Annals of Internal Medicine LETTERS

OBSERVATION Table. Self-reported Past-Month Prevalence of Marijuana

Use Among Females Aged 12 44 Years in the United
States, by Pregnancy Trimester and Sociodemographic
Characteristics (n = 410 000)*
Marijuana Use During Stages of Pregnancy in the
United States Characteristic Females Aged 1244 Years
Background: Marijuana is the most common illicit drug
Pregnant Nonpregnant
used during pregnancy (1). Because of concerns about poten- (n ! 14 400) (n ! 395 600)
tial deleterious effects on neurodevelopment, the American (95% CI), % (95% CI), %
College of Obstetricians and Gynecologists recommends that Overall annual average 3.82 (3.414.23) 7.54 (7.427.66)
pregnant women discontinue marijuana consumption. De-
spite these recommendations, use increased among pregnant Trimester
and nonpregnant women between 2002 and 2014 (2). Mari- First 6.44 (5.507.53)
Second 3.34 (2.764.05)
juana may have different effects across pregnancy trimesters, Third 1.82 (1.412.34)
and use may be more common among pregnant teenagers.
Objective: To examine the prevalence of past-month mar- Age
ijuana use among U.S. females between 2002 and 2015, by 1217 y 14.02 (11.5116.99) 6.45 (6.296.62)
1825 y 6.21 (5.576.92) 14.11 (13.8514.37)
pregnancy trimester and sociodemographic characteristics,
26 y 1.77 (1.322.38) 5.17 (5.005.35)
across the full range of reproductive ages.
Methods: Data were obtained from females aged 12 to Race/ethnicity
44 years who participated in the 20022015 National Survey Non-Hispanic white 3.82 (3.314.40) 8.44 (8.278.62)
on Drug Use and Health (NSDUH). This survey provides Non-Hispanic black 6.45 (5.138.07) 8.00 (7.668.35)
Non-Hispanic other 1.39 (1.001.94) 5.12 (4.795.46)
nationally representative data among civilian, noninstitutional- Hispanic 2.92 (2.173.92) 5.22 (4.985.47)
ized populations aged 12 years or older (3). Information the
NSDUH collects includes sociodemographic characteristics, Annual family income
past-month marijuana use, and pregnancy status. Respon- <$20 000 6.57 (5.607.70) 10.80 (10.5011.11)
$20 000$49 999 3.90 (3.284.62) 7.76 (7.557.98)
dents who answered within the past 30 days to How long
$50 000$74 999 2.80 (1.954.00) 6.19 (5.916.48)
has it been since you last used marijuana or hashish? were $75 000 1.86 (1.312.63) 5.64 (5.445.85)
considered past-month marijuana users. Respondents who
answered yes to Are you currently pregnant? were asked Health insurance status
How many months pregnant are you? Descriptive analyses Private insurance only 1.82 (1.422.34) 6.49 (6.346.64)
Uninsured 7.87 (5.8510.52) 9.46 (9.139.81)
were conducted using SUDAAN software (Research Triangle Medicaid 5.55 (4.896.30) 9.35 (9.049.66)
Institute) to account for the NSDUH's complex sample design Other insurance 4.65 (2.947.28) 8.08 (7.598.60)
and sampling weights (3).
Findings: Among 14 400 pregnant and 395 600 nonpreg- Census region
Northeast 3.21 (2.534.06) 8.67 (8.388.97)
nant female respondents, self-reported past-month marijuana
Midwest 3.36 (2.794.05) 7.53 (7.307.76)
use was less prevalent among the former (3.82% vs. 7.54%) South 4.33 (3.655.14) 6.35 (6.156.56)
(Table). Prevalence was higher in the first trimester than the West 3.90 (2.985.07) 8.55 (8.258.86)
second and third trimesters (6.44% vs. 3.34% and 1.82%, re-
spectively). Metropolitan statistical area
Large metropolitan 3.34 (2.813.96) 7.76 (7.587.95)
In both pregnant and nonpregnant groups, self-reported Small metropolitan 4.58 (3.885.41) 7.65 (7.447.86)
marijuana use was lower among females aged 26 years or Nonmetropolitan 3.95 (3.174.90) 6.50 (6.236.78)
older than in those aged 12 to 17 years or 18 to 25 years.
* Data were obtained from the 20022015 National Surveys on Drug
Among pregnant females, non-Hispanic black respondents Use and Health. The Substance Abuse and Mental Health Services
had a higher prevalence (6.45%) than other racial/ethnic Administration requires that any description of overall sample size
based on the restricted-use data files be rounded to the nearest 100
groups (1.39% to 3.82%). For each examined sociodemo- to minimize potential disclosure risk. P values from overall between-
graphic category, prevalence of marijuana use was higher group comparisons (pregnant vs. nonpregnant females) for each char-
among nonpregnant females than pregnant ones except for acteristic were <0.001. After a Bonferroni correction was used to ac-
count for the 7 tests, between-group comparisons continued to reach
girls aged 12 to 17 years, in whom the prevalence was 14.02% statistical significance at the 0.05 level.
among pregnant respondents and 6.45% among nonpreg-
nant ones. pregnant ones. This may reflect underlying risky behavior
Discussion: In the United States, marijuana use was par- common to both teen pregnancy and early substance use (5)
ticularly common in the first trimester (6.44%) when fetuses and suggests the importance of intervention for teenagers.
may be most susceptible to damage from drugs (4) but was Because of consistent overlap between use of marijuana and
also prevalent in the second and third trimesters (3.34% and other substances, identification of marijuana use during preg-
1.82%, respectively). For most examined sociodemographic nancy warrants evaluation for comorbid substance abuse
categories, prevalence was higher among nonpregnant fe- (1, 2, 5).
males than pregnant ones. However, it was more than 2-fold This study may underestimate marijuana use during preg-
higher among pregnant girls aged 12 to 17 years than non- nancy because of respondents' lack of awareness of preg-

This article was published at Annals.org on 18 April 2017.

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 LETTERS
nancy status, use during pregnancy but not in the past month,
the NSDUH's exclusion of homeless females not living in shel-
ters and incarcerated females, and recall and social desirabil-
ity biases. Despite these limitations, it suggests that enhanced
prevention against marijuana use and efforts to promote gen-
eral health should target women attempting to conceive or
who are already pregnant, youth, and socioeconomically dis-
advantaged persons. Furthermore, reports suggest that some
pregnant women are using marijuana as an antiemetic, partic-
ularly during the first trimester. Evidence for the effects of
marijuana on human prenatal development is limited; how-
ever, research suggests that concern is warranted (5) and that,
even with the current uncertainty about marijuana's influence
on human neurodevelopment, clinicians should exert caution
by not recommending this drug for pregnant patients (1).
Pregnant females and those considering becoming pregnant
should be advised not to use marijuana or other cannabinoids
recreationally or to treat nausea.
Nora D. Volkow, MD
National Institute on Drug Abuse
Bethesda, Maryland
Beth Han, MD, PhD, MPH
Substance Abuse and Mental Health Services
Administration
Rockville, Maryland
Wilson M. Compton, MD, MPE
Carlos Blanco, MD, PhD
National Institute on Drug Abuse
Bethesda, Maryland
Note: Dr. Han had full access to all of the data in this study and takes
responsibility for the integrity of the data and the accuracy of the data
analysis.
Disclaimer: The findings and conclusions of this study are those of
the authors and do not necessarily reflect the views of the National
Institute on Drug Abuse of the National Institutes of Health, Substance
Abuse and Mental Health Services Administration, or U.S. Department
of Health and Human Services. The sponsors supported the authors,
2 Annals of Internal Medicine
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who were responsible for preparation, review, and approval of the
manuscript and the decision to submit the manuscript for publication.
The sponsors had no role in the design and conduct of the study,
analysis and interpretation of the data, preparation and review of the
manuscript, or decision to submit the manuscript for publication. The
sponsors reviewed and approved the manuscript. Dr. Compton re-
ports ownership of stock in General Electric, 3M, and Pfizer unrelated
to the submitted work; Dr. Blanco reports ownership of stock in Gen-
eral Electric, Sanofi, and Eli Lilly unrelated to the submitted work. Drs.
Volkow and Han have no conflicts to disclose.
Financial Support: The NSDUH was supported by contracts from the
Substance Abuse and Mental Health Services Administration. This
study was jointly sponsored by the National Institute on Drug Abuse of
the National Institutes of Health and the Substance Abuse and Mental
Health Services Administration of the U.S. Department of Health and
Human Services.
Disclosures: Disclosures can be viewed at www.acponline.org
/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0067.
doi:10.7326/L17-0067
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