Medical Cannabis Use among US Women of Reproductive Age

Panagiota (Yiota) Kitsantas, PhD
George Mason University

Co-authors: Panagiota Kitsantas¹, Lea Sacca², Jabed Al Faysal³, Xingquan Zhu², Peter J. Holland², Maria C. Mejia², Md Mahmudul Hasan³, Charles H. Hennekens^2
1George Mason University, ²Florida Atlantic University, ³University of Florida

Objectives: In the United States, medical cannabis (MC) use among pregnant and non-pregnant women of reproductive age (WRA) is increasing. In this study, we described qualifying medical conditions, prescribed daily tetrahydrocannabinol (THC) dosages over time, and medical cannabis product types as well as routes of administration among WRA, with comparisons between pregnant and non-pregnant women.

Methods: We utilized medical cannabis certification data from the Florida Medical Marijuana Use Registry (2021-2024) among WRA (18-45 years old, n=615,219 certifications). Certification characteristics were explored overall and stratified by pregnancy status. Qualifying medical conditions, the number of conditions listed per certification, prescribed daily THC dosages during the first three months, and months 3–7 following certification initiation, and recommended product types and routes of administration were described. Differences between pregnant and non-pregnant women were evaluated using appropriate statistical tests.

Results: The distribution of qualifying medical conditions was largely similar between pregnant and non-pregnant women. Posttraumatic stress disorder was the most common qualifying condition (47.8%), followed by chronic non-malignant pain (9.8%), and multiple sclerosis (7.6%). Most certifications included either one (39.6%) or two (52.2%) qualifying conditions, with no significant differences by pregnancy status. Prescribed THC dosages increased over time, with higher-dose certifications becoming more common during months 3–7 than during the first three months after certification. A greater proportion of certifications involving pregnant women reported at least 31 mg of THC per day at both time periods compared with certifications involving non-pregnant women. For example, among certifications involving pregnant women, 23.5% reported 31–45 mg of THC per day at both <3 months and 3–7 months, compared with 16.5% and 18.7%, respectively, among certifications involving non-pregnant women. Product types were distributed relatively evenly across standard non-smokable, low-THC and smokable MC. Pregnant women more frequently received certifications for low-THC products and less frequently for smokable MC. Recommendations for oral, topical, sublingual, edible, non-smokable inhalation, and suppository routes were slightly more common among pregnant women, whereas smoking was recommended less frequently.

Conclusions: Medical cannabis certification patterns among WRA were generally similar between pregnant and non-pregnant women. However, pregnant women were more likely to receive higher prescribed THC dosages while being less likely to receive smokable MC. These findings provide important descriptive evidence on MC certification practices in WRA, and particularly during pregnancy, and highlight the need for further research to evaluate the clinical rationale, safety, and maternal and fetal health implications of these prescribing patterns.