Racial Differences in Prenatal Cannabis Screening Among Women at Elevated Risk for Substance Use and Sexually Transmitted Infections

INTRODUCTION: Cannabis use during pregnancy is rising, in part due to an increased perception of safety and legalization across the country. National guidelines recommend that clinicians universally screen for substance use, including cannabis use, during pregnancy. METHODS: This is a longitudinal study assessing cannabis use frequency and reasons for use at baseline and patient-clinician communication at 4 study timepoints. Data are drawn from a randomized controlled trial testing an innovative, technology-delivered brief intervention, Health Check-up for Expectant Moms, with 176 pregnant cisgender women (mean age, 30.2; SD, 5.02; 25.6% Black) reporting substance use risk, condomless sex, and multiple sexual partners. We used t-tests, chi-square tests, Fisher's exact tests, and logistic regression to analyze the data. RESULTS: Overall, 18.2% (n = 32) self-reported current cannabis use at baseline, and 26.1% (n = 46) reported past year use. The most cited reason for use was relaxation or tension relief. Black women were significantly more likely than White women to have reported being talked to by their clinician about cannabis use in general during pregnancy and breastfeeding at every timepoint (all timepoints P ≤ .01). Clustered logistic regression analysis also showed higher odds for Black women to have been talked to about cannabis use in general compared with White women (adjusted odds ratio, 4.09; 95% CI, 2.29-7.32; P < .0001), and this significance prevailed even after adjusting for prior cannabis use. DISCUSSION: Seeking relaxation or tension relief was the most cited reason for use during pregnancy. Results suggest a racial bias that led to significantly more Black women being asked about cannabis use during pregnancy or breastfeeding at every timepoint, as compared with White women. There is a need for systemic and clinician-level improvement in universal screening and counseling.