Prenatal Marijuana Use Research Articles

The Risk of Ventricular Septal Defects Associated With Prenatal Marijuana Exposure: A Systematic Review and Meta-Analysis.

With the recent legalization of marijuana across the United States, its usage in pregnant women has increased. The aim of this meta-analysis was to determine if prenatal marijuana use increases the likelihood of ventricular septal defects. The analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search strategy identified 4 case-control studies that were ultimately included in the analysis with a combined 381,621 infant records. Quantitative analysis demonstrated prenatal marijuana usage significantly increases the likelihood of ventricular septal defects (odds ratio = 2.39, 95% confidence interval = 1.11-5.18).

Marijuana Use and Breastfeeding: A Survey of Newborn Nurseries.

Marijuana use has increased nationally and is the most common federally illicit substance used during pregnancy. This study aimed to describe hospital practices and nursery director knowledge and attitudes regarding marijuana use and breastfeeding and assess the association between breastfeeding restrictions and provider knowledge, geographic region, and state marijuana legalization status. We hypothesized that there would be associations between geography and/or state legalization and hospital practices regarding breastfeeding with perinatal marijuana use. A cross-sectional, 31-question survey was sent electronically to the 110 US hospital members of the Academic Pediatric Association's Better Outcomes through Research for Newborns (BORN) network. Survey responses were analyzed using descriptive statistics to report frequencies. For comparisons, χ2 and Fisher exact tests were used to determine statistical significance. Sixty-nine (63%) BORN nursery directors across 38 states completed the survey. For mothers with a positive cannabinoid screen at delivery, 16% of hospitals universally or selectively restrict breastfeeding. Most (96%) nursery directors reported that marijuana use while breastfeeding is "somewhat" (70%) or "very harmful" (26%). The majority was aware of the potential negative impact of prenatal marijuana use on learning and behavior. There were no consistent statistical associations between breastfeeding restrictions and provider marijuana knowledge, geographic region, or state marijuana legalization status. BORN newborn clinicians report highly variable and unpredictable breastfeeding support practices for mothers with perinatal marijuana use. Further studies are needed to establish evidence-based practices and to promote consistent, equitable care of newborns with perinatal marijuana exposure.

Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge.

To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively. Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward. · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..

Exploration of Differences between Women Who Do and Do Not Disclose Their Marijuana Use during Pregnancy.

This study aimed to explore demographic and health-related factors that may differentiate women who do and do not disclose their marijuana use during pregnancy. The current study is a secondary analysis of data from a prospective cohort of pregnant women identified as using marijuana during pregnancy via a variety of assessment tools including self-report, urine screen, and obstetrics record abstraction. The cohort included a convenience sample of women recruited from several antenatal clinics at The Ohio State University Wexner Medical Center (OSUWMC). To be eligible, women needed to be within the first or second trimester of their pregnancy, 16 to 50 years of age, able to communicate in English, and intended to deliver at OSUWMC. Chi-square, independent samples t-tests, and logistic regression analyses were used to explore differences between those who did and did not disclose their use in relation to physical and mental health diagnoses, adverse experiences, use of other substances, and demographics. Women who used marijuana during their pregnancy and had mental/physical health data available comprised the current sample (n = 109). Women who attended college were more likely to disclose their marijuana use compared with women who did not attend college (p < 0.001). Women who experienced homelessness (p < 0.01) or self-reported alcohol use during pregnancy (p < 0.001) were significantly more likely to disclose their marijuana use. Findings, suggesting disclosure of other substance use and adverse experiences, such as homelessness, may increase the likelihood that pregnant women will voluntarily disclose their marijuana use to providers. Findings did not reflect racial differences nor significant differences in mental/physical health status among women based on their disclosure. Future research with larger datasets is needed to build on these findings by confirming results, as well as exploring additional factors, that may more effectively differentiate women who are unlikely to disclose their prenatal marijuana use from those who do disclose their use. · Women with higher education were more likely to self-disclose their prenatal marijuana use.. · Women who experienced homelessness were more likely to self-disclose their prenatal marijuana use.. · Self-disclosure of prenatal alcohol use was related to self-disclosure of prenatal marijuana use.

Prenatal marijuana exposure and neonatal outcomes: a retrospective cohort study

ObjectivesPrevious literature on the effects of marijuana exposure on neonatal outcomes has been limited by the reliance on maternal self-report. The objective of this study was to examine the relationship...

Understanding Relationships Between Fetal Health Locus of Control (FHLC) and Maternal Marijuana Use During Pregnancy.

The objective of this study was to examine relationships between maternal perceptions of Fetal Health Locus of Control (FHLC) and perceived risk/benefit related to prenatal marijuana use with maternal marijuana use behaviors during pregnancy. The sample included women seeking prenatal care at The Ohio State University Wexner Medical Center (OSUWMC, Columbus OH) between 2010 and 2015, who participated in a follow-up study (2019-2020). Logistic regression models were run to estimate associations between maternal perceptions and prenatal marijuana use behaviors. Higher perceived benefit to mother (AOR = 1.53, 95% CI: 1.08-2.17) and lower perceived risk to children (AOR = 0.59, 95% CI: 0.45-0.78) were related to increased prenatal marijuana use, adjusted for confounders. In contrast, FHLC perceptions were not associated with maternal marijuana use; however, FHLC predicted women's perceptions of risk and benefit which in turn was associated with marijuana use during pregnancy. Understanding how maternal perceptions influence health-related risk behaviors during pregnancy is important because perceptions are feasible intervention targets.

Adverse childhood experiences and marijuana use during pregnancy: Findings from the North Dakota and South Dakota PRAMS, 2017–2019

BackgroundEmerging research suggests that adverse childhood experiences (ACEs) may be a risk factor for prenatal marijuana use. This study is the first to use a representative sample from state surveillance systems to assess the connection between accumulating ACEs and marijuana use during pregnancy. MethodsData are from the North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2017–2019 (N = 5399). The bivariate association between number of ACEs and marijuana use during pregnancy is assessed using a chi-square test. The multivariable association is assessed using linear probability modeling. ResultsOnly 0.9% of women with zero ACEs reported marijuana use during pregnancy, compared to 11.7% of women with four or more ACEs. Findings from linear probability models showed that mothers reporting two ACEs (b =0.023, 95% CI =0.003,.043), three ACEs (b =0.042, 95% CI =0.014,.069), and four or more ACEs (b =0.053, 95% CI =0.035,.071) are more likely to report marijuana use during pregnancy relative to those with zero ACEs, net of demographic and socioeconomic control variables. ConclusionsAccumulating maternal ACEs —especially four or more— is associated with increased likelihood of using marijuana during pregnancy. These findings demonstrate the early life trauma is a key social determinant of health over the life course and highlights how ACEs can contribute to intergenerational harm via the worsening of health behaviors during pregnancy.

Quantification of prenatal marijuana use: evaluation of the correlation between self-report, serum, urine and umbilical cord assays among women delivering at two urban Colorado hospitals.

To estimate during pregnancy correlations between frequency of self-reported use of marijuana and quantified marijuana metabolite in biospecimens including urine, sera and umbilical cord homogenate. Prospective cohort. Two urban hospitals in Colorado with legal recreational and medicinal marijuana. Pregnant women (<16weeks gestation) self-reporting marijuana use. Participants completed a written self-report survey and provided biospecimens at <16weeks gestation (n=46), 18 to 22weeks gestation (n=43), 32 to 36weeks gestation (n=39), and delivery (n=37). Self-reported marijuana use frequency was calculated based on past-monthdays of use multiplied by number of daily uses. Maternal urine and sera were tested for presence (>5ng/mL) of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH). Liquid chromatography tandem mass spectrometry quantified THC-COOH in umbilical cord homogenate (ng/g). Last marijuana use by any measure was recorded to evaluate the time frame over which THC-COOH remains detectable (>0.10ng/g) in cord. From December 2017 through May 2019, 51 pregnant women enrolled, and 46 were included in analyses (2 withdrew and 3 had a spontaneous abortion). The majority were normal weight, White or Black race, and insured by Medicaid. At the time of enrollment between 7 to 15weeks' gestation, 87% had ongoing use by self-report, or positive urine or serum. The majority (33 [66%]) stopped using before delivery. Sera and urine results were strongly correlated with self-reported use frequency (Spearman correlation coefficient [r] range 0.70-0.87 across visits, P<0.001), and with each other. There was only one positive cord result when use stopped before 22weeks. Frequency of self-reported marijuana use at delivery had strong correlation with quantified cord THC-COOH (r=0.80, 95% CI = 0.62-0.89). Quantified umbilical cord THC-COOH appears to strongly correlate with frequency of maternal marijuana use in the last month of pregnancy. Earlier use can be measured by either quantitative urine or serum assay.

55715 Quantification of Neonatal THC Exposure Following Prenatal Marijuana Use

ABSTRACT IMPACT: Quantification of neonatal THC exposure will allow for better insight into how THC exposure correlates with neurodevelopmental outcomes. OBJECTIVES/GOALS: Tetrahydrocannabinol (THC) use has become increasingly prevalent in recent years, including among pregnant women. However, few, if any, clinical studies have quantified precise in utero exposure levels of THC during pregnancy. Our study aims to fill this gap by using analytical methods to quantify THC in mother and baby following prenatal THC use. METHODS/STUDY POPULATION: Pregnant women were asked to give a self-report of all cannabis and cannabinoid use during pregnancy, including dose, frequency, and route of consumption. Upon arrival at the labor and delivery unit, maternal blood samples were collected. Immediately following birth and 24 hours after birth, umbilical cord and neonatal blood samples were collected, respectively. All blood samples were analyzed using tandem liquid chromatography-mass spectrometry (LC-MS) for the presence of THC, tetrahydrocannabinol carboxylic acid (THC-COOH), and hydroxy-tetrahydrocannabinol (THC-OH). Maternal THC and metabolite levels were compared to both cord and neonate samples. RESULTS/ANTICIPATED RESULTS: To date, we have collected 3 mother-infant sample dyads and 4 mother-infant control samples. We anticipate collecting a total of 20 mother-infant samples from each group. We will quantify levels of THC and its metabolites in maternal samples and compare these to cord and infant samples. We expect that THC/metabolite levels will vary as a function of dose and frequency of consumption. We also expect that THC/metabolites will be higher in umbilical cord blood relative to neonatal blood. DISCUSSION/SIGNIFICANCE OF FINDINGS: This study is among the first to directly measure exposure in the neonate following prenatal cannabis use. Quantification of THC/metabolite concentrations will be supplemented with developmental evaluations of infants at 6 and 12 months of age in order to gain better insight into how THC exposure correlates with neurodevelopmental outcomes.

Why Do I Smoke Pot when I’m Pregnant? A National Study Examining Social Correlates to Marijuana Use during Pregnancy

This study examined depression, legal involvement and social correlates to marijuana use among pregnant females in the US. The National Survey on Drug Use and Health data was examined. Unadjusted odds ratios were computed to determine if marijuana use duringpregnancy differed based on demographic variables, depression, legal involvement and smoking and alcohol use. Results from the unadjusted odds ratios indicated that marijuana use during pregnancy differed significantly based on age, race, health status, past year participation in governmental assistance, past year major depressive episode, past year legal involvement, and past month cigarette smoking, alcohol use and binge drinking. Multivariable logistic regression models revealed that those at highest risk for prenatal marijuana use were those who reported their health status was poor/fair/good health and those who drank alcohol in the past month. Past year majordepressive episode or legal involvement were not associated with marijuana use during pregnancy. Medical care providers and public health educators are encouraged to educate females of reproductive age regarding the adverse effects of marijuana use during pregnancy. Continued awareness campaigns, educational interventions and comprehensive substance abuse prevention programs addressing prenatal marijuana use are needed. Recommendations for future research are offered.

Maternal Marijuana Exposure, Feto-Placental Weight Ratio, and Placental Histology.

Marijuana use is associated with placenta-mediated adverse pregnancy outcomes including fetal growth restriction, but the mechanism remains uncertain. The objective was to evaluate the association between maternal marijuana use and the feto-placental weight ratio (FPR). Secondarily, we aimed to compare placental histology of women who used marijuana to those who did not. This was a secondary analysis of singleton pregnancies enrolled in a multicenter and case-control stillbirth study. Prior marijuana use was detected by electronic medical record abstraction or cord homogenate positive for 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid. Prior tobacco use was detected by self-report or presence of maternal serum cotinine. Stillbirths and live births were considered separately. The primary outcome was FPR. Association of marijuana use with FPR was estimated with multivariable linear modeling adjusted for fetal sex, preterm birth, and tobacco use. Comparisons between groups for placental histology were made using Chi-square and stratified by live birth and stillbirth, term and preterm deliveries, and fetal sex. Of 1,027 participants, 224 were stillbirths and 803 were live births. Overall, 41 (4%) women used marijuana during the pregnancy. The FPR ratio was lower among exposed offspring but reached statistical significance only for term stillbirths (mean 6.84 with marijuana use vs. mean 7.8 without use, p < 0.001). In multivariable modeling, marijuana use was not significantly associated with FPR (p = 0.09). There were no differences in histologic placental features among those with and without marijuana use overall or in stratified analyses. Exposure to marijuana may not be associated with FPR. Similarly, there were no placental histologic features associated with marijuana exposure. Further study of the influence of maternal marijuana use on placental development and function is warranted to better understand the association between prenatal marijuana use and poor fetal growth. · Maternal marijuana exposure was not associated with the feto-placental weight ratio.. · Marijuana exposure was not associated with differences in placental histology.. · Concerning trend toward lower feto-placental weight ratios among marijuana-exposed stillbirths..

Preterm Birth of Infants Prenatally Diagnosed with Congenital Heart Disease, Characteristics, Associations, and Outcomes.

There are limited data on the relation between congenital heart disease (CHD) and preterm birth (PTB). We aimed to estimate the risk of PTB in newborns with CHD, to study associations and risk factors (modifiable and non-modifiable) as well as investigate postnatal outcomes. This was a retrospective cohort study of 336 pregnancies diagnosed with CHD between 2011 and 2016. Groups consisted of those delivered at or after 37weeks, and those who delivered prior to 37weeks. Collected data included maternal and fetal characteristics as well postnatal outcomes. Complete data were obtained from 237 singleton pregnancies. The overall proportion of PTB was 23.2% for all CHD, of which 38.2% were spontaneous PTB which was almost unchanged after excluding extracardiac anomalies and pathogenic chromosomal abnormalities. Significant non-modifiable risk factors were pregnancy-related HTN disorders (P < 0.001), fetal growth restriction (P = 0.01), and pathogenic chromosomal abnormalities (P = 0.046). Significant PTB modifiable risk factors included prenatal marijuana use (P = 0.01). Pregnancies delivered at 37-38weeks had significantly more newborns with birthweight < 2500 g (P < 0.001), required more pre-operative NICU support including intubation (P = 0.049), vasopressors (P = 0.04), prostaglandins (P = 0.003), antibiotics (P = 0.01), and had longer hospital stay (P = 0.001) than those delivered at ≥ 39weeks. Prenatally diagnosed pregnancies with CHD had higher PTB rate compared to the general population, with spontaneous PTB comprising 38.2% of these preterm deliveries. Most PTB risk factors were non-modifiable, however, significant modifiable factors included marijuana use in pregnancy. Outcomes were favorable in neonates delivered at or beyond 39weeks.

Marijuana Use among Pregnant Women with Mental Health-Related Disabilities

This study was designed to examine prenatal marijuana use in pregnant women with disabilities related to mental health. Almost one-third (28.8%) of 3805 pregnant women reported a mental health-related disability, and 4% reported past 30-day marijuana use. Women with a moderate/severe mental health-related disability had higher adjusted-odds of marijuana use (OR: 2.05, 95% CI: 1.33, 3.16) than did their counterparts. Women were significantly more likely to use marijuana in the first than in a later trimester. Given potential adverse health outcomes associated with prenatal marijuana use, providers should screen pregnant women with mental health-related disabilities for marijuana use, and intervene to prevent and reduce/eliminate use.

1115: Measurement of prenatal marijuana use with bioassays and survey data

There is no gold standard for measurement of marijuana (MJ) use in pregnancy, and ethics preclude traditional pharmacokinetic studies. We aimed to evaluate the correlation of bioassays and detailed self-reported use in a longitudinal cohort of pregnant women in a state with legal recreational and medicinal MJ. Prospective longitudinal cohort of pregnant women (< 16 weeks singleton) identified by self-reported MJ use in the Denver metro area. The study involved a written self-report survey and metabolite detection in biospecimens at 4 longitudinal study visits (Table). Maternal urine and sera were tested for presence (>5ng/mL) of 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH). Liquid chromatography tandem mass spectrometry was used to quantify THC-COOH in umbilical cord homogenate. Cessation of use was defined as no reported use and negative serum and urine. Last MJ use was recorded to evaluate time frame over which THC-COOH remains detectable (>100pg/g) in cord. Spearman correlation was assessed between the bioassays and self-report. 50 pregnant women enrolled. 33 of 50 (66%) met the definition of MJ cessation prior to delivery (Table). Sera and urine results were strongly correlated with self-reported use at all study visits (Spearman correlation coefficient range 0.70-0.87 across visits, p< 0.001). 36 cord samples were collected at delivery (9 lost to follow-up, 2 miscarriages, 1 withdrew, 2 cords discarded). There were no positive cord results when MJ use stopped before 22 weeks. Among 6 women with use at the 32-36 week visit, 1 had detectable cord THC-COOH, and among 17 with ongoing use at delivery, 15 (88%) had cord THC-COOH. Frequency of MJ use in the past 30 days by self-report at delivery had strong correlation with quantified cord THC-COOH (Figure). Quantification of THC-COOH in cord homogenate strongly correlated with frequency of maternal MJ use in the last month of pregnancy. Earlier use can be measured by urine or serum assay. Together, these assays may allow for quantitative measurement and assessment of perinatal effects of MJ.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Impact of Marijuana Legalization on Prevalence of Maternal Marijuana Use and Perinatal Outcomes.

We aimed to assess whether marijuana legalization was associated with a difference in prevalence of prenatal use or an increase in incidence of adverse perinatal outcomes. The present study is a retrospective cohort of September and October deliveries in the years 2012 through 2015 at a tertiary center in Colorado. Primary outcome of the study was use of marijuana, defined by self-report or biodetection. Secondary outcomes of the study included growth restriction, spontaneous preterm birth, stillbirth, preeclampsia, and neonatal or maternal death. Marijuana use prevalence was compared by year, and secondary outcomes between two periods, before and after the opening of the first recreational dispensary. A total of 2,392 pregnant women were included (1,165 before legalization and 1,227 after). More women used marijuana over the period of legalization (trend p = 0.01). Odds of marijuana use were higher after legalization versus before (adjusted odds ratio [aOR] = 1.8, 95% confidence interval [CI]: 1.2-2.6). Incidence of growth restriction was higher after legalization (2.9 vs. 5.1%, p = 0.0084). This difference persisted after adjustment for ethnicity and other drugs in multivariable modeling (aOR = 1.9, 95%CI: 1.2-3.0). The prevalence of prenatal marijuana use increased over the time of legalization. Further investigation into the population impact of legalization on obstetrical outcomes is warranted given the observed increase in growth restriction.

Interaction of maternal choline levels and prenatal Marijuana's effects on the offspring.

This study investigated whether higher maternal choline levels mitigate effects of marijuana on fetal brain development. Choline transported into the amniotic fluid from the mother activates α7-nicotinic acetylcholine receptors on fetal cerebro-cortical inhibitory neurons, whose development is impeded by cannabis blockade of their cannabinoid-1(CB1) receptors. Marijuana use was assessed during pregnancy from women who later brought their newborns for study. Mothers were informed about choline and other nutrients, but not specifically for marijuana use. Maternal serum choline was measured at 16 weeks gestation. Marijuana use for the first 10 weeks gestation or more by 15% of mothers decreased newborns' inhibition of evoked potentials to repeated sounds (d' = 0.55, p < 0.05). This effect was ameliorated if women had higher gestational choline (rs = -0.50, p = 0.011). At 3 months of age, children whose mothers continued marijuana use through their 10th gestational week or more had poorer self-regulation (d' = -0.79, p < 0.05). This effect was also ameliorated if mothers had higher gestational choline (rs = 0.54, p = 0.013). Maternal choline levels correlated with the children's improved duration of attention, cuddliness, and bonding with parents. Prenatal marijuana use adversely affects fetal brain development and subsequent behavioral self-regulation, a precursor to later, more serious problems in childhood. Stopping marijuana use before 10 weeks gestational age prevented these effects. Many mothers refuse to cease use because of familiarity with marijuana and belief in its safety. Higher maternal choline mitigates some of marijuana's adverse effects on the fetus.

Marijuana Use in Pregnancy: A Review.

Marijuana is the most commonly used dependent substance in pregnancy. The main active chemical of marijuana (delta-9-tetrahydrocannabinol [THC]) readily crosses the placenta, and cannabinoid receptors have been identified in fetal brain and placenta. As a result, prenatal marijuana use could potentially have detrimental impact on fetal development. This review aims to summarize the existing literature and current recommendations for marijuana use while pregnant or lactating. A PubMed literature search using the following terms was performed to gather relevant data: "cannabis," "cannabinoids," "marijuana," "fetal outcomes," "perinatal outcomes," "pregnancy," "lactation." Available studies on marijuana exposure in pregnancy were reviewed and support some degree of developmental disruption, including an increased risk of fetal growth restriction and adverse neurodevelopmental consequences. However, much of the existing prenatal marijuana research was performed in the 1980s, when quantities of THC were lower and the frequency of use was less. Additionally, most human studies are also limited and conflicting as most studies have been observational or retrospective, relying primarily on patient self-report and confounded by polysubstance abuse and small sample sizes, precluding determination of a causal effect specific for marijuana. Given the paucity of evidence, it is currently recommended to avoid using marijuana while pregnant or when breastfeeding. There is a critical need for research on effects in pregnancy using present-day THC doses. Once the adverse perinatal effects of marijuana exposure are identified and well characterized, patient education and antenatal surveillance can be developed to predict and mitigate its impact on maternal and fetal health.

Excerpts From the World Medical Literature: Obstetrics.

Summary: This was a cross-sectional study among pregnant women admitted for delivery at two urban hospitals in a state with legalized marijuana use. Singleton, viable pregnancies at 24 weeks gestation or more were eligible for the study. The principal goal of the study was to compare subjective reporting of marijuana use with quantitative biological samples from the umbilical cord for the most stable marijuana metabolite, 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH). A secondary objective was to correlate the reported frequency of use in the month before delivery with the amount of drug detected in the umbilical cord. Patients were asked to complete an anonymous survey designed by the authors of the study, addressing the frequency and recency of marijuana use in pregnancy. Study identification numbers linked the patients’ survey to their self-report of past or current prenatal marijuana use to a health care provider during the admission history and physical examination. Umbilical cord segments were collected at delivery and tested for the metabolite by liquid chromatography–tandem mass spectrometry only as a batched analysis at the end of study enrolment, in order not to link cord test results to individual patients. The study participants were not informed of the biological testing component of the umbilical cord. The authors note that waiver of consent was granted by the institutional review board for collection of the biological sample; the study could not practicably occur without this waiver, and samples are routinely collected for cord gas analysis and subsequently discarded, thereby ensuring no to minimal risk to the patients. The limit of detection in the cord assay was 100pg/g, and the limit of quantification was 200pg/g. Data analyses were based on 116 patients with both survey and cord data. Gestational ages at delivery were categorized as preterm, less than 37 weeks, and term; term gestational ages were categorized into three groups. More women admitted to past-month use on their self-reported survey compared with when asked by the health care provider (6% vs. 2.6%, respectively). Among cord assays, 22.4% had THC-COOH values above the detection limit (research test threshold), and 10.3% were above the limit of quantification (clinical test threshold). The studyfound poor agreement between self-reported measures of marijuana consumption and objective samples. Many women who reported no consumption in the past 30days actually had positive cord samples for the drug's metabolite.

Developmental Consequences of Prenatal Substance Use in Children and Adolescents.

Objective: Prenatal substance use is increasing and is a major public health concern due to its impact on women's health and child development. Prior studies demonstrate an association between prenatal substance use and deficits in children's physical, cognitive, behavioral, and emotional development. Many studies, however, have significant methodological limitations that hinder our understanding of the impact of substance use on child development. The goal of this review is to describe the risks of prenatal substance use on child development among studies that have overcome major study limitations to inform the development of targeted interventions to improve child health. Methods: Studies investigating the relationship between prenatal substance use and its impact on child development are identified. Studies employing a prospective, longitudinal study design with appropriate comparison groups and methods accounting for potentially confounding variables are reviewed. Results: Prenatal tobacco or alcohol use has the most well-established adverse impact on child development, including an increased risk for behavioral problems and deficits in academic performance, resulting in significant functional impairment. Prenatal marijuana use is associated with deficits in executive and intellectual functioning among school-age children and adolescents. Prenatal opioid use and child development findings are conflicting, but treatment with opioid agonist therapy for opioid use disorder (e.g., methadone or buprenorphine) does not appear to have a negative impact on child growth, cognition, language abilities, sensory processing, or temperament. Prenatal amphetamine and cocaine use may have a negative impact on child development, but effects, in part, are mediated by childhood environment and adversity. Conclusions: Preventative efforts in women's health are needed to reduce substance use and unplanned pregnancies. Early interventions for children exposed to substances are needed as well as interventions targeting the myriad of issues that co-occur with substance use, including poverty, mental health problems, and childhood adversity.

Trends in marijuana use among pregnant women with and without nausea and vomiting in pregnancy, 2009–2016

BackgroundCross-sectional studies indicate an elevated prevalence of prenatal marijuana use in women with nausea and vomiting in pregnancy (NVP). However, it is unknown whether differences in marijuana use by NVP status have persisted over time as marijuana becomes more acceptable and accessible and prenatal use increases overall. We compared trends in prenatal marijuana use by NVP status in the first trimester of pregnancy using data from Kaiser Permanente Northern California’s (KPNC) large healthcare system. MethodsThe sample comprised KPNC pregnant women aged ≥12 who completed a self-administered questionnaire on marijuana use and a urine toxicology test for cannabis during standard prenatal care from 2009 to 2016. The annual prevalence of marijuana use via self-report or toxicology by NVP status was estimated using Poisson regression with a log link function, adjusting for sociodemographics and parity. We tested for linear trends and differences in trends by NVP. ResultsOf 220,510 pregnancies, 38,831 (17.6%) had an NVP diagnosis. Prenatal marijuana use was elevated each year among women with NVP. The adjusted prevalence of use increased significantly from 2009 to 2016 at an annual rate of 1.086 (95%CI = 1.069–1.104) among women with NVP, from 6.5% (95%CI = 5.7%–7.2%) to 11.1% (95%CI = 0.2%–12.0%), and 1.069 (95%CI = 1.059–1.080) among women without NVP, from 3.4% (95%CI = 3.2%–3.7%) to 5.8% (95%CI = 5.5%–6.1%). Trends did not vary by NVP status. DiscussionThe prevalence of prenatal marijuana use has remained elevated over time among women with NVP. Clinicians should ask pregnant patients about their reasons for marijuana use and treat NVP with evidence-based interventions.