For example, smoked cannabis and use of concentrates among adolescents have been associated with a higher risk of continued use relative to other modes , and smoked cannabis may carry the greatest risks due to exposure to carbon monoxide and other harmful by-products of combustion . Yet, little is known about the prevalence or correlates of different modes of cannabis administration during or before pregnancy. Previous research indicates that smoking is the most common mode of cannabis administration during pregnancy, followed by use of edibles and vaping . However, data on mode of cannabis administration in the preconception period is limited and studies have not described sociodemographic characteristics associated with specific modes of cannabis administration. Further, the prevalence of some modes may have changed in recent years due to the perception of health risk and the availability of new cannabis products. To address this knowledge gap, our study examined correlates of different modes of preconception cannabis use among pregnant patients in Northern California who self-reported preconception cannabis use in 2020 and 2021, during which time cannabis grow tray was legal for recreational and medical use.
We focused on racial/ethnic differences and associations with neighborhood deprivation, to examine use patterns among potentially under-served populations. Younger patients were more likely to smoke , smoke blunts, use dabs/wax, and they had a greater number of administration modes, while older patients were more likely to report using edibles/ oral and lotion/topicals . Smoking was most common among Hispanic and Black patients and least common among Asian patients, while smoking blunts was most common among Black patients and least common among non-Hispanic White patients. Edibles/oral were most common among Asian patients and least common among Hispanic and Black patients. Use of lotion/topicals was least common among Black and Asian patients. Finally, Hispanic patients were the most likely and Black patients were the least likely to report more than one mode of administration. Examination and surveillance of cannabis use practices and modes of administration before pregnancy is an essential aspect of prevention. Using data from a large healthcare delivery system with routine preconception cannabis use screening, we found substantial variation in preconception use and co-use of different cannabis administration modes among patients who self-reported use.
While smoking was the most commonly endorsed mode, more than half of individuals with preconception cannabis use reported using edibles, more than a quarter reported vaping, 12% reported using high potency concentrates , and 10% reported using lotions/topicals. The prevalence of different modes of cannabis in our sample was similar to findings on modes of past-year cannabis administration in a nationally representative US sample of adult women with a slightly lower prevalence of smoking and higher prevalence of edible use in the current study. The proliferation of cannabis administration options in the context of recreational legalization may entail evolving yet rarely studied risks to individuals who are pregnant or contemplating pregnancy . In our sample of patients who reported preconception cannabis use in Northern California where cannabis is legal for medical and recreational use, vertical grow system more than a quarter reported using daily and use of more than one mode was common. Notably, daily cannabis users were more likely to report each mode of administration and had a greater number of modes of administration than less frequent users, with the exception that daily users were less likely to use edibles.
Based on studies in other populations, edibles are perceived to be less harmful than other modalities and they may be the modality of choice for those who use cannabis on specific occasions and for reasons of discreetness . However, additional research is needed to better understand the higher prevalence of edibles among individuals who use cannabis less frequently. The high prevalence of blunt smoking among individuals with preconception cannabis use warrants special attention as tobacco is known to adversely affect maternal and fetal health . Co-use of cannabis and tobacco is associated with greater risk for cannabis use disorders and ongoing long-term cannabis use . National data indicate that rates of blunt smoking are increasing over time among reproductive-aged women, and continued surveillance of blunt use in this population is important . In addition, in clinical settings these individuals could potentially be targeted for additional assistance in quitting cannabis use during pregnancy.