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      Association of Recreational Cannabis Legalization With Maternal Cannabis Use in the Preconception, Prenatal, and Postpartum Periods

      research-article
      , PhD 1 , 2 , , , PhD 3 , , PhD, JD 1
      JAMA Network Open
      American Medical Association

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          Abstract

          This cross-sectional study examines the association between state legalization of recreational cannabis and prevalence of maternal cannabis use during the preconception, prenatal, and postpartum periods.

          Key Points

          Question

          Is there an association between recreational cannabis legalization and prevalence of maternal cannabis use during the preconception, prenatal, and postpartum periods?

          Findings

          In this cross-sectional study of 73 551 women, cannabis use increased significantly among women before pregnancy and after pregnancy but not during pregnancy in states that had legalized recreational cannabis compared with states that had not legalized cannabis.

          Meaning

          These findings suggest the need for interdisciplinary research to better understand how recreational cannabis policies are associated with maternal cannabis use.

          Abstract

          Importance

          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.

          Objective

          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.

          Exposure

          State recreational cannabis legalization.

          Main Outcomes and Measures

          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.

          Results

          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).

          Conclusions and Relevance

          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.

          Related collections

          Most cited references55

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          Adverse Health Effects of Marijuana Use

          New England Journal of Medicine, 370(23), 2219-2227
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            • Record: found
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            Methods for evaluating changes in health care policy: the difference-in-differences approach.

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              • Article: not found

              Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States.

              Marijuana is the most widely used illicit drug in the United States and all over the world. Reports indicate that the potency of cannabis preparation has been increasing. This report examines the concentration of cannabinoids in illicit cannabis products seized by the U.S. Drug Enforcement Administration over the last 2 decades, with particular emphasis on Δ(9)-tetrahydrocannabinol and cannabidiol.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                25 February 2021
                February 2021
                25 February 2021
                : 4
                : 2
                : e210138
                Affiliations
                [1 ]Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
                [2 ]Department of Health Sciences, Towson University College of Health Professions, Towson, Maryland
                [3 ]Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
                Author notes
                Article Information
                Accepted for Publication: January 5, 2021.
                Published: February 25, 2021. doi:10.1001/jamanetworkopen.2021.0138
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Skelton KR et al. JAMA Network Open.
                Corresponding Author: Kara R. Skelton, PhD, Department of Health Sciences, Towson University College of Health Professions, 251 Towson Way, Towson, MD 21204 ( kskelton@ 123456towson.edu ).
                Author Contributions: Drs Skelton and Hecht had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
                Concept and design: All authors.
                Acquisition, analysis, or interpretation of data: All authors.
                Drafting of the manuscript: Skelton.
                Critical revision of the manuscript for important intellectual content: All authors.
                Statistical analysis: Skelton, Hecht.
                Administrative, technical, or material support: Skelton, Benjamin-Neelon.
                Supervision: Benjamin-Neelon.
                Conflict of Interest Disclosures: None reported.
                Additional Contributions: We thank the Pregnancy Risk Assessment Monitoring System (PRAMS) study participants; members of the PRAMS Team, Women’s Health and Fertility Branch, Division of Reproductive Health; and the following members of the PRAMS working group: Alabama: Tammie Yelldell, MPH; Alaska: Kathy Perham-Hester, MS, MPH; Arizona: Enid Quintana-Torres, MPH; Arkansas: Letitia de Graft-Johnson, DrPH, MHSA; Colorado: Ashley Juhl, MSPH; Connecticut: Jennifer Morin, MPH; Delaware: George Yocher, MS; Florida: Tara Hylton, MPH; Georgia: Florence A. Kanu, PhD, MPH; Hawaii: Matt Shim, PhD, MPH; Illinois: Julie Doetsch, MA; Indiana: Brittany Reynolds, MPH; Iowa: Jennifer Pham; Kentucky: Tracey D. Jewell, MPH; Louisiana: Rosaria Trichilo, MPH; Maine: Tom Patenaude, MPH; Maryland: Laurie Kettinger, MS; Massachusetts: Hafsatou Diop, MD, MPH; Michigan: Peterson Haak; Minnesota: Mira Grice Sheff, PhD, MS; Mississippi: Brenda Hughes, MPPA; Missouri: Venkata Garikapaty, PhD; Montana: Emily Healy, MS; Nebraska: Jessica Seberger; New Hampshire: David J. Laflamme, PhD, MPH; New Jersey: Sharon Smith Cooley, MPH; New Mexico: Sarah Schrock, MPH; New York State: Anne Radigan; New York City: Lauren Birnie, MPH; North Carolina: Kathleen Jones-Vessey, MS; North Dakota: Grace Njau, MPH; Oklahoma: Ayesha Lampkins, MPH, CHES; Oregon: Cate Wilcox, MPH; Pennsylvania: Sara Thuma, MPH; Puerto Rico: Wanda Hernandez, MPH; Rhode Island: Karine Tolentino Monteiro, MPH; South Carolina: Harley T. Davis, PhD, MPSH; South Dakota: Maggie Minett; Texas: Tanya Guthrie, PhD; Tennessee: Ransom Wyse, MPH, CPH; Utah: Nicole Stone, MPH; Vermont: Peggy Brozicevic; Virginia: Kenesha Smith, PhD, MSPH; Washington: Linda Lohdefinck; West Virginia: Melissa Baker, MA; Wisconsin: Fiona Weeks, MSPH; Wyoming: Lorie Chesnut, PhD.: Gary Stuart, MEd; Brian Morrow, MA; and Leslie Harrison, MPH. Gary Stuart, MEd, was the primary point of contact throughout this study at PRAMS, and Brian Morrow, MA, prepared the final dataset from the US Centers for Disease Control and Prevention. All received funding or were employed by the US Centers for Disease Control and Prevention.
                Article
                zoi210010
                10.1001/jamanetworkopen.2021.0138
                7907954
                33630088
                cfa493d3-93c9-4d63-927b-cc695922633e
                Copyright 2021 Skelton KR et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 4 November 2020
                : 5 January 2021
                Categories
                Research
                Original Investigation
                Online Only
                Substance Use and Addiction

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