Columbia Researchers Warn of Underestimated Cannabis Risks in Pregnancy

Cannabis use and cannabis use disorder during pregnancy are increasing in the U.S., prompting concern among researchers and highlighting the need for better diagnosis, support, and intervention.

Cannabis use during pregnancy has been on the rise, according to researchers from the Columbia University Mailman School of Public Health and the Columbia University Irving Medical Center. Data from previous studies show that self-reported past-month cannabis use among pregnant women in the U.S. more than tripled between 2002 and 2020, increasing from 1.5% to 5.4%. These findings are published in the American Journal of Preventive Medicine.

Medical guidelines advise against cannabis use during pregnancy due to its association with increased risks of negative maternal and neonatal outcomes, as well as potential long-term mental health effects on the child.

In their recent study, the researchers examined rates of cannabis use disorder (CUD) diagnoses during pregnancy using data from the Merative MarketScan Commercial Claims and Encounters Database. The study focused on pregnant individuals aged 12 to 55 who had continuous health insurance coverage between 2015 and 2020. CUD diagnoses were identified using International Classification of Diseases (ICD) codes.

Their findings show between 2015-2020, 893,430 pregnant women were identified, resulting in 1,058,448 total pregnancies. The cumulative prevalence of CUD diagnosis was 0.26%, yearly prevalence ranged from 0.22 (2015) to 0.27 (2018 and 2019).

Scope and Significance of the Findings

“While earlier research analyzed data from a specific geographic sample of pregnant women, this study aimed to examine the prevalence of CUD diagnosis during pregnancy among a large sample of commercially insured women determined from commercial administrative claims data during a five-year period,” observed Priscila Gonçalves, PhD, assistant professor in the Department of Psychiatry, Columbia University Irving Medical Center, and first author.

Cannabis for medical use was legal in 34 states and Washington DC in 2020 (last year of data included in the study). Although women could be self-medicating during pregnancy through the anti-nausea properties of cannabis, it is also possible that many pregnant women meet criteria for CUD.

Clinicians who regularly meet with pregnant women are well-positioned to intervene in cannabis use and CUD but might lack the structural support to conduct relevant interventions, according to Goncalves. This is in addition to some women’s fear of legal repercussions related to disclosing substance use that could impede the degree of underestimated CUD diagnoses as well as medically appropriate interventions.

Call for Further Research and Action

“Our results highlight the need to better understand the determinants of CUD among pregnant women, including factors related to CUD diagnosis – from the severity of CUD — as well as factors contributing to diagnosis and treatment,” noted Silvia Martins, MD, PhD, professor of Epidemiology at Columbia Mailman School, and senior author of the study. “This study makes it clear that additional research is needed to inform prevention and intervention opportunities.”

Reference: “Cannabis use disorder among insured pregnant women in the U.S., 2015-2020.” by Priscila Dib Goncalves, Morgan M. Philbin, Weijia Fan, Yongmei Huang, Megan E. Marziali, Emilie Bruzelius, Luis E. Segura, Pia M. Mauro and Silvia S. Martins, 28 February 2025, American Journal of Preventive Medicine.

The study reported in this press release was supported by the National Institute on Drug Abuse of the National Institutes of Health, under grant numbers R01DA053745, T32DA031099, K01DA057389, R36DA061635, and K01DA045224. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.