Abstract
BACKGROUND AND OBJECTIVE: Medical cannabis (MC) use has increased among pregnant women, yet little is known about the quantity, product types, and timing of use. This study conducted a population-level analysis of MC purchasing patterns among pregnant women in Arkansas. STUDY DESIGN: This descriptive exploratory analysis examined MC purchasing among pregnant women in Arkansas from May 11, 2019 to August 31, 2022, following MC availability. Data from three statewide data sources, the MC Card Registry (patient and qualifying condition data), MC Dispensary Database (transactions and product details), and Birth Certificate Records (maternal demographics and obstetric diagnoses), were linked with the national Social Determinants of Health Database, which provided neighborhood-level socioeconomic indicators. Descriptive statistics summarized maternal and purchasing characteristics and identified factors associated with the amount of purchased delta-9-tetrahydrocannabinol (THC), cannabis main psychoactive ingredient. RESULTS: Of the 72,992 pregnancies, 1185 (1.62%) included MC purchases during pregnancy. Among these, 774 (65.3%) were continuers, defined as those with MC purchases within 90 days prior to pregnancy that continued during pregnancy, and 411 (34.7%) initiated MC beginning during pregnancy. An additional 94 pregnancies purchased MC in the 90 days prior to pregnancy but discontinued by pregnancy onset. Compared to nonpurchasers, MC purchasers were more likely to be ≥30 years old (adjusted odds ratio (aOR)=1.34; P<.0001) and tobacco smokers (aOR=1.64; P<.0001) and less likely to be non-Hispanic Black (aOR=0.44; P<.0001), married (aOR=0.68; P<.0001), and privately insured (aOR=0.69; P=.0001). The mean (SD) daily THC purchased was 137.36 (170.04) mg/d. Continuers purchased 1.54 (95% CI, 1.32-1.78) times more daily THC during pregnancy than initiators and 3.84 (95% CI, 2.66-5.55) times more prepregnancy THC than discontinuers. The adjusted mean ratio (AMR) of daily THC was 1.82 (P<.0001) times higher among continuers compared to initiators, and lower for women <20 years (AMR=0.52; P=.0021), privately insured (AMR=0.81; P=.0093), receiving prenatal care (AMR=0.72; P=.0420), residing in micropolitan (AMR=0.71; P=.0070) or small-town areas (AMR=0.67; P=.0095), or residing in neighborhoods with higher household food-stamp receipt (AMR=0.78; P=.0424). CONCLUSIONS: The mean daily THC purchased during pregnancy exceeded therapeutic dosing ranges established for FDA-approved cannabinoid formulations in nonpregnant adults and was particularly high among women initiating MC purchase prepregnancy. These findings highlight the need to understand the risks of maternal MC exposure and the drivers to high-dose use, to better guide counseling and reduce harm, particularly from high-dose THC.