Marijuana use in Pregnant Women with Disabilities in the United States.

OBJECTIVES: While perinatal marijuana use is increasing, limited research exists related to its use during pregnancy among vulnerable subpopulations of women with disabilities. The purpose of this study is to assess marijuana use in pregnant U.S. women with disabilities. METHODS: The analytic sample using 2015-2019 National Survey on Drug Use and Health (NSDUH) data included 3657 pregnant women. Descriptive statistics were performed and adjusted logistic regression models estimated the size and direction of the association between the type of disability and marijuana use. RESULTS: Approximately 13.0% of pregnant women with disabilities used marijuana in the past month, which was higher than pregnant women without disabilities (4.4%). The highest prevalence of past month marijuana use was observed among pregnant women with sensory disabilities (17.2%) followed by women with cognitive disabilities (14.6%) and daily living limitations (11.7%). Marijuana use was also associated with younger age (≤ 25 years old), Black non-Hispanic, high school education or less, non-married, and past month alcohol/tobacco use. Overall, pregnant women with any disability, and particularly those with sensory disabilities (AOR 2.32, 95% CI 1.21, 4.47), were significantly more likely (AOR 1.65, 95% CI 1.02, 2.69) to use marijuana than their counterparts without disabilities. CONCLUSIONS: The higher prevalence of marijuana use among pregnant women with disabilities in this study supports the American College of Obstetricians and Gynecologists recommendations for universal screening of maternal substance use. Screening for marijuana use in vulnerable populations is crucial and it may require training of health care providers to administer such screenings to women with disabilities.

Prevalence and correlates of suicidal behaviors during pregnancy: evidence from the National Survey on Drug Use and Health.

Suicidal behaviors during pregnancy are prevalent and have the potential to adversely affect a woman's health and her developing infant. The purpose of this study was to examine prevalence and correlates of suicidal behaviors in a national sample of pregnant women. Using data from the 2009-2018 National Survey on Drug Use and Health, a sample of 7479 pregnant women was analyzed. Multiple logistic regression was used to examine associations between sample characteristics and suicidal behaviors overall and by pregnancy trimester. In this sample, 3.4% of women exhibited suicidal behaviors such as ideation, planning, and attempt. Suicidal behaviors were more prevalent at 4.4% among women in the first trimester compared to the second/third trimesters (2.9%). Of those exhibiting suicidal behavior, 63.0% were ideators, 18.9% planned suicide, and 18.1% attempted suicide. Logistic regression analyses revealed that all racial/ethnic groups of women in the third trimester were less likely to be suicidal relative to black non-Hispanic women. Alcohol abuse (OR 3.70, 95% CI 1.97, 6.81) and major depressive episode (OR 4.91, 95% CI 3.10, 7.84) in the past year significantly increased the odds of suicidality for all pregnant women. Perceived unmet need for treatment increased the likelihood (OR 5.64, 95% CI 3.55, 8.97) of suicidal behavior regardless of trimester. These findings underscore the importance of screening for suicidal behaviors in the first trimester, especially among those with existing mood disorders and substance abuse. Racial/ethnic differences should be considered in targeted interventions for suicide prevention.

Perception of Risk of Harm from Cannabis Use Among Women of Reproductive Age with Disabilities.

Objectives: To examine perceived risk of harm from weekly cannabis use among reproductive-aged women with disabilities. Methods: Using data from the 2021 National Survey on Drug Use and Health, we assessed perceived risk of harm associated with weekly cannabis use among women of reproductive age by disability status. Disabilities included sensory, cognitive, and those related to daily activities. Logistic regression was employed to examine correlates of risk perception associated with weekly cannabis in this subpopulation of women. Results: A significantly higher percentage of women with any disability perceived no risk associated with weekly cannabis use (37.9%) compared to those with no disabilities (26.1%). Approximately, 60.0% of women with disabilities who used cannabis in the past 12 months perceived no risk of harm from weekly cannabis use. Overall, women with disabilities and cannabis use in the past 12 months had higher adjusted odds (AOR=2.90, 95% CI=2.10-4.10) of perceiving no risk associated with weekly use of cannabis compared to women without any disability and no cannabis use. Other significant factors associated with an increased likelihood of perceiving no risk of harm from weekly use of cannabis included younger women, having higher income, being in good health, and using alcohol or tobacco. Conclusions: Perceived risk of harm associated with weekly cannabis use is particularly low among women with disabilities who use cannabis. Given current attitudes toward cannabis as a harmless drug, and the potential adverse health outcomes, it is imperative to monitor and understand women's perceptions of risk of harm from cannabis use for clinical guidance, provider and patient education, and public health programs to support evidence-based approaches in addressing its use among vulnerable populations such as those of reproductive age with disabilities.

Treatment outcomes among pregnant women with cannabis use disorder.

Cannabis use disorder (CUD) among pregnant women is on the rise in the United States. The American College of Obstetricians and Gynecologists have recommended against the use of cannabis during pregnancy and breastfeeding. However, limited research exists on CUD treatment in this vulnerable population. The purpose of this study was to examine factors that influence CUD treatment completion in pregnant women. Data from the 2010-2019 Treatment Episode Data Set-Discharges (TEDS-D) were used (n = 7,319 pregnant women who reported CUD and had no prior treatment history). Descriptive statistics, logistic regression, and classification tree analyses were conducted to assess treatment outcomes. Only 30.3% of the sample completed CUD treatment. Length of stay between 4 and 12 months was associated with a higher likelihood of CUD treatment completion. The odds of treatment completion were higher if the referral source was alcohol/drug use care provider (AOR = 1.60, 95% CI [1.01, 2.54]), other community referral (AOR = 1.65, 95% CI [1.38, 1.97]), and the court/criminal justice (AOR = 2.29, 95% CI [1.92, 2.72]) relative to being referred by individual/self. A relatively high proportion of CUD treatment completion (52%) was observed among pregnant women who had > 1 month of CUD treatment and were referred to the treatment program by the criminal justice system. For pregnant women, referrals from the justice system, community, and healthcare providers can increase the likelihood of successful CUD treatment outcomes. Developing targeted CUD treatments for pregnant populations is crucial due to increasing CUD rates, cannabis accessibility, and potency.

Racial/ethnic differences in medication for addiction treatment for opioid use disorders among pregnant women in treatment facilities supported by state funds.

INTRODUCTION: Medication for addiction treatment (MAT) for opioid use disorder (OUD) in pregnant women is known to improve neonatal health outcomes. Despite the benefits of this evidence-based treatment for OUD, MAT has been underutilized during pregnancy among certain racial/ethnic groups of women in the United States. The purpose of this study was to examine racial/ethnic differences and factors that affect MAT administration among pregnant women with OUD seeking treatment at publicly funded facilities. METHODS: We used data from the 2010-2019 Treatment Episode Data Set system. The analytic sample included 15,777 pregnant women with OUD. We built logistic regression models to examine associations between race/ethnicity and MAT and determine differences and similarities in factors that may influence the use of MAT across racial/ethnic groups of pregnant women with OUD. RESULTS: Although in this sample only 31.6 % received MAT, an increasing trend of MAT receipt has been observed during 2010-2019. Approximately 44 % of the Hispanic pregnant women received MAT, and this was significantly higher than non-Hispanic Black (27.1 %) and White (31.3 %) women. Even after adjusting for potential confounders, the adjusted odds of receiving MAT during pregnancy were lower for Black (AOR = 0.57, 95 % CI 0.44, 0.75) and White (AOR = 0.75, 95 % CI 0.61, 0.91) women compared to Hispanic women. Not being in the labor force increased the odds of receiving MAT in Hispanic women relative to their employed counterparts while homelessness or dependent living decreased the odds of MAT for White women compared to those living independently. Regardless of their racial/ethnic background, pregnant women younger than 29 years old were less likely to receive MAT relative to older women; however, if they were arrested once prior to admission to treatment, they had significantly higher odds of receiving MAT than those with no arrests. Treatment of at least 7 months was associated with a higher likelihood of MAT across all racial/ethnic groups. CONCLUSIONS: This study highlights the underutilization of MAT, particularly among pregnant Black and White women who seek treatment for OUD in publicly funded treatment facilities. A multi-dimensional approach to MAT intervention programs is needed to increase MAT for all pregnant women and reduce racial/ethnic inequities.

Marijuana Use Among Women of Reproductive Age With Disabilities.

INTRODUCTION: Despite the increasing prevalence and potential adverse health outcomes associated with marijuana use, limited research exists related to its use in women of reproductive age with disabilities. The purpose of this study is to examine the past-month marijuana use in women of reproductive age with disabilities. METHODS: Data from the 2015-2019 National Survey on Drug Use and Health included 76,765 women of reproductive age (18-44 years). Descriptive statistics and adjusted logistic regression analyses were conducted to assess the associations between past-month marijuana use and overall disability, including the type of disability. RESULTS: In this sample, 12.6% of women reported past-month marijuana use. Approximately, 21% of women with disabilities reported past-month marijuana use, compared with only 11.1% of women without a disability. Marijuana use was more prevalent in women with disabilities who were younger (aged ≤25 years), who were non-Hispanic White, who were nonmarried, who had at least some college education, and who used alcohol or tobacco. Women with disabilities had 1.68 (95% CI=1.57, 1.80) higher odds of reporting past-month marijuana use than those with no disabilities. The odds of past-month marijuana use were higher among those with cognitive (AOR=1.78, 95% CI=1.64, 1.94), sensory (AOR=1.30, 95% CI=1.12, 1.51), and daily activities-related (AOR=1.64, 95% CI=1.49, 1.80) disabilities than among their counterparts without disabilities. CONCLUSIONS: This study found an increased prevalence of past-month marijuana use among women of reproductive age with disabilities. Enhanced screening and counseling using evidence-based practices during routine care for women with disabilities may be necessary to mitigate marijuana use.