Making Decisions about Cannabis Use during Pregnancy: A Qualitative Study

Context: Since the Canadian legalization of recreational cannabis use in 2018, cannabis use has increased, including during pregnancy, although prevalence rates are difficult to determine. The evidence of clinical harm of prenatal cannabis use is still emerging, with some signals that prenatal cannabis use is associated with pre-term birth, small for gestational age, and some neurodevelopmental outcomes in childhood. However, many pregnant people perceive benefit to their cannabis use, and wish to continue using during pregnancy.

Objective: Describe the motivations and decision-making processes of pregnant people who use cannabis.

Study Design and Analysis: We used Constructivist Grounded Theory to conduct semi-structured interviews with pregnant or lactating people who made a decision about prenatal cannabis use.

Setting or Dataset: All participants lived in Canada

Population Studied: Pregnant or lactating people, 19 years of age or older who made a decision about ceasing, continuing, or initiating cannabis use.

Intervention/Instrument: Semi-structured interviews

Outcome Measures: Qualitative perceptions, experiences, opinions and beliefs.

Results: We interviewed 52 pregnant and lactating people who spoke about their cannabis use decisions in their current and previous pregnancies. They perceived that cannabis use during pregnancy may carry risk to their fetus, although few were able to specifically articulate what that risk was. Those who perceived benefit to their cannabis use made deliberate and thoughtful decisions about how to balance that risk and benefit, using information gleaned online and from known sources. Those who continued to use cannabis during pregnancy were motivated by a desire to manage symptoms and secondarily, to cope with the unpleasant aspects of life. After giving birth, they were more likely to endorse recreational reasons for using cannabis.

Conclusions: Participants considered cannabis use during pregnancy and lactation as two separate decisions. They were clear that their motivation to use cannabis was prompted by the benefits they perceived in relation to symptom management and coping with the unpleasant aspects of life. They made careful decisions, informed by the information that was available to them, although they often judged this information to be insufficient. They desire clear and comprehensive, evidence-based information to help them balance the risks and benefits of perinatal cannabis use.