Medical Marijuana Use and Clinical Characteristics of Users among Pregnant Women in Florida

Wen Wen, MS
University of Florida

Co-authors: Nicole E. Smolinski¹, Arthur N. Rosales¹, Yanning Wang¹, Almut G. Winterstein^1
1University of Florida

Background: With increasing legalization, use of cannabis is growing. We aimed to describe the utilization pattern of medical marijuana (MMJ) during pregnancy and clinical characteristics of users.

Methods: Using the Medical Marijuana Research Repository (MEMORY 2017-2024), we identified pregnant women with ≥1 MMJ dispensing during pregnancy, livebirth deliveries, and enrollment in Florida Medicaid from 90 days before to 30 days after pregnancy. We described the timing of MMJ dispensing and QMCs on the MMJ certification. From Medicaid claims, we extracted clinical characteristics and prescription medication dispensings. Pregnancies were grouped by new users (i.e., first MMJ certification during pregnancy) and prevalent users (i.e., first certification before pregnancy). Prevalent users were split into continuers (i.e., MMJ dispensings in second or third trimester) and discontinuers (i.e., no dispensings in second or third trimester). Using no MMJ-exposed pregnancies as reference, we compared clinical characteristics and medication dispensings of new MMJ users in the month before certification, whereas for prevalent users we focused on clinical characteristics and medications in the second trimester.

Results: Among 248,829 livebirth pregnancies in Florida Medicaid, 3,955 pregnancies (1.6%) had MMJ dispensings during pregnancy. About one quarter (22.2%) initiated MMJ during pregnancy. Among prevalent users, most continued use throughout (67.2%). The most common QMCs were post-traumatic stress disorder or similar, chronic nonmalignant pain, and multiple sclerosis or similar. Compared to pregnancies without MMJ use, prevalent users had higher prevalence of medical encounters indicating substance use disorders (12.9% among continuers and 9.0% among discontinuers vs. 2.1% in non-users), anxiety (9.3% and 7.0% vs. 2%), depression (5.1% and 5.2% vs. 1.7%), and cannabis-related disorders (6.3% and 3.2% vs. <0.01%). Among MMJ continuers, 15.8% used antiemetics compared to 13.4% in discontinuers, and 8.3% in non-users. Conversely, prenatal vitamins were used by 16.2% of non-users and 9.6% of continuers and 10.3% of discontinuers. Among first trimester new users, the most common comorbidities were anxiety (8.7% vs. 1.7% in non-users), depression (6.5% vs. 1.3%), and tobacco-related disorders (4.9% vs. 2.6%).  The most common medications were antidepressants (12.2%) compared to 2.6% among non-users, antiemetics (5.3% vs. 4.2%), and anxiolytics (5.3% vs. 0.8%).

Conclusion: While most prenatal MMJ exposure originated from continuation of pre-pregnancy use into the first trimester, about one quarter of exposed pregnancies were new initiations. Women with prenatal MMJ use had more substance use and mental health disorders, pointing to the need for further research to investigate the complex clinical scenarios that may explain use.