Development of a lifestyle physical activity intervention to reduce risk for perinatal cannabis use

Rates of cannabis use (CU) among pregnant women are increasing dramatically. A sizable proportion of
women who use cannabis prenatally exhibit clinical levels of distress (e.g., depression and anxiety), conditions
that already raise risk for poor outcomes. Indeed, some women may use cannabis because it is perceived as
less risky, or more acceptable, than psychopharmacological treatments for depression and anxiety.
Pregnancy-related physical symptoms (e.g., nausea) are also identified motives for CU. However, adverse
outcomes to both mother and child associated with perinatal CU have been documented. Despite medical
recommendations to avoid cannabis use during pregnancy, there are currently no empirically-tested effective
interventions to aid pregnant women in doing so. Our team’s pilot data, as well as others’ findings, show that
many women who continue CU prenatally have conflicted feelings about their use, and experience challenges
with the process of quitting. Among women who are able to quit CU when they become pregnant, relapse is
not uncommon, especially after delivery. Interventions that address the needs of cannabis-using perinatal
women - elevated distress (depression, anxiety) and physical symptoms (nausea, pain) are critically needed.
Physical activity (PA) interventions may play a key role as an alternate coping strategy for distressed pregnant
women – thus decreasing CU. Our team has a strong history of developing PA interventions for pregnant
women and individuals with addictive behaviors. We were the first group to develop and test a lifestyle physical
activity (LPA) approach with depressed pregnant women, and for women with depression in alcohol treatment.
LPA interventions represent simple low-cost approaches that are supported by brief counseling and activity
monitors (e.g., Fitbit) to facilitate goal-setting and monitoring. Because LPA involves short bouts of activity
integrated into the structure of daily life, pregnant women can engage in PA in-the-moment to cope with
negative affect or cravings as an alternate to CU. In light of its potential as an efficacious, acceptable, and
disseminable intervention to reduce perinatal CU, we propose to develop an LPA intervention for women at
high risk for prenatal CU, and obtain data on the intervention’s feasibility and acceptability. This R34 will have
an intervention development phase, which will include a small open pilot trial (N=20), followed by a pilot
RCT phase, during which we will conduct a pilot randomized trial (N=50) comparing the LPA+Fitbit condition to
a Fitbit Only condition, with assessments of CU, PA, and other outcomes at multiple points extending to 4
weeks postpartum. At the study’s conclusion, we will have developed and pilot-tested a novel, technology-
supported PA intervention for pregnant women at high risk for prenatal CU. If deemed acceptable and feasible,
the efficacy of this intervention can be evaluated in a subsequent fully-powered trial. Ultimately, this research
will facilitate development of an alternate coping strategy for women to manage their distress and symptoms
during pregnancy, thus decreasing prenatal CU and lowering risk for adverse maternal and infant outcomes.

Grant Number: 5R34DA055317-03
NIH Institute/Center: NIH
Principal Investigator: CYNTHIA BATTLE