Health Problems Mediate the Effects of Adverse Childhood Experiences on the Frequency of Cannabis Use in a Sample of Pregnant and Breastfeeding Women

Abstract

Many health organizations recommend that mothers avoid cannabis during pregnancy and breastfeeding because they are concerned about exposing infants to Δ-9-tetrahydrocannabinol (THC), the psychoactive substance in cannabis. Yet, data collected by the U.S. Centers for Disease Control demonstrate that a small percentage of mothers continue to use cannabis despite warnings. The frequency of cannabis use is an important variable because frequent use increases THC exposure. The present study examined two variables related to the frequency of cannabis use during pregnancy and breastfeeding: health problems and adverse childhood experiences (ACEs). We examined a possible mediation effect of health problems on the relationship between ACEs and the frequency of cannabis use during pregnancy and breastfeeding. Our sample was entirely comprised of 1,343 women who used cannabis during pregnancy and breastfeeding. We collected data online. The women were recruited from a Facebook group that supports pregnant and breastfeeding mothers who use cannabis. To be included, participants needed to be at least 18 years old and to have used cannabis while pregnant or breastfeeding. The sample was 79% White, 8% Hispanic, and 14% Black, and 1,199 currently resided in the United States, 76 in Canada, 11 in the United Kingdom, and the rest resided in 13 other countries. Ninety-three percent of the sample reported at least one ACE, and 59% reported 4 or more. Ninety-six percent reported that they were using cannabis to treat a health problem, and the number of health problems ranged from 0 to 8. Two mediation analyses found that the total number of ACEs increased the risk of health problems, which increased the frequency of cannabis use. ACE total was not significantly related to the frequency of use once health problems were accounted for. ACEs are related to the frequency of cannabis use in pregnant and breastfeeding women, but indirectly through trauma’s impact on health problems. These findings suggest that practitioners might be able to lower the frequency of cannabis if they directly address health problems.

Keywords

adverse childhood experiences health problems pregnancy breastfeeding cannabis

Get full access to this article

View all access options for this article.

References

Baker

Datta

Rewers-Felkins

Thompson

Kallem

RR.

Hale

T. W.

(2018). Transfer of Inhaled Cannabis Into Human Breast Milk. Obstetrics and Gynecology, 131(5), 783–788.

Bellis

M. A.

Hughes

Cresswell

Ford

(2023). Comparing relationships between single types of adverse childhood experiences and health-related outcomes: A combined primary data study of eight cross-sectional surveys in England and Wales. BMJ Open, 13(4), e072916. https://doi.org/10.1136/bmjopen-2023-072916

Bertrand

K. A.

Hanan

N. J.

Honerkamp-Smith

Best

B. M.

Chambers

C. D.

(2018). Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics, 142(3), e20181076.

Bussieres

Hancock

M. J.

Elklit

Ferreira

M. L.

Ferreira

P. H.

Stone

L. S.

Wideman

T. H.

Boruff

J. T.

Al Zoubi

Chaudhry

Tolentino

Hartvigsen

(2023). Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: A systematic review and meta-analysis. European Journal of Psychotraumatology, 14(2), 2284025. https://doi.org/10.10080/20008066.2023.2284025

Buysse

D. J.

Reynolds

C. F.

Monk

T. H.

Berman

S. R.

Kupfer

(1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatric Research, 28(2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4

Centers for Disease Control. (2023). Adverse childhood experiences: Preventing early trauma to improve adult health. https://www.cdc.gov/vitalsigns/aces/pdf/vs-1105-aces-H.pdf

Centers for Disease Control and Prevention. (n.d.). Marijuana use and pregnancy. https://www.cdc.gov/marijuana/factsheets/pdf/marijuanafactsheets-pregnancy-508compliant.pdf

Corsi

D. J.

Walsh

Weiss

Hsu

El-Chaar

Hawken

Fell

D. B.

Walker

(2019). Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes. JAMA, 322(2), 145–152. https://doi.org/10.1001/jama.2019.8734

Cox

J. L.

Holden

J. M.

Sagovsky

(1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150, 782–786.

10.

Coy

K. C.

Haight

S. C.

Anstey

E. H.

Grant

A. M.

Ruffo

J. Y.

(2021). Postpartum marijuana use, perceptions of safety, and breastfeeding initiation and duration: An analysis of PRAMS data from seven states, 2017. Journal of Human Lactation, 37, 803–812. https://doi.org/10.1177/0890334421993466

11.

Crouch

Chambers

Bertrand

Bandoli

(2023). The association between adverse and positive childhood experiences and marijuana use during lactation. Breastfeeding Medicine, 18(3), 212–218. https://doi.org/10.1089/bfm.2022.0243

12.

Crume

T. L.

Juhl

A. L.

Brooks-Russell

Hall

K. E.

Wymore

Borgelt

L. M.

(2018). Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: The association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. The Journal of Pediatrics, 197, 90–97.

13.

Duko

Dachew

B. A.

Pereira

Alati

(2023). The effect of prenatal cannabis exposure on offspring preterm birth: A cumulative meta-analysis. Addiction, 118(4), 607–619. https://doi.org/10.1111/add.16072.

14.

Felitti

V. J.

(2009). Adverse childhood experiences and adult health. Academic Pediatrics, 9(3), 131–132. https://doi.org/10.1016/j.acap.2009.03.001

15.

Felitti

V. J.

Anda

R. F.

Nordenberg

Williamson

D. F.

Spitz

A. M.

Edwards

Koss

M. P.

Marks

J. S.

(1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/S0749379798000178

16.

Garner

C. D.

Kendall-Tackett

K. A.

Young

Baker

Hale

T. W.

(2022). Mode of cannabis use and factors related to frequency of cannabis use among breastfeeding mothers: Results from an online survey. Breastfeeding Medicine, 17(3), 269–276. https://doi.org/10.1089/bfm.2021.0151

17.

Hicks

T. A.

Bountress

K. E.

Adkins

A. E.

Svikis

D. S.

Gillespie

N. A.

Dick

D. M.

, Spit for Science Working Group, & Amstadter, A. B. (2023). A longitudinal mediational investigation of risk pathways among cannabis use, interpersonal trauma exposure, and trauma-related distress. Psychological Trauma, 15, 969–978. https://doi.org/10.1037/tra0001207

18.

Kendall-Tackett

K. A.

(2013). Treating the lifetime health effects of childhood victimization (2nd ed.). Civic Research Institute.

19.

Kendall-Tackett

K. A.

(2024). Depression in new mothers, Vol II: Screening, assessment, and treatment options (4th ed.). Routledge.

20.

Klasner

Brown

Gopalakrishnan

El Metwally

Besse

Mark

(2022). Effect of maternal adverse childhood experiences (ACE) and cannabis use on pregnancy outcomes. Archives of Women’s Mental Health, 25(6), 1097–1104. https://doi.org/10.1007/s00737-022-01269-x

21.

J. Y.

Coy

K. C.

Haight

S. C.

Haegerich

T. M.

Williams

L. J.

Cox

Njai

Grant

A. M.

(2020). Characteristics of marijuana use during pregnancy—Eight states, pregnancy risks assessment monitoring system, 20217. Morbidity & Mortality Weekly Report, 69(32), 1058–1063.

22.

Kroenke

Spitzer

R. L.

Williams

J. B. W.

Lowe

(2009). An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics, 50, 613–621.

23.

Lavender

McGregor

I. S.

Suraev

Grunstein

R. R.

Hoyos

C. M.

(2022). Cannabinoids, insomnia, and other sleep disorders. Chest, 162(2), 452–465. https://doi.org/10.1016/j.chest.2022.04.151

24.

Legare

C. A.

Raup-Konsavage

Vrana

K. E.

(2021). Therapeutic potential of cannabis, cannabidiol, and cannabinoid-based pharamaceuticals. Pharmacology, 107, 131–149. https://doi.org/10.1159/000521683

25.

Logsdon

M. C.

Wisner

K. L.

Hanusa

B. H.

(2009). Does maternal role functioning improve with antidepressant treatment in women with postpartum depression. Journal of Women’s Health, 18(1), 85–90.

26.

March of Dimes. (2016). Street drugs and pregnancy. https://www.marchofdimes.org/pregnancy/street-drugs-and-pregnancy.aspx

27.

Moss

M. J.

Bushlin

Kazmierczak

Koop

Hendrickson

R. G.

Zuckerman

K. E.

Grigsby

T. M.

(2021). Cannabis use and measurement of cannabinoids in plasma and breast milk of breastfeeding mothers. Pediatric Research, 90, 861–868. https://doi.org/10.1038/s41390-020-01332-2

28.

National Center for Injury Prevention and Control. (2023). Fast facts: Preventing adverse childhood experiences. https://www.cdc.gov/violenceprevention/aces/fastfact.html

29.

Osofsky

J. D.

Osofsky

H. J.

Frazer

A. L.

Fields-Olivieri

M. A.

Many

Selby

Holman

Conrad

(2021). The importance of adverse childhood experiences during the perinatal period. American Psychologist, 76(2), 350–363. https://doi.org/10.1037/amp0000770

30.

Rokeby

A. C. E.

Natale

B. V.

Natale

D. R. C.

(2023). Cannabinoids and the placenta: Receptors, signaling, and outcomes. Placenta, 135, 51–61. https://doi.org/10.1016/j.placenta.2023.03.002

31.

Smith

C. B.

Schmidt

Holdsworth

E. A.

Caffe

Brooks

Williams

J. E.

Gang

D. R.

McGuire

M. A.

Barbosa-Leiker

Meehan

C. L.

(2024). Cannabis use, decision making, and perceptions of riks among breastfeeding individuals: The Lactation and Cannabis (LAC) study. Journal of Cannabis Research, 6(1), 6. https://doi.org/10.1186/s42238-023-00212-w

32.

Solmi

De Toffol

Kim

J. Y.

Choi

M. J.

Stubbs

Thompson

Firth

Miola

Croatto

Baggio

Michelon

Ballan

Gerdle

Monaco

Simonato

Scocco

Ricca

Castellini

Fornaro

. . . Dragioti

(2023). Balancing risks and benefits of cannabis use: Umbrella review of meta-analyses of randomised controlled trials and observational studies. British Medical Journal, 382, e072348. https://doi.org/10.1136/bmj-2022-072348

33.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). Marijuana and breastfeeding. https://www.samhsa.gov/marijuana/marijuana-pregnancy

34.

Swedo

E. A.

D’Angelo

D. V.

Fasula

A. M.

Clayton

H. B.

Ports

K. A.

(2023). Associations of adverse childhood experiences with pregnancy and infant health. American Journal of Preventive Medicine, 64(4), 512–524.

35.

Thomas

S. A.

Clements-Nolle

K. D.

Wagner

K. D.

Omaye

Yang

(2023). Adverse childhood experiences, antenatal stressful life events, and marijuana use during pregnancy: A population-based study. Preventative Medicine, 174, 107656. https://doi.org/10.1016/j.ypmed.2023.107656

36.

Velez

M. L.

Jordan

C. J.

Jansson

L. M.

(2019). Cannabis use disorder during the perinatal period. In Montoya

I. D.

Weiss

S. R. B.

(Eds.), Cannabis use disorder (pp. 177–188). Springer Nature.

37.

Weathers

F. W.

Litz

B. T.

Keane

T. M.

Palmieri

P. A.

Marx

B. P.

Schnurr

P. P.

(2013). PTSD Checklist for DSM-5 (PCL-5). https://www.ptsd.va.gov/

38.

Yang

Tibbo

P. G.

Stewart

S. H.

Simon

Bullerwell

Wang

(2024). A cross-sectional study of the relationship between frequency of cannabis use and psychiatric symptoms among people seeking mental health and addiction services in Nova Scotia (2019–21). Journal of Psychiatric Research, 173, 104–110. https://doi.org/10.1016/j.jpsychires.2024.03.018