for publication.
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