New Kaiser Permanente study adds evidence to body of research suggesting pregnant women are using marijuana to self-medicate morning sickness.
By Brett Israel, Senior Communications Consultant
A Kaiser Permanente study has found that women with mild and severe nausea and vomiting in pregnancy were significantly more likely to have used marijuana during pregnancy than women without these symptoms.
Recent studies have shown that the prevalence of marijuana use among pregnant women is increasing, but little is known about what has contributed to these increases. One hypothesis is that pregnant women use marijuana to treat symptoms of morning sickness, but few studies have examined the association between nausea and vomiting in pregnancy and prenatal marijuana use.
The new study of more than 220,000 pregnancies in Northern California found that pregnant women with severe nausea and vomiting in pregnancy had nearly 4 times greater odds of prenatal marijuana use, and those with mild nausea and vomiting in pregnancy had more than 2 times greater odds of prenatal marijuana use than women without nausea and vomiting in pregnancy.
“This is the largest study to date of nausea and vomiting in pregnancy and prenatal marijuana use,” said the study’s lead author, Kelly Young-Wolff, PhD, MPH, a research scientist at Kaiser Permanente Northern California’s Division of Research. “Our findings add important evidence to a small but growing body of research suggesting that some pregnant women may use marijuana to self-medicate morning sickness.”
The study was published August 20 as a Research Letter in the online edition of the journal JAMA Internal Medicine, a peer-reviewed medical journal published monthly by the American Medical Association. Young-Wolff also published a viewpoint in the journal Annals of Internal Medicine on August 20 about the need for data on the potential adverse effects of marijuana use in pregnancy.
The women in the study were members of Kaiser Permanente Northern California who completed a self-reported substance use questionnaire and urine toxicology test in the first trimester. Nausea and vomiting in pregnancy in these members was identified based on diagnostic medical codes in the electronic health record during the first trimester.
The prevalence of prenatal marijuana use among the 220,510 women who received the screening in the first trimester was 5.3 percent, which is consistent with national statistics.
Severe nausea and vomiting in pregnancy occurred in 2.3 percent of the pregnant women, and 11.3 percent of them used marijuana during pregnancy. Mild nausea and vomiting in pregnancy occurred in 15.3 percent of the group, and 8.4 percent of them used marijuana during pregnancy. Marijuana use by women with no nausea and vomiting in pregnancy was 4.5 percent.
Compared to women without these symptoms, those with severe nausea and vomiting in pregnancy were nearly 4 times more likely to use marijuana, and women with mild nausea and vomiting in pregnancy were a little more than twice as likely to use marijuana.
The results are consistent with the hypothesis that women use marijuana to self-medicate for nausea and vomiting in pregnancy, but the study cannot rule out other possible explanations, such as whether marijuana use contributes to nausea and vomiting in pregnancy, or whether clinicians diagnose nausea and vomiting in pregnancy more frequently among women who report using marijuana to treat it. The study included women from Kaiser Permanente Northern California who were screened for marijuana use in the first trimester of pregnancy, and the results may not generalize nationally or to women without health care or to those who enter prenatal care late.
National guidelines recommend that pregnant women discontinue marijuana use due to concerns about the potential for impaired fetal neurodevelopment, low birth weight and exposure to the adverse effects of marijuana smoke, but additional research on the health effects of prenatal marijuana exposure are needed. The guidelines recommend that patients with nausea and vomiting in pregnancy should be screened for marijuana use and educated about effective and safe treatments for nausea and vomiting in pregnancy.
“We hope that our study can help alert clinicians to the fact that women with nausea and vomiting in pregnancy are more likely to use marijuana,” said the study’s senior author, Nancy Goler, MD, a Kaiser Permanente Northern California OB/GYN and Associate Executive Director for The Permanente Medical Group. “Pregnant women need to be screened and given the information about the possible negative effects while also receiving medically recommended treatment options.”
Future work from this research team will examine how the women used marijuana (smoking, eating, etc.), whether trends in prenatal marijuana use change with legalization for recreational use, and the health effects of prenatal marijuana exposure.
The National Institute on Drug Abuse and the National Institute of Mental Health, both part of the National Institutes of Health, funded the research.
Other co-authors of the JAMA Internal Medicine study include Amy Conway, MPH, of Kaiser Permanente Northern California’s Early Start Program, and Varada Sarovar, PhD, Lue-Yen Tucker, BA, Lyndsay Avalos, PhD, and Mary Anne Armstrong, MA, all from Kaiser Permanente Northern California’s Division of Research. Goler and Conway were also co-authors on the Annals of Internal Medicine viewpoint.