Perception of Risks of Cannabis and Cannabidiol Use during Pregnancy: A Multi-Methods Study

The American College of Obstetrics and Gynecology advises against cannabis and cannabidiol (CBD) product use during pregnancy; despite this, recent studies suggest cannabis and CBD use is increasing during pregnancy. The objective of this study is to assess risk perceptions of cannabis and CBD use during pregnancy among pregnant and non-pregnant patients.

The study design is multi-method; a cross-sectional survey assessing use behaviors and risk perceptions is supplemented with qualitative focus group discussions (FGDs). Recruitment for surveys was from outpatient obstetrics clinics and recruitment for FGDs was from the same clinics and a substance-use treatment clinic, from October 2022 to February 2023. The survey instrument was developed via combining question items from validated instruments that assess cannabis and CBD use and risk perceptions. Comparisons of response frequency distributions for pregnant versus non-pregnant participants were calculated with chi-square analysis for individual risk perception question items. Data from the FGDs were coded and analyzed via a deductive content analysis approach.

There were 261 survey respondents and 5 FGDs (n = 17). Of the surveys, 198 (75.9%) were currently pregnant, 55 (21.1%) were not pregnant, and 8 (3.1%) did not disclose pregnancy status. Approximately 5.0% (n = 13) reported currently breastfeeding. For the question, "How risky is it to use marijuana [cannabis] once or twice a week during pregnancy?", pregnant versus non-pregnant participants responded most frequently with "great risk" (29.2% vs. 27.3%) and "not sure" (40.0% vs. 34.5%), where p = 0.88 (not significant) between pregnant vs. non-pregnant response distribution. For the question, "How risky is it to use CBD once or twice a week during pregnancy?" pregnant vs. non-pregnant participants responded most frequently with: "great risk" (22.1% vs. 20.0%), and "not sure" (52.3% vs. 41.8%), where p = 0.12 (not significant). Ever use of cannabis and CBD differed in pregnant versus non-pregnant patients (cannabis 36.0% pregnant vs. 65.5% non-pregnant; CBD 19.9% pregnant vs. 38.2% non-pregnant). Qualitative findings indicated that participants perceived that legalization of marijuana has resulted in reduction of stigma against users, but participants expressed mixed feelings toward the perception of marijuana safety due to legalization, though several participants described perceived benefits of marijuana use more generally.

Findings indicate uncertainty of risk related to cannabis and CBD use during pregnancy regardless of current pregnancy or lactation status, despite prevalent ever use of cannabis and CBD in those who were pregnant. This suggests an urgent need for clearer risk communication about cannabis and CBD use in pregnancy.