A Longitudinal EMA Study Examining the Role of Maternal Mood and Physical Symptoms on Women's Cannabis Use Across the Perinatal Period

摘要 大麻是孕妇中使用最广泛的药物，使用率正在上升 戏剧性地。在围产期妇女中使用大麻（CU）急剧增加的原因尚不清楚。 大麻合法化的变化，毒品的可获得性和可接受性的增加，以及人们对低 健康风险或治疗益处是可能的解释。一般情况下，由于医学原因，CU增加 人群可能会促使女性考虑CU的怀孕症状，如恶心。此外，症状 焦虑和抑郁是常见的围产期，一些妇女可能会转向大麻，如果它 被认为比标准的精神药物治疗风险更小，或更容易接受。然而不利的 结果已被记录，包括低出生体重的发生率较高，新生儿 重症监护室入院，新生儿发病率的3倍风险。产前使用大麻的母亲 经历更高的抑郁率;在产后使用者中，患抑郁症的风险也更大， 以及母乳喂养的可能性较低。并非所有在怀孕前使用大麻的妇女都继续 在围产期。一些数据表明，2/3的妇女在得知怀孕后停止服用CU， 三分之一的人继续使用。我们的数据显示，许多继续CU的女性表达了矛盾的感觉， 关于他们的使用。在那些戒烟的人中，复发并不罕见，特别是在分娩后。原因 持续CU在围产期期间，和动机停止，是相对未知的。考虑到 由于围产期广泛的CU，迫切需要制定量身定制的干预措施，服务， 和教育材料，特别是满足情绪激动的孕妇的需要， 身体症状。然而，在制定干预措施和服务之前， 孕妇的动机CU，预测使用和停止，在多大程度上，情绪和身体 症状驱动使用模式，以及上下文因素的显著性（例如，获得大麻）。 利用一个基于健康行为的社会生态学模型的框架，我们建议检查的因素， 有助于妇女在围产期的CU行为。在这项为期5年的研究中，我们将招募200名孕妇， 在怀孕前和/或怀孕期间报告定期CU并从第一次开始跟踪的妇女 怀孕三个月至产后12周。我们包括4，10天的生态瞬间爆发， 评估（EMA）在围产期跟踪产妇情绪和身体之间的关联 症状CU和对大麻的渴望此外，我们将对妇女进行定性访谈， 关于未来服务和干预的理想内容和方式的反馈。定量和定性 研究结果会综合起来，以得出有凝聚力的研究结果，作为日后研究和服务发展的指引。定制 对妇女的支持可以减少围产期与CU相关的有害结果。

Abstract Cannabis is the most widely used drug among pregnant women, and rates of use are increasing dramatically. Reasons for the sharp increase in cannabis use (CU) among in perinatal women are not clear. Changes in cannabis legalization, increased access and acceptability of the drug, and a perception of low health risk or therapeutic benefit are possible explanations. Increased CU for medicinal reasons in the general population may prompt women to consider CU for pregnancy symptoms, such as nausea. Further, symptoms of anxiety and depression are common during the perinatal period, and some women may turn to cannabis if it is perceived to be less risky, or more acceptable, than standard psychopharmacologic treatments. Yet adverse outcomes have been documented, including higher incidence of low birth weight, greater need for neonatal intensive care admission, and a 3-fold risk of neonatal morbidity. Mothers who use cannabis prenatally experience higher rates of depression; among postpartum users, there is also a greater risk for depression and as well as lower likelihood of breastfeeding. Not all women who use cannabis prior to pregnancy continue during the perinatal period. Some data suggest that 2/3 of women discontinue CU upon learning of pregnancy, with up to 1/3 continuing use. Our data show that many women who continue CU express conflicted feelings about their use. Among those who quit, relapse is not uncommon, especially after delivery. Reasons for continued CU during the perinatal period, and motivations for cessation, are relatively unknown. In light of the widespread CU during the perinatal period, a critical need exists to develop tailored interventions, services, and educational materials, particularly addressing the needs of pregnant women with high levels of mood and physical symptoms. However, before interventions and services can be developed, it is crucial to elucidate pregnant women’s motives for CU, predictors of use and cessation, the extent to which mood and physical symptoms drive patterns of use, as well as the salience of contextual factors (e.g., access to cannabis). Utilizing a framework based on socioecological models of health behavior, we propose to examine factors that contribute to women’s CU behavior in the perinatal period. In this 5-year study, we will recruit 200 pregnant women who report regular CU immediately prior and/or during pregnancy and follow them from the first trimester of pregnancy to 12 weeks postpartum. We include 4, 10-day bursts of ecological momentary assessment (EMA) during the perinatal period to track associations between maternal mood and physical symptoms, CU, and cannabis cravings. Further, we will conduct qualitative interviews with women to elicit feedback regarding ideal content and modality of future services and interventions. Quantitative and qualitative results will be integrated to yield cohesive findings to guide future research and service development. Tailored support for women may reduce deleterious outcomes associated with CU during the perinatal period.