Associations Between Violence and Unsafe Living Situations With Cannabis Use During Early Pregnancy

Background: Maternal and child health are adversely impacted by experiences of violence, unstable living situations, and cannabis use during pregnancy. Women who experience intimate partner violence (IPV) are more likely to use cannabis than those who do not experience IPV. However, IPV can be difficult to identify as patients may not be ready to disclose. As IPV is associated with prior experiences of violence and unsafe/unstable housing, this study aimed to estimate the associations between experiences of current IPV, any past-year violence, and unsafe or unstable living situations with cannabis use during early pregnancy. This study used a large, diverse sample to further our understanding of the relationship between violent experiences and prenatal cannabis use. Methods: Using data from 303 178 pregnancies in California from 2014 to 2023, we used chi-square tests and modified Poisson regression models to estimate associations between experiences of current IPV, past-year violence, and unsafe/unstable living situations with cannabis use during early pregnancy. Results: Individuals endorsed current IPV or any past-year violence in <1% of the pregnancies (n = 324 [0.1%] and n = 979 [0.3%], respectively), and about 2% (n = 6284) reported having unsafe/unstable living situations. Over two-thirds (69.1%) of the pregnancies where patients endorsed current IPV also endorsed past-year physical violence or unsafe/unstable living situation. Individuals used cannabis during 7.2% (n = 21 868) of the pregnancies. In unadjusted analyses, current IPV, past-year violence, and unsafe/unstable living situations were associated with higher prenatal cannabis use. In adjusted analyses, past-year violence and unsafe/unstable living situations were associated with higher prenatal cannabis use. Conclusions: It is crucial for experiences of violence and unsafe living situations to be concurrently assessed and addressed with cannabis use. Interventions that incorporate education, advocacy, and connections to mental health and IPV services could help reduce cannabis use and recurrent violence and improve pregnancy-related outcomes and patient safety.