Table 3:

Illustrative qualitative data to support description of cannabis use at each stage of reproduction

Stage of reproduction	Finding	Illustrative quote
Prepregnancy	All participants used cannabis before pregnancy for many reasons, typically beginning with recreational use.	“Long before I had [multiple sclerosis], I’ve always used recreationally” (Participant 18).
	Many participants used cannabis to cope with the unpleasant or difficult aspects of life (e.g., to improve sleep quality, to relax, to alleviate mild anxiety).	“It was something that I found would just help me be calmer. A little more patient and just kind of like relax and let the day go kind of thing” (Participant 49). “It was a nice way to fall asleep” (Participant 10).
	More than half of participants described their prepregnancy cannabis use as motivated by reasons that spanned multiple categories.	“It really helps with a myriad of problems. Like it will help with my sleep, with my headaches—I get chronic migraines — but I mean I also enjoy it [laughter]” (Participant 22).
Pregnancy	Motivations for cannabis use changed during pregnancy. Many participants chose to abstain for fear of harming their developing fetus.	“I wasn’t sure of the side effects and I would hate for something to happen and it was pretty much my fault. I decided it’s only 40 weeks, I can handle 40 weeks and then afterwards I can readjust and decide through breastfeeding” (Participant 35).
	Other reasons for ceasing included stigma, guilt, affordability, desire to remain alert and sober, and potential interference with other medications.	“I had a fear of my physician judging me” (Participant 14). “I was being put on antidepressants so I just didn’t smoke because I didn’t want to mess them up” (Participant 15).
	Of those who continued to use cannabis during pregnancy, nearly all participants explained their motivation as related to symptom management for conditions that pre-existed pregnancy or were related to pregnancy (most commonly nausea and vomiting).	“I couldn’t keep anything down, including water and my own saliva, so I started using cannabis. It essentially kept me alive for half my pregnancy, if not more” (Participant 1). “During pregnancy, like once the weight hits, I get pain in my sciatica nerve” (Participant 41).
	Some participants tried other medical alternatives for symptom management and found them ineffective.	“I find that the Diclectin or whatever the hell the pills they gave me for nausea, it doesn’t help as well as the cannabis does so I just kind of threw the pills away and kept smoking” (Participant 40).
	Many participants used cannabis for coping alongside their symptom management use. Reasons for coping were very similar to those provided prepregnancy.	“It was kind of hard to manage my anxiety and stress and taking care of a little baby, like a little child, while being pregnant, so I continued to smoke and use the edibles at that time. I found that it helped with the nausea and a lot of times it helped keep me calm and I was able to focus more” (Participant 34).
	Few participants described using cannabis for sensation-seeking reasons during pregnancy.	“I’m doing it for a little break and I think a doctor can’t give me any suggestions besides maybe like ‘go for a run’ or something” (Participant 44).
Lactation	Participants using for sensation-seeking reasons compared cannabis and alcohol use. They found cannabis useful to relax and unwind.	“It was something I did — like it was almost like alcohol — it’s the end of the day, the kids go to bed, you have a glass of wine, well I would go smoke a bowl” (Participant 33).
	Reasons related to symptom management during lactation resembled those described before pregnancy, as symptoms related to pregnancy (e.g., nausea) had subsided.	“I don’t have that same kind of intense emotional turmoil I had throughout my pregnancy … and the nausea is gone” (Participant 16). “Currently I use it for very bad cramps. … when I have my period” (Participant 9)
	Cannabis was described by some participants as more helpful than pharmaceutical medication.	“I’ve gone from 15 pills a day and no cannabis to three pills a day and cannabis and I’m able to focus and be there for my kids and be attentive and help them cope with their own emotions because I’m not numb” (Participant 38).
	Coping reasons during lactation also closely resembled those provided before pregnancy, with the addition of coping with the stress and monotony of caring for a newborn.	“With all the stress of having a baby and housework and keeping up with everything I did kind of — I’m not going to lie — I did depend on it a little more” (Participant 34). “I am feeling more calm [after using cannabis] and that gives me the confidence to wean off my [antidepressant] pills” (Participant 9).
	A small number of participants described their desire to use cannabis as influencing their choice to cease or not to initiate lactation.	“The milk was starting to go and the pumping was also a bit of a pain … so because of that and because of the fact that it was the thing keeping me from being able to use the marijuana — I had some episodes of anxiety where it would have been useful — I decided to stop [breastfeeding]” Participant 2).