Whereas now we have seen reducing charges of alcohol and tobacco use throughout being pregnant over the previous couple of many years, using hashish throughout being pregnant is on the rise. Qualitative research point out that pregnant girls report utilizing hashish to handle a variety 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 energetic depressive signs and/or nervousness are extra probably to make use of substances. A cross-sectional research from Californaia examines the associations between prenatal hashish use and using prescribed psychotropic drugs amongst pregnant sufferers with despair or nervousness in a big, built-in healthcare system (between 2012 and 2018).
On this research, knowledge from the Kaiser Permanente Northern California (KPNC) well being care system was used to determine pregnant people with a depressive or nervousness dysfunction outlined by Worldwide Classification of Illnesses codes. Sufferers have been screened for prenatal substance use utilizing a self-reported questionnaire and urine toxicology exams 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 research examined the associations between prenatal hashish use and using prescribed psychotropic treatment use amongst pregnant people with a prognosis of an nervousness dysfunction or despair. The evaluation included 35,047 pregnancies (32,278 people; 17.6% underneath 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 have been extra prone to display screen optimistic for prenatal benzodiazepine use (adjusted odds ratios [aOR] = 1.40) and for sedative-hypnotic use (aOR = 1.28). Nonetheless, girls have been not extra probably to make use of antidepressants (aOR = 1.05). The percentages of prenatal benzodiazepine and sedative-hypnotic use together with prenatal hashish use have been increased amongst pregnancies with extreme despair symptom severity (31.8% of the pattern).
Different Findings of Concern
Whereas this research focuses totally on the affiliation between hashish use and using prescribed psychotropic drugs, one of the crucial regarding findings is that ladies with a prognosis of despair and/or nervousness dysfunction (no matter hashish use) have been not extra probably to make use of an antidepressants however have been extra probably to make use of benzodiazepines and/or sedative-hypnotic drugs. Even after they appeared solely at girls with higher despair severity (31.8% of the ladies had a PHQ-9 of 10 or higher) , girls have been extra probably to make use of benzodiazepines (aOR 1.37) and sedative-hypnotic drugs (aOR 1.45) however not antidepressants.
Given the sort of cross-sectional research, it’s not attainable to totally perceive how girls with despair and/or nervousness make selections relating to treatment use throughout being pregnant; nonetheless, the present research raises some vital questions.
Whereas screening for perinatal temper and nervousness problems was routinely accomplished throughout being pregnant, did these girls obtain acceptable counseling relating to using drugs 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 providers?
Are girls with despair and/or nervousness selecting to keep away from antidepressants and to make use of as an alternative benzodiazepines and sedative-hypnotics (or hashish) as a result of these drugs can be utilized as wanted as an alternative of each day?
If charges of hashish use is increased amongst depressed girls, does this point out that ladies could imagine 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 mandatory to raised perceive the decision-making course of; nonetheless, this research raises many issues. On this subset of ladies with despair and/or nervousness, significantly these with extra extreme signs, what now we 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 youngster. A few third of this inhabitants reported extreme depressive signs (Publicity #1). This group of ladies have been extra probably to make use of psychotropic drugs — benzodiazepines and/or sedative-hypnotics — that didn’t lead to decision of depressive signs or nervousness (Publicity #2), though it’s attainable that these drugs had some affect on the severity of signs. Girls with extreme depressive signs have been extra probably to make use of hashish (Publicity #3). And at last, despair throughout being pregnant is a strong 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.