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It is a prospective statewide pregnancy cohort recruited in 2017\u20132023 using births as a sampling frame.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A three\u2010stage stratified cluster sample design that randomly selected hospitals, prenatal clinics and mothers across the lower peninsula of Michigan, where 97% of Michigan hospital births take place.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Pregnant individuals recruited at their first prenatal visit primarily from 20 clinics serving 11 hospitals. Of 1105 eligible pregnant participants, 1092 (98.8%) had information on cannabis use either from self\u2010reports (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009999), urine toxicology (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091028) or both (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009945). Study participants had a median age of 29.3\u00a0years (interquartile range\u2009=\u20097.6).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Cannabis use was self\u2010reported by interviewer\u2010administered phone surveys twice during pregnancy and further ascertained by measuring tetrahydrocannabinol (THC) metabolites in up to two urine samples collected during pregnancy. The prevalence of cannabis use was estimated using sampling weights and clustering by sampled hospital to account for the complex survey design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The weighted prevalence of prenatal cannabis use was 16.8% [95% confidence interval (CI) = 8.0%\u201325.7%] based on either self\u2010report or urinalysis. Prevalence based on self\u2010report alone was 12.3% (95% CI = 6.1%\u201318.6%) and from urinalysis alone was 13.3% (95% CI = 5.1%\u201321.6%). Adjusted for creatinine concentrations, levels of 11\u2010nor\u20109\u2010carboxy\u2010tetrahydrocannabinol (THC\u2010COOH) in positive samples ranged from 5.43 to 4694.89\u2009ng\/mg with a median of 122.00\u2009ng\/mg. Multivariate analysis revealed that participants who were single [adjusted prevalence rate ratio (aPRR)\u2009=\u20092.08, 95% CI = 1.15\u20133.78], had lower educational attainment (aPRR\u2009=\u20093.76, 95% CI = 1.23\u201311.53 for some college education and aPRR\u2009=\u20093.15, 95% CI = 0.97\u201310.25 for high school education as compared with undergraduate education or above), reported symptoms of depression (aPRR\u2009=\u20091.72, 95% CI = 1.19\u20132.48) and had a history of adverse childhood events (ACEs; aPRR\u2009=\u20092.04, 95% CI = 1.21\u20133.45 for ACEs \u2265 3 and aPRR\u2009=\u20091.64, 95% CI = 1.07\u20132.52 for 1\u20132 ACEs as compared to 0 ACEs) were more likely to use cannabis prenatally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cannabis use is estimated to have occurred in one of six pregnancies in a population\u2010based sample in Michigan, USA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70188","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T05:59:27Z","timestamp":1758002367000},"page":"126-137","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prevalence and characteristics of prenatal cannabis use in Michigan, USA: A statewide population\u2010based pregnancy cohort"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4005-1748","authenticated-orcid":false,"given":"Ban","family":"Al\u2010Sahab","sequence":"first","affiliation":[{"name":"Department of Family Medicine Michigan State University  East Lansing MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean M.","family":"Kerver","sequence":"additional","affiliation":[{"name":"Department of Epidemiology &amp; 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