Whereas we now have seen reducing charges of alcohol and tobacco use throughout being pregnant over the previous couple of a long time, using cannabis during pregnancy is on the rise. Qualitative research point out that pregnant girls report utilizing hashish to handle a spread of psychological signs, together with insomnia, nervousness, and despair. Research carried out previous to the legalization of medical and leisure marijuana (in some states) have demonstrated that pregnant girls with lively depressive signs and/or nervousness are extra seemingly to make use of substances. A cross-sectional examine from Californaia examines the associations between prenatal hashish use and using prescribed psychotropic medicines amongst pregnant sufferers with despair or nervousness in a big, built-in healthcare system (between 2012 and 2018).
On this examine, knowledge from the Kaiser Permanente Northern California (KPNC) well being care system was used to establish pregnant people with a depressive or nervousness dysfunction outlined by Worldwide Classification of Illnesses codes. Sufferers had been screened for prenatal substance use utilizing a self-reported questionnaire and urine toxicology assessments as a part of routine prenatal care. As well as, any dispensation of antidepressants, benzodiazepines, and/or sedative-hypnotics throughout being pregnant was assessed. Severity of depressive signs was measured utilizing the Affected person Well being Questionnaire (PHQ-9).
This cross-sectional examine examined the associations between prenatal hashish use and using prescribed psychotropic remedy use amongst pregnant people with a analysis of an nervousness dysfunction or despair. The evaluation included 35,047 pregnancies (32,278 people; 17.6% below 25 years of age, 48.1% non-Hispanic White). On this inhabitants, 12.8% of the ladies screened optimistic for hashish use.
After adjusting for affected person age, earnings, race/ethnicity, and despair symptom severity, the researchers discovered that 12.6% of the sufferers who screened optimistic for prenatal hashish use had been extra prone to display optimistic for prenatal benzodiazepine use (adjusted odds ratios [aOR] = 1.40) and for sedative-hypnotic use (aOR = 1.28). Nonetheless, girls had been not extra seemingly to make use of antidepressants (aOR = 1.05). The percentages of prenatal benzodiazepine and sedative-hypnotic use together with prenatal hashish use had been increased amongst pregnancies with extreme despair symptom severity (31.8% of the pattern).
Different Findings of Concern
Whereas this examine focuses totally on the affiliation between hashish use and using prescribed psychotropic medicines, one of the vital regarding findings is that ladies with a analysis of despair and/or nervousness dysfunction (no matter hashish use) had been not extra seemingly to make use of an antidepressants however had been extra seemingly to make use of benzodiazepines and/or sedative-hypnotic medicines. Even after they seemed solely at girls with better despair severity (31.8% of the ladies had a PHQ-9 of 10 or better) , girls had been extra seemingly to make use of benzodiazepines (aOR 1.37) and sedative-hypnotic medicines (aOR 1.45) however not antidepressants.
Given the sort of cross-sectional examine, it isn’t attainable to totally perceive how girls with despair and/or nervousness make choices concerning remedy use throughout being pregnant; nonetheless, the present examine raises some necessary questions.
Whereas screening for perinatal temper and nervousness issues was routinely accomplished throughout being pregnant, did these girls obtain applicable counseling concerning using medicines throughout being pregnant and the dangers related to untreated psychiatric sickness within the mom? Have been they in a position to entry psychological well being companies?
Are girls with despair and/or nervousness selecting to keep away from antidepressants and to make use of as a substitute benzodiazepines and sedative-hypnotics (or hashish) as a result of these medicines can be utilized as wanted as a substitute of every day?
If charges of hashish use is increased amongst depressed girls, does this point out that ladies might consider that hashish is safer than antidepressants? Is it simpler to get hashish than antidepressants? Does hashish trigger or worsen despair on this inhabitants? Is hashish use a symptom of despair (akin to poor self-care)?
Future research are essential to raised perceive the decision-making course of; nonetheless, this examine raises many considerations. On this subset of ladies with despair and/or nervousness, notably these with extra extreme signs, what we now have is a considerable proportion of pregnancies with a number of exposures which have been related to worse outcomes for each the mom and her baby. A few third of this inhabitants reported extreme depressive signs (Publicity #1). This group of ladies had been extra seemingly to make use of psychotropic medicines — benzodiazepines and/or sedative-hypnotics — that didn’t end in decision of depressive signs or nervousness (Publicity #2), though it’s attainable that these medicines had some impression on the severity of signs. Girls with extreme depressive signs had been extra seemingly to make use of hashish (Publicity #3). And eventually, despair throughout being pregnant is a sturdy predictor of postpartum despair (Publicity #4).
Ruta Nonacs, MD PhD
Hirschtritt ME, Avalos LA, Sarovar V, Ridout KK, Goler NC, Ansley DR, Satre DD, Younger-Wolff KC. Association Between Prenatal Cannabis Use and Psychotropic Medication Use in Pregnant Patients With Depression and Anxiety. J Addict Med. 2022 Jan 11.
