Researchers from Columbia University found that women with depression are more than three times as likely to use cannabis during pregnancy.

Using marijuana while pregnant is among the most debated topics in the cannabis space right now. Some studies found babies exposed to marijuana in their mother’s womb were later undersized and could result in premature births. Others question the efficacy of such research. We don’t know if the damage caused is because of the THC cannabinoid, or if inhaling smoke of any substance is to blame.

What we do know is that more women than ever are using marijuana while pregnant. In California, cannabis use during pregnancy doubled between 2009 and 2016. And now, new research from Columbia University has determined that depression could play a meaningful role on whether a pregnant woman does or doesn’t use cannabis.

The study, published in the Drug and Alcohol Dependence journal, found that women with depression are more than three times as likely to use cannabis during pregnancy. In fact, more than one in 10 pregnant women with depression admitted to past-month marijuana use. For teenagers, that figure jumps dramatically; one in four pregnant teens with depression said they used cannabis in the past month.

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“Our findings are timely given rapidly shifting perceptions about risks associated with cannabis use and its legalization,” lead study author Renee Goodwin said in a statement. “We found the prevalence of cannabis use was much higher among those with depression who perceived no risk (24%) relative to those who perceived moderate-great risk associated with use (5.5%).”

Researchers analyzed data from the 2005-2018 National Survey on Drug Use and Health, which is a cross-sectional annual survey of Americans ages 12 and older. Scientists considered the individual a “current cannabis user” if they had used marijuana at least once in the past 30 days. They then investigated what role depression had in these responses, as well as if the perception of risk associated with marijuana influenced decision making.

Pregnant women without depression varied greatly on using cannabis depending on that risk level. Those who perceived no risk used marijuana (16.5%) significantly higher than those who perceived moderate-great risk (0.9%). When compared to women with depression, though, both groups used cannabis at substantially lower levels.

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But scientists remained most concerned about pregnant teenagers with depression, believing more education is needed.

“As brain development is ongoing until age 25, cannabis use in this group may increase risks for both mother and offspring,” said Goodwin. “Our results provide recent nationally representative estimates suggesting that education and intervention efforts should be targeted at pregnant teens.”