Cannabis Use among Pregnant Women with Polysubstance Use and Psychiatric Problems

Despite widespread and increasing use of cannabis during pregnancy in the US, we know little about whether women with psychiatric and non-cannabis substance use disorders (SUDs) are at increased risk for prenatal cannabis use. Further, it is unknown whether co-occurring psychiatric or SUDs impact the likelihood of engaging in substance use treatment among women with prenatal cannabis use. This study will use data from >400,000 pregnancies screened for cannabis use by urine toxicology tests and self-report as part of standard prenatal care in Kaiser Permanente Northern California. Using rich electronic health record data, Investigators aim to test: 1) whether pregnant patients with psychiatric disorders (e.g., PTSD, bipolar disorders, schizophrenia/psychotic disorders, ADHD, and non-cannabis SUDs are at increased risk of prenatal cannabis use, and 2) whether co-occurring psychiatric disorders and SUDs are associated with initiating substance use treatment (either in an integrated care model in obstetrics or in specialty SUD treatment) among women with prenatal cannabis use.  Results will yield important findings about the associations between psychiatric and SUD disorders, prenatal cannabis use and treatment engagement, which will support development and testing of interventions targeting these important patient groups in larger, multi-site studies.