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.