Cannabis Use Motives Across the Reproductive Continuum: An Integrative Literature Review

Objective: Cannabis is one of the most used substances in pregnancy, with an estimated 10% of U.S. pregnancies affected by cannabis use. Although research has linked fetal cannabis exposure to potential risks, many pregnant women continue to use cannabis for diverse medical and nonmedical reasons. Motives for substance use are modifiable targets for intervention that can be leveraged for tailored intervention and prevention strategies, yet little work has been done to integrate women's motives for cannabis use across the reproductive continuum. Method: To address this gap, this integrative review examines literature on cannabis motives across reproductive time periods using the Whittemore and Knafl approach, to map the range of motives reported across studies, synthesize distinct motives into meaningful categories, and examine how motives are related to cannabis use behavior-including frequency, initiation and persistence. Results: Overall, 33 studies met inclusion criteria with 27 focused on the prenatal period and no studies exclusively on preconception, for a total of 45 period-specific observations. Across the reproductive continuum, medical/therapeutic motives were frequently reported (97%) and were linked to persistent and frequent use. Coping motives were also linked to use behavior and were more prominent during postpartum compared to preconception or prenatal periods (100% vs. 80% vs. 79%, respectively). Recreational and social motives appeared more often preconception. Conclusions: Altogether, motives for cannabis use were varied and dynamic, but medical motives were the most consistent across the reproductive continuum. Motives can provide a framework for non-stigmatizing intervention that distinguishes symptom driven use, bridges provider communication barriers, and acknowledges patient reported benefits.