Maternal Marijuana and Tobacco Use: Exploring the Relationship with Offspring Child Protective Service Reports

BACKGROUND:  Parental substance use is documented in the literature to be strongly associated with child welfare contacts. As Alaska voters recently approved an initiative legalizing recreational marijuana use, we are interested in better understanding aspects of this relationship. This study describes the association between pre-birth maternal marijuana and cigarette use and subsequent Child Protective Service (CPS) reports; and how that association is altered by changes in maternal usage during pregnancy.

METHODS:  Since 1990 the Alaska Division of Public Health has surveyed approximately 17% of all birthmothers each year using the Pregnancy Risk Assessment Monitoring Survey (PRAMS). We linked the 2009-11 PRAMS respondents (n = 3,549) to CPS reports that occurred during 2009-2013. Probabilistic linkages were made on three infant identifiers: date of birth, infant first name, and infant last name. We used this novel data set to examine the relationship between maternal self-reported marijuana and cigarette use and cessation, and subsequent CPS reports among offspring by age 2 years. Numbers reported are survey respondents and percentages are weighted. Crude odds ratios (OR) and Wald 95% confidence intervals are presented.

RESULTS: Among the 3,549 PRAMS respondents, 1,274 (33.0%) self-reported smoking cigarettes during the three months before pregnancy, 550 (15.7%) self-reported using marijuana in the year before, and 394 (10.3%) self-reported using both. 356 (8.9%) of respondents had an offspring CPS report by age 2 years. Offspring of respondents who self-report cigarette use, marijuana use, or use of both substances are more likely to experience a maltreatment report compared with nonusers (OR=3.25; 95%CI 2.36, 4.46) , (OR=5.24; 95%CI 3.84, 7.15), and (OR=3.77; 95%CI 2.76, 5.17), respectively. The likelihood of a maltreatment report was attenuated among respondents who quit marijuana, cigarettes, or both during pregnancy, compared to those who continued equivalent substance use (OR=0.62; 95%CI 0.35, 1.08), (OR=0.62; 95%CI 0.43, 0.90), and (OR=0.30; 95%CI 0.13, 0.73), respectively.

CONCLUSIONS:  Both maternal marijuana and tobacco usage are associated with subsequent offspring social welfare contacts. Cigarette and marijuana cessation during pregnancy appears to attenuate the risk. An ability to recognize expecting mothers who aren’t ready to adopt healthy behavioral change may assist a provider in identifying families with a higher risk of subsequent social welfare contact. While further investigation is needed, healthcare providers should begin counseling women on marijuana cessation along with tobacco cessation.