How cannabis use methods relate to disorder before pregnancy

This cross-sectional study examined associations between modes of cannabis use (smoke, vape, edibles, and/or dabs) during the year before pregnancy and cannabis use disorder (CUD). Patients were universally screened for substance use at entrance to prenatal care in an integrated healthcare delivery system (January 2020-July 2024). CUD diagnoses were ascertained from ICD-10 codes in electronic health records during the year before pregnancy. At entrance to prenatal care, patients self-reported frequency of cannabis used during the year before pregnancy (monthly or less, weekly, daily, none) and modes of use during the year before pregnancy (smoke, vape, edibles, dabs). Mode was categorized as no cannabis use, only smoking, only vaping, only dabbing, only edibles, or multiple modes. Of 159,270 pregnancies among 130,712 women (mean age of 31.8 [SD = 5.2]), 16.6% used cannabis during the year before pregnancy (4.4% only smoked, 1.0% only vaped, 0.1% only dabbed, 3.8% only used edibles, and 7.2% used multiple modes); 908 (0.6%) had a CUD diagnosis in the year before pregnancy. Compared to no cannabis use, use of multiple modes was associated with the greatest CUD prevalence (adjusted prevalence ratio, aPR:11.11, 95% CI: 9.09-13.58), followed by only smoking (aPR:10.10, 95% CI: 8.11-12.58), only dabbing (aPR: 8.99, 95% CI: 3.98-20.30), only vaping (aPR: 5.03, 95% CI:3.04-8.33), and only using edibles (aPR:3.21, 95% CI: 2.15-4.79). Comparing modes, only smoking was associated with greater CUD than only vaping (aPR 2.01, 95% CI: 1.22-3.30) and only using edibles (aPR 3.15, 95% CI: 2.11-4.70); and only dabbing was associated with greater CUD prevalence than only using edibles (aPR 2.80, 95% CI: 1.15-6.82). Use of multiple cannabis modes and use of smoked or dabbed modes, compared with edibles or vaping, were associated with a higher prevalence of preconception CUD.