CL Case Conference: The Evaluation and Management of Anxiety and Cannabis Use in Pregnancy.

Kappagantu A.; Shenai N.; Gopalan P.; Hage B. · Journal of the Academy of Consultation-Liaison Psychiatry · 2026

**Background & Methods** This is a case conference review presenting a 25-year-old pregnant patient (G2P0010, second trimester) with concurrent anxiety disorder, cannabis use disorder, and insulin-dependent diabetes who presented with recurrent self-induced vomiting requiring multiple hospitalizations. The case discussion involves reproductive psychiatry experts evaluating psychiatric management strategies during pregnancy, with emphasis on medication selection, risk-benefit analysis, and integrated obstetrical-psychiatric care. **Key Findings** • Multiple anxiolytic agents with varying safety profiles in pregnancy were trialed during hospitalization, highlighting the clinical complexity of balancing anxiety treatment efficacy against potential fetal risks and the consequences of untreated maternal psychiatric illness. • Perinatal cannabis use significantly impacts anxiety symptomatology and complicates treatment planning; the case illustrates how substance use patterns must be integrated into comprehensive psychiatric assessment and medication management strategies in pregnant patients. • Systemic factors including psychiatric disposition, coordination between obstetrics and psychiatry services, and management of comorbid medical conditions (diabetes) are critical determinants of maternal and fetal outcomes in complex cases requiring multidisciplinary care. **Dosage & Administration** Not reported. The abstract indicates that multiple anxiolytics were trialed but does not specify drug names, doses, routes of administration, or duration of therapy. **Safety & Adverse Effects** Not reported in detail. The abstract emphasizes that anxiolytic selection required consideration of "varied safety profiles in pregnancy" and discussion of risks of medication versus risks of untreated illness, but specific adverse effects are not enumerated. **Evidence Quality** This is a case conference review with limited evidence quality (Level 5 evidence). Limitations include: single case presentation without comparative data, lack of systematic outcome measurement, absence of control group, reliance on clinical narrative rather than empirical data, and no quantitative assessment of intervention efficacy. The value lies in illustrative clinical reasoning and expert consensus regarding management principles rather than generalizable evidence. Findings are not applicable to broader populations without additional research. The review format provides educational value for clinicians managing similar cases but cannot establish causation or efficacy of specific interventions.

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