Cannabis-only
There were 12 studies that examined perspectives on cannabis use in pregnancy in isolation from any other substances 8, 20, 52-61. These studies were conducted in the US, Canada, and Jamaica, in jurisdictions where recreational cannabis was legal or decriminalized8, 20, 53, 54, 60 as well as jurisdictions where it was illegal 55-59.
Across these 12 papers, participants considered how to modulate their cannabis use to maximize benefit and minimize risk. Participants discussed changing the form of cannabis they used 20, 55, 56, the amount 20, 54, 56, or using cannabis at particular stages of pregnancy 8, 60 to attain the perceived benefits while minimizing perceived risk.
Perceptions of the risks of cannabis were broad. Participants were consistently concerned about the risk of potential harms to their baby, both from the consumption of cannabis but also from the cessation or replacement of cannabis with a substance they deemed to be more harmful8, 20, 53, 54, 56, 59, 60. It is relevant here that many participants evaluated cannabis to carry less risk than over-the-counter or prescribed pharmaceuticals 20, 54, 55, 59. Participants also noted involvement with criminal justice or child welfare services as a risk of using cannabis 8, 20, 53-55, 59-61.
This group of studies was unique in its description of the perceived benefits of cannabis use in pregnancy. These benefits included managing conditions that pre-existed pregnancy including anxiety, depression, bipolar disorder, substance use disorders, PTSD, insomnia, anemia, chronic pain, Helicobacter pylori, osteoarthritis, fibromyalgia20, 54, 61, or improving general health and mental, physical, and spiritual well-being 56, 61. Benefits also included managing conditions related to pregnancy, including nausea and vomiting, weight gain, sleep, pain related to the physical toll of pregnancy or labour, stress related to pregnancy and parenting8, 20, 54-56, 60, 61.
Participant decisions about whether, when, and how to consume cannabis were also influenced by their pre-pregnancy habits or reasons for use including improving mood, providing pleasure, managing stress, and making difficult circumstances more tolerable 20, 54-56. The financial implications of cannabis use were mentioned as influencing both decisions to use and cease using 8, 57. Support or disapproval from friends, family, and healthcare professionals could also be influential 8, 57.
The sources, types, and evaluation of information was a common topic in this group of papers. Pregnant people sought information from healthcare providers 53, 55, the internet 20, 55, 59, 61, and friends and family 55, 59, as well as cannabis retailers 20, 53. Reconciling diverse and conflicting information was necessary, and participants described contradictions between what they heard from healthcare providers, read about online, and experienced personally or heard anecdotally from others 20, 59. Participants in several studies expressed disappointment at the lack of clarity regarding the safety of using cannabis in pregnancy, describing the available information as confusing, inconsistent, and incomplete 20, 54, 55, 57, 59.