Key Findings

A new analysis of nationally representative data shows that pregnant women with depression are more than three times as likely to report cannabis use in the past 30 days compared with pregnant women without depression. The study used data from the 2005–2018 National Survey on Drug Use and Health (NSDUH) and examined how cannabis use during pregnancy relates to depressive symptoms, sociodemographic factors, age, and perceived risk of regular cannabis use.

Background and Rationale

Cannabis use has been increasing in the United States while perceptions of its risks have shifted in many communities. Prior research indicates higher rates of tobacco use in pregnancy among individuals with depression, but less was known about how depression relates to cannabis use in pregnant populations. Identifying groups at higher risk is essential to design effective prevention and intervention strategies for maternal and fetal health.

Methods

The researchers analyzed data from the NSDUH, an annual cross-sectional survey representative of the U.S. civilian, noninstitutionalized population aged 12 and older. Pregnant respondents were categorized as current cannabis users if they reported using marijuana at least once in the past 30 days. Depression was defined based on a past-12-month major depressive episode. The study evaluated prevalence across sociodemographic groups and examined how perceived risk of regular cannabis use modified the relationship between depression and cannabis use.

Results

Cannabis use during pregnancy was markedly more common among women with depression than among those without. Overall, 12.7 percent of pregnant women with a recent major depressive episode reported past-month cannabis use, compared with 3.7 percent of pregnant women without depression. Statistically, this corresponded to an odds ratio of approximately 3.8, indicating that depression was associated with more than a threefold increase in the likelihood of cannabis use during pregnancy.

Perceived risk mattered, but depression increased vulnerability across risk-perception levels. Among pregnant women who perceived no risk from regular cannabis use, prevalence was higher in both groups, but especially in those with depression (about 24 percent versus 16.5 percent for those without depression). Notably, even among pregnant women who perceived moderate to great risk from regular cannabis use, those with depression were substantially more likely to use cannabis: the association in this group produced an odds ratio indicating more than six times greater likelihood of use for women with depression compared with those without.

The elevated prevalence among women with depression was consistent across sociodemographic subgroups. A particularly high prevalence was observed among pregnant adolescents: roughly one in four pregnant teens with depression reported past-month cannabis use. Given that brain development continues into the mid-20s, cannabis exposure in younger pregnant women may pose additional concerns for both maternal and offspring health.

Interpretation and Implications

The findings suggest that depressive symptoms increase susceptibility to cannabis use during pregnancy, even among women who recognize the potential risks of regular use. As cannabis legalization expands and public perceptions of its risks decline, pregnant women—particularly those with depression—may be increasingly likely to use cannabis. This pattern echoes prior trends seen with prenatal tobacco use, where mental health conditions have been associated with higher use.

Given the elevated prevalence among pregnant teens and the broader association between depression and prenatal substance use, the authors recommend targeted education and prevention efforts. Healthcare providers, public health programs, and perinatal mental health services should consider integrating screening for cannabis use and depressive symptoms, and offering appropriate counseling or referral to treatment when needed.

Recommendations

• Increase education about potential risks of cannabis use during pregnancy for both mother and child, with special attention to pregnant women experiencing depression.
• Target prevention and intervention efforts toward pregnant adolescents and other high-risk groups identified in the study.
• In clinical settings, incorporate routine screening for depression and substance use in prenatal care, and provide resources for mental health and substance use treatment as needed.

Study Details, Authors and Funding

The analysis was led by researchers at Columbia University Mailman School of Public Health with collaborators at The City University of New York and other institutions. Co-authors include Jiaqi Zhu, Zoe Heisler, Katarzyna Wyka (The City University of New York), Melody Wu (Columbia Mailman School), Torri Metz (University of Utah Health), and Rina Das Eiden (Pennsylvania State University).

Funding: Supported by the National Institutes of Health / National Institute on Drug Abuse (grant number DA20892).

Publication: The full study, titled “Cannabis use during pregnancy in the United States: The role of depression” by Renee Goodwin et al., appears in the journal Drug and Alcohol Dependence (closed access).