Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Jane M. Georges, PhD, RN, committee member; Semira Semino- Asaro, PhD, PMHCNS-BC, PMHNP-BC, committee member


cannabis, maternal mental health, substance use, pregnancy


Purpose: The purpose of the study is to examine cannabis use and mental health symptoms among a national sample of pregnant women.

Background: With the increase of state level marijuana legalization and corresponding decrease in perception of harm, marijuana use in pregnant women is rising. Between 2002 and 2017, the adjusted prevalence of self-reported past month cannabis use among pregnant women doubled from 3.4% to 7.0%. Antenatal cannabis use has been linked to low birthweight, preterm birth and increased NICU admission in exposed neonates. Extant literature examining reasons for maternal use during pregnancy include managing nausea as well as coping with anxiety and stress. Extant research that has examined associations between poor mental health and cannabis in pregnant women have been limited to associations between one mental health diagnosis (e.g. depression) in large national samples of American or Canadian women or multiple diagnoses (e.g. depression, anxiety and/ or trauma) in smaller samples with limited generalizability to the general population.

Methods: We employed a cross-sectional correlational design using secondary analysis of existing data from the 2008- 2014 National Survey on Drug Use and Health (NSDUH). The sample was restricted to pregnant women ages 18-44 years old who identify as pregnant (n=5,520) and self- report marijuana use in the past 30 days (n=312). Bivariate analysis using Chi-square and t-test were calculated to examine the association and strength of the relationships between variables. Logistic regression was used to identify whether past month psychological distress, past year depression, past year anxiety increase the odds for past month cannabis use after adjusting for sociodemographic characteristics

Results: The sample was diverse: 55.9% identified as Non- Hispanic white, 16.0% as Non- Hispanic Black, 19.0% as Hispanic, 10% as Other. There were significant differences in sociodemographic, clinical, substance use and mental health characteristics between women who self-report versus denied cannabis use during pregnancy. The regression coefficients for psychological distress scores and past year anxiety were significant. Psychological distress was the most significant of the two mental health variables with a Wald score of 42.968 compared to 7.677 for past year anxiety. The regression coefficient for psychological distress (B = 0.079, OR = 1.08, p < .001) indicated that for a one unit increase in the psychological distress score, the odds of using cannabis during pregnancy would increase by approximately 8%. The regression coefficient for past year anxiety was significant (B = 0.531, OR = 1.70, p < .001). Women who had a past year diagnosis of anxiety by a healthcare professional were 1.7 times more likely to endorse past month cannabis use during pregnancy than those without a past year diagnosis of anxiety.

Implications: Despite an increasing awareness of the impact of poor maternal mental health and substance use during pregnancy, universal screening protocols for substance use and mental health disorders remains an exception. This study points to a need to be especially sensitive to women with a past history of anxiety who are using cannabis to cope with distress during pregnancy.

Document Type

Dissertation: USD Users Only