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Zhu K, Shelton J, Li C, Mendola P, Barnabei VM, Myneni AA, Giovino GA, Stevens R, Taylor RN, Niu Z, Mu L. Association between maternal cigarette smoking cessation and risk of preterm birth in Western New York. Paediatr Perinat Epidemiol 2024; 38:316-326. [PMID: 38558461 DOI: 10.1111/ppe.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/20/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Although many studies suggested the benefit of smoking cessation among pregnant women in reducing the risk of preterm birth (PTB), the timing of the effect of the cessation remains inconclusive. OBJECTIVES To examine the association of trimester-specific smoking cessation behaviours with PTB risk. METHODS We included 199,453 live births in Western New York between 2004 and 2018. Based on self-reported cigarette smoking during preconception and in each trimester, we created six mutually exclusive groups: non-smokers, quitters in each trimester, those who smoked throughout pregnancy, and inconsistent smokers. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression to examine the association between smoking cessation and PTB. Effect modification by illegal drug use, maternal age, race and ethnicity and pre-pregnancy body mass index (BMI) was investigated multiplicatively by ratio of relative risk and additively by relative excess risk due to interaction (RERI). RESULTS Overall, 6.7% of women had a PTB; 14.1% smoked throughout pregnancy and 3.4%, 1.8% and 0.8% reported quitting smoking during the first, second and third trimesters, respectively. Compared to non-smokers, third-trimester cessation (RR 1.20, 95% CI 1.01, 1.43) and smoking throughout pregnancy (RR 1.27, 95% CI 1.21, 1.33) were associated with a higher PTB risk, while quitting smoking during the first or second trimester, or inconsistent smoking was not associated with PTB. A positive additive interaction was identified for maternal age and late smoking cessation or smoking throughout pregnancy on PTB risk (RERI 0.17, 95% CI 0.00, 0.36), and a negative interaction was observed for pre-pregnancy BMI ≥30 kg/m2 (ratio of relative risk 0.70, 95% CI 0.63, 0.78; RERI -0.42, 95% CI -0.56, -0.30). CONCLUSION Compared to non-smokers, smoking throughout pregnancy and third-trimester smoking cessation are associated with an increased risk of PTB, while quitting before the third trimester may not increase PTB risk.
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Affiliation(s)
- Kexin Zhu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - James Shelton
- Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Chan Li
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Vanessa M Barnabei
- Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gary A Giovino
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Rebeccah Stevens
- Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Robert N Taylor
- Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Zhongzheng Niu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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Chaput KH, McMorris CA, Metcalfe A, Ringham C, McNeil D, Konschuh S, Sycuro LJ, McDonald SW. Development and validation of the Cannabis Exposure in Pregnancy Tool (CEPT): a mixed methods study. BMC Pregnancy Childbirth 2024; 24:280. [PMID: 38627667 PMCID: PMC11022340 DOI: 10.1186/s12884-024-06485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Evidence of associations between prenatal cannabis use (PCU) and maternal and infant health outcomes remains conflicting amid broad legalization of cannabis across Canada and 40 American states. A critical limitation of existing evidence lies in the non-standardized and crude measurement of prenatal cannabis use (PCU), resulting in high risk of misclassification bias. We developed a standardized tool to comprehensively measure prenatal cannabis use in pregnant populations for research purposes. METHODS We conducted a mixed-methods, patient-oriented tool development and validation study, using a bias-minimizing process. Following an environmental scan and critical appraisal of existing prenatal substance use tools, we recruited pregnant participants via targeted social media advertising and obstetric clinics in Alberta, Canada. We conducted individual in-depth interviews and cognitive interviewing in separate sub-samples, to develop and refine our tool. We assessed convergent and discriminant validity internal consistency and 3-month test-retest reliability, and validated the tool externally against urine-THC bioassays. RESULTS Two hundred fifty four pregnant women participated. The 9-item Cannabis Exposure in Pregnancy Tool (CEPT) had excellent discriminant (Cohen's kappa = -0.27-0.15) and convergent (Cohen's kappa = 0.72-1.0) validity; as well as high internal consistency (Chronbach's alpha = 0.92), and very good test-retest reliability (weighted Kappa = 0.92, 95% C.I. [0.86-0.97]). The CEPT is valid against urine THC bioassay (sensitivity = 100%, specificity = 82%). CONCLUSION The CEPT is a novel, valid and reliable measure of frequency, timing, dose, and mode of PCU, in a contemporary sample of pregnant women. Using CEPT (compared to non-standardized tools) can improve measurement accuracy, and thus the quality of research examining PCU and maternal and child health outcomes.
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Affiliation(s)
- Kathleen H Chaput
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 2500 Unievrsity Drive NW, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Carly A McMorris
- Werklund School of Education, School and Child Psychology, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 2500 Unievrsity Drive NW, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Catherine Ringham
- School of Nursing, Thomson Rivers University, 40 College Way, Kamloops, BC, Canada
| | - Deborah McNeil
- Department of Community Health Sciences, Cumming School of Medicine University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Shaelen Konschuh
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Laura J Sycuro
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 2500 Unievrsity Drive NW, Calgary, AB, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sheila W McDonald
- Department of Community Health Sciences, Cumming School of Medicine University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
- Research and Innovation Population, Public, and Indigenous Health, Alberta Health Services, Edmonton, Canada
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Hossein-Javaheri N, O’Connor K, Steinhart H, Deshpande A, Maxwell C, Huang V, Tandon P. Perceptions and Prevalence of Cannabis Use in Women With Inflammatory Bowel Disease of Reproductive Age: A Cross-Sectional Study. J Can Assoc Gastroenterol 2024; 7:204-211. [PMID: 38596807 PMCID: PMC10999762 DOI: 10.1093/jcag/gwad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background Many patients with inflammatory bowel disease (IBD) may use cannabis for relief of symptoms. During pregnancy, however, cannabis exposure may be associated with adverse pregnancy outcomes. We aimed to determine the prevalence and perceptions of cannabis use in women with IBD. Methods Through recruitment at Mount Sinai Hospital and online platforms such as Twitter, women with IBD (age 18-45) were asked to complete anonymous surveys on demographics, cannabis use, perception of use during pregnancy, and discussing its use with healthcare providers (HCP). Categorical variables were reported as frequencies and compared across groups with the chi-square test. Results One-hundred and two pregnant patients with IBD were included in this study, 19 (18.6%) reported using cannabis. Current users were more likely to report constant pain in the last 12 months and discuss its use with their HCP. Fifty-three (52.0%) women were unsure of the specific risks associated with cannabis use during pregnancy, and only 15 (14.7%) had ever discussed its use with their HCP. Those who had discussed cannabis use with their HCP were more likely to have prior IBD-related surgery, perceive its use unsafe during pregnancy, and be more likely to be using cannabis. Conclusion Many women with IBD report uncertainty of the risks of cannabis use during pregnancy and the majority have never discussed cannabis use with their providers. With the increasing legalization of cannabis in many jurisdictions, it is imperative patients and healthcare providers discuss the risks and benefits of its use, particularly during vulnerable times such as pregnancy.
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Affiliation(s)
- Nariman Hossein-Javaheri
- Department of Internal Medicine, University at Buffalo-State University of New York, Buffalo, New York, USA
| | - Katie O’Connor
- Division of Gastroenterology and Hepatology, University Health Network/Mount Sinai Hospital, University of Toronto, Toronto, Ontario, M5G 1X5Canada
| | - Hillary Steinhart
- Division of Gastroenterology and Hepatology, University Health Network/Mount Sinai Hospital, University of Toronto, Toronto, Ontario, M5G 1X5Canada
| | - Amol Deshpande
- Department of Family and Community Medicine, Toronto Rehabilitation Institute, Quality and Innovation, University of Toronto, Ontario, Canada
| | - Cynthia Maxwell
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Vivian Huang
- Division of Gastroenterology and Hepatology, University Health Network/Mount Sinai Hospital, University of Toronto, Toronto, Ontario, M5G 1X5Canada
| | - Parul Tandon
- Division of Gastroenterology and Hepatology, University Health Network/Mount Sinai Hospital, University of Toronto, Toronto, Ontario, M5G 1X5Canada
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Tadesse AW, Dachew BA, Ayano G, Betts K, Alati R. Prenatal cannabis use and the risk of attention deficit hyperactivity disorder and autism spectrum disorder in offspring: A systematic review and meta-analysis. J Psychiatr Res 2024; 171:142-151. [PMID: 38281464 DOI: 10.1016/j.jpsychires.2024.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND It is plausible that exposure to cannabis in-utero could be associated with an increased risk of neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) symptoms and autism spectrum disorder (ASD) during childhood and adolescence; however, mixed results have been reported. This study investigated whether there is an association between prenatal cannabis use and ADHD symptoms and ASD in offspring using a systematic review and meta-analysis methodology. METHODS A systematic literature search was conducted in PubMed/Medline, Scopus, EMBASE, Web of Science, Psych-Info, and Google Scholar to identify relevant studies. The study protocol has been preregistered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42022345001), and the Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess the methodological quality of included studies. An inverse variance weighted random effect meta-analysis was conducted to pool the overall effect estimates from the included studies. RESULTS Fourteen primary studies, consisting of ten on ADHD and four on ASD, with a total of 203,783 participants, were included in this study. Our meta-analysis underscores an increased risk of ADHD symptoms and/or disorder [β = 0.39: 95 % CI (0.20-0.58), I2 = 66.85 %, P = 0.001)] and ASD [RR = 1.30: 95 % CI (1.03-1.64), I2 = 45.5 %, P = 0.14] associated with in-utero cannabis exposure in offspring compared to their non-exposed counterparts. Additionally, our stratified analysis highlighted an elevated risk of ADHD symptoms [β = 0.54: 95 % CI (0.26-0.82)] and a marginally significant increase in the risk of diagnostic ADHD among exposed offspring compared to non-exposed counterparts [RR = 1.13, 95 % CI (1.01, 1.26)]. CONCLUSION This study indicated that maternal prenatal cannabis exposure is associated with a higher risk of ADHD symptoms and ASD in offspring.
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Affiliation(s)
- Abay Woday Tadesse
- School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia; Department of Public Health, College of Medicine and Health Sciences, Samara University, 132, Semera, Ethiopia.
| | - Berihun Assefa Dachew
- School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Getinet Ayano
- School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Kim Betts
- School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Rosa Alati
- School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia; Institute for Social Sciences Research, The University of Queensland, 80 Meier's Rd, Indooroopilly, QLD, 4068, Australia
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Moore BF. Prenatal Exposure to Cannabis: Effects on Childhood Obesity and Cardiometabolic Health. Curr Obes Rep 2024; 13:154-166. [PMID: 38172481 PMCID: PMC10933144 DOI: 10.1007/s13679-023-00544-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW To consolidate information on the obesogenic and cardiometabolic effects of prenatal exposure to cannabis. RECENT FINDINGS A PubMed search strategy updated from January 1, 2014, through 14 June 2023, produced a total of 47 epidemiologic studies and 12 animal studies. Prenatal exposure to cannabis is consistently associated with small for gestational age and low birth weight. After birth, these offspring gain weight rapidly and have increased adiposity and higher glucose (fat mass percentage) in childhood. More preclinical and prospective studies are needed to deepen our understanding of whether these associations vary by sex, dose, timing, and composition of cannabis (e.g., ratio of delta-Δ9-tetrahydrocannabinol [Δ9-THC] to cannabidiol [CBD]). Addressing these gaps may help to solidify causality and identify intervention strategies. Based on the available data, clinicians and public health officials should continue to caution against cannabis use during pregnancy to limit its potential obesogenic and adverse cardiometabolic effects on the offspring.
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Affiliation(s)
- Brianna F Moore
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Aurora, 80045, CO, USA.
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6
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Baía I, Domingues RMSM. The Effects of Cannabis Use during Pregnancy on Low Birth Weight and Preterm Birth: A Systematic Review and Meta-analysis. Am J Perinatol 2024; 41:17-30. [PMID: 35901851 DOI: 10.1055/a-1911-3326] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Our objective was to summarize the literature regarding the effects of cannabis use during pregnancy on low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). STUDY DESIGN This is a systematic review and meta-analysis. A literature search was conducted in PubMed, Scopus, EBSCO, and Web of Science in May 2021 and updated in November 2021. Only studies that assessed the isolated use of cannabis during pregnancy, controlling for cigarette smoking, and other illicit drug use were included. Data were synthesized using a narrative summary and pooled adjusted estimates, and 95% confidence intervals (CIs) were calculated for each outcome. Data were analyzed using Stata 13.0 with METAN software package, using random effects. Statistical heterogeneity was assessed using Cochran's Q and Higgins I2 tests. RESULTS In total, 32 studies were included with data from approximately 5.5 million women with the LBW outcome and 23 million with the PTB and SGA outcomes. Pregnant women using cannabis are at increased risk for LBW (adjusted odds ratio [aOR] = 1.52; 95% CI = [1.18; 1.96]), PTB (aOR = 1.39; 95% CI = [1.28; 1.51]), and SGA (aOR = 1.47; 95% CI = [1.38; 1.58]). Studies that assessed the type of PTB and gestational age at birth indicate higher risks of spontaneous PTB and of early or very-early PTBs associated with cannabis use during pregnancy. The few studies that assessed the timing and frequency of consumption suggest a dose-response effect, with higher odds of negative outcomes among women who reported heavy use and with continued use during the second and third trimesters of gestation. CONCLUSION There is an effect of cannabis irrespective of other illicit drugs and tobacco despite high heterogeneity and low quality of evidence. There is a need to discuss public policies regarding cannabis' regulation and how it influences its consumption. Future studies should focus on the effects of cannabis's type (medicinal or recreational), timing, and dosage during pregnancy on perinatal outcomes. KEY POINTS · Cannabis use during pregnancy is increasing.. · Cannabis has an independent effect on PTB, LBW, and SGA.. · Future studies should focus on the timing of exposure during pregnancy, mode of use, and dosage..
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Affiliation(s)
- Inês Baía
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Rosa M S M Domingues
- Epidemiologist, Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz. Rio de Janeiro, Brazil
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Skala K, Trabi T, Fuchs M, Gössler R, Haas-Stockmair CW, Kriechbaumer N, Leitner M, Ortner N, Reiter M, Müller C, Wladika W. [Cannabis use in adolescents : Narrative Review and Position paper of the "Addiction Disorders in Adolescents" task force of the Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP)]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:175-195. [PMID: 35900691 DOI: 10.1007/s40211-022-00424-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cannabis is the illegal drug most frequently used by Minors in Austria. Due to the gradual decriminalization and legalization that has taken place in many European countries in recent years, the ÖGKJP would like to take a balanced and scientifically based stand on the complex issue of cannabis use and abuse among young people. METHODS The authors searched the medline for current studies using searches tailored to each specific subtopic. Furthermore, recognized compendiums were quoted. RESULTS While occasional recreational use of cannabis in adults with completed brain maturation and no risk profile for mental disorders is likely to be relatively harmless, early initiation of use with regular use and the increasingly available, highly potent cannabis varieties can lead to explicit and sometimes irreversible neurocognitive brain dysfunction. CONCLUSION Legalisation of cannabis consumption for minors needs to be objected to due to the risks of the expected damage in the area of brain development. At the same time, however, it is important to establish sensible legal regulations in order to be able to adequately counteract the fact that over 30% of all European young people occasionally consume cannabis. We are also clearly recommending to not criminalize cannabis users and provide necessary support to vulnerable and addicted cannabis users.
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Affiliation(s)
- Katrin Skala
- Univ. Klinik für Kinder und Jugendpsychiatrie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Thomas Trabi
- Abteilung für Kinder- und Jugendpsychiatrie, LKH Graz II, Graz, Österreich
| | - Martin Fuchs
- Univ. Klinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Ralf Gössler
- Abteilung für Kinder- und Jugendpsychiatrie, Klinik Floridsdorf, Floridsdorf, Österreich
| | | | | | - Monika Leitner
- Praxis für Kinder- und Jugendpsychiatrie, Graz, Österreich
| | - Nora Ortner
- Univ. Klinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Melanie Reiter
- Univ. Klinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Christian Müller
- Ambulatorium für Kinder- u. Jugendpsychiatrie, PSD Einsenstadt, Einsenstadt, Österreich
| | - Wolfgang Wladika
- Abteilung für Neurologie und Psychiatrie des Kindes- und Jugendalters, Klinikum Klagenfurt, Klagenfurt, Österreich
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Ayonrinde OT, White SW, Mehta S, Dunn ML, Bradley C, Fisher P, Ayonrinde OA. Response to Letter to the Editor 'Gestational cannabis use - Implications for neonatal size and maturity?'. Aust N Z J Obstet Gynaecol 2023; 63:831-832. [PMID: 38140751 DOI: 10.1111/ajo.13742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Oyekoya T Ayonrinde
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Medical School, The University of Western Australia, Nedlands, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Scott W White
- Medical School, The University of Western Australia, Nedlands, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Shailender Mehta
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Department of Neonatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mikaela L Dunn
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Clare Bradley
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Petrovia Fisher
- Department of Obstetrics and Gynaecology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Oyedeji A Ayonrinde
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
- Providence Care Hospital, Kingston, Ontario, Canada
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Avalos LA, Adams SR, Alexeeff SE, Oberman NR, Does MB, Ansley D, Goler N, Padon AA, Silver LD, Young-Wolff KC. Neonatal outcomes associated with in utero cannabis exposure: a population-based retrospective cohort study. Am J Obstet Gynecol 2023:S0002-9378(23)02034-3. [PMID: 38029850 PMCID: PMC11128475 DOI: 10.1016/j.ajog.2023.11.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The full spectrum of associations between in utero cannabis exposure and adverse neonatal outcomes is still unclear. OBJECTIVE This study aimed to evaluate the associations between in utero cannabis exposure and neonatal outcomes. STUDY DESIGN This population-based retrospective cohort study of singleton births among Kaiser Permanente Northern California members (January 1, 2011-July 31, 2020) included parent-infant dyads in which the pregnant parent was screened for cannabis use as part of standard prenatal care, generally upon entrance into care. Data were ascertained from electronic health records. Generalized estimating equation models were adjusted for sociodemographic characteristics, other non-cannabis prenatal substance use, medical and mental health comorbidities, and adequacy of prenatal care. In utero cannabis exposure was defined as self-reported use since becoming pregnant and/or a positive urine toxicology test for cannabis at any time during pregnancy (yes/no; primary exposure). Frequency of use was self-reported and categorized as daily, weekly, monthly or less, never, or unknown (secondary exposure). Neonatal outcomes included low birthweight, small for gestational age, preterm birth, neonatal intensive care unit admission, and infant respiratory support. RESULTS Of 364,924 infants, 22,624 (6.2%) were exposed to cannabis in utero. After adjustment for potential confounders, including in utero exposure to other substances, in utero exposure to cannabis was associated with greater odds of low birthweight (adjusted odds ratio, 1.20; 95% confidence interval, 1.12-1.28), small for gestational age (adjusted odds ratio, 1.24; 95% confidence interval, 1.18-1.30), preterm birth (<37 weeks; adjusted odds ratio, 1.06; 95% confidence interval, 1.00-1.13), and neonatal intensive care unit admission (adjusted odds ratio, 1.06; 95% confidence interval, 1.01-1.11). There was a suggestive association with early preterm birth (<34 weeks; adjusted odds ratio, 1.11; 95% confidence interval, 1.00-1.23; P=.055), but no significant association with respiratory support (adjusted odds ratio, 1.07; 95% confidence interval, 0.97-1.18). Dose-response analysis found an increasing likelihood of low birthweight and small for gestational age with increasing frequency of prenatal cannabis use by the pregnant individual. Sensitivity analyses further supported an increased likelihood of low birthweight and small for gestational age, although associations with other outcomes did not reach statistical significance. CONCLUSION In utero cannabis exposure was associated with increased likelihood of low birthweight, small for gestational age, preterm birth, and neonatal intensive care unit admission. Clinicians should counsel individuals who are pregnant or considering pregnancy about the potential adverse neonatal health outcomes associated with prenatal cannabis use.
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Affiliation(s)
- Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Nina R Oberman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Monique B Does
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Deborah Ansley
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA
| | | | | | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA
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Talavera-Barber MM, Morehead E, Ziegler K, Hockett C, Elliott AJ. Prenatal cannabinoid exposure and early language development. Front Pediatr 2023; 11:1290707. [PMID: 38078314 PMCID: PMC10702953 DOI: 10.3389/fped.2023.1290707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/31/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction The effect of prenatal cannabis exposure (PCE) on childhood neurodevelopment remains poorly understood. There is a paucity of studies describing the neurodevelopment impact of PCE in infancy. The Mullen Scale of Early Learning (MSEL) is a cognitive screening tool that can be used from birth to 68 months and includes language and motor domains. Here we aim to explore the association between PCE during pregnancy and neurodevelopmental outcomes at 12 months of age. Methods Participants were pregnant persons/infant pairs enrolled in The Safe Passage Study, a large prospective cohort study. Inclusion criteria included data available on PCE with associated MSEL scores at 12 months of age. Exposed participants were defined as early exposure (1st trimester only) or late exposure (2nd or 3rd trimester) and were randomly matched with unexposed participants. Multiple linear regression models were performed to test associations between prenatal cannabis exposure and the five Mullen subscales: gross motor, fine motor, expressive language, receptive language, and visual reception. Results Sixty-nine exposed and 138 randomly matched unexposed infants were included in the analyses. Mothers of children with PCE were younger with the mean age 23.7 years for early exposure (n = 51) and 22.8 years for late exposure (n = 18). Maternal characteristics with prenatal cannabis use include a high-school education, American Indian or Alaska Native descent, lower socioeconomic status and co-use of tobacco. There were no gestational age or sex difference among the groups. Expressive (95% CI: 2.54-12.76; p = 0.0036,) and receptive language scores (95% CI: 0.39-8.72; p = 0.0322) were significantly increased between late-exposed infants compared to unexposed infants following adjustment for covariates. Gross motor scores (95% CI: 1.75-13; p = 0.0105) were also significantly increased for early-exposed infants with no difference in visual reception scores. Conclusion Preclinical studies have shown abnormal brain connectivity in offspring exposed to cannabis affecting emotional regulation, hyperactivity, and language development. Results from this study link PCE to altered early language development within the first year of life. Exposed infants demonstrated increased expressive and receptive language scores at 12 months of age, which can translate to better performance in school. However, further research is needed to determine the implications of these results later in childhood.
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Affiliation(s)
- Maria M. Talavera-Barber
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
| | - Evlyn Morehead
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Katherine Ziegler
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
| | - Christine Hockett
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
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11
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Avalos LA, Oberman N, Alexeeff SE, Croen LA, Adams SR, Davignon M, Young-Wolff KC. Association between maternal prenatal cannabis use and missed child preventive care visits in an integrated health care delivery system in Northern California. Prev Med 2023; 175:107716. [PMID: 37775081 PMCID: PMC10849893 DOI: 10.1016/j.ypmed.2023.107716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
The periodicity of well-child visits recommended by the American Academy of Pediatrics emphasizes the importance of continuity of care in health management. Exposure to cannabis in utero has been associated with adverse development, and adherence to well-child visits is critical for earlier detection and intervention. To assess whether maternal prenatal cannabis use was associated with missed well-child visits in the first three years after birth we conducted a longitudinal cohort study in Kaiser Permanente Northern California of pregnant individuals and their children born between January 1, 2011 and December 31, 2018. Maternal prenatal cannabis use was defined as any self-reported cannabis use since becoming pregnant and/or a positive urine toxicology test for cannabis during pregnancy. Well-child visits were defined as an encounter for a well-child visit or physical exam and categorized into seven time periods from birth to 36 months. Modified Poisson regression models were conducted. Of the 168,589 eligible pregnancies, 3.4% screened positive for maternal prenatal cannabis use. Compared to no use, maternal prenatal cannabis use was associated with more missed well-child visits at every time period; (missed 12-month visit: adjusted relative risk (aRR): 1.43, 95%CI: 1.32-1.54; missed 3-year visit: aRR: 1.15, 95%CI: 1.11-1.20). Maternal prenatal cannabis use was also associated with missing two or more well-child visits through 36 months of age (35.8% among cannabis users vs. 23.0% among non-users, Χ2p < .001). Educating pregnant individuals who use cannabis on the importance of well-child visits may benefit children's health and development.
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Affiliation(s)
- Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America.
| | - Nina Oberman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Meghan Davignon
- The Permanente Medical Group, Oakland, CA, United States of America
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States of America
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12
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Alves P, Amaral C, Teixeira N, Correia-da-Silva G. Effects of a combination of cannabidiol and delta-9-tetrahydrocannabinol on key biological functions of HTR-8/SVneo extravillous trophoblast cells. Toxicology 2023; 495:153614. [PMID: 37567336 DOI: 10.1016/j.tox.2023.153614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
In recent years, cannabis use has increased among pregnant women. In addition, the phytocannabinoids cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) alone or in combination are being used for therapeutical applications. THC and CBD are able to cross the placenta and a lot remains unknown concerning their impact on angiogenesis and extravillous trophoblasts' (EVTs) migration and invasion, which are essential processes for placentation. Thus, in this study, the HTR-8/SVneo cell line was employed to evaluate the effects of CBD, THC and of their combination (1:1, 2 µM). Cannabinoids affected epithelial-mesenchymal transition, as showed by increased expression of the epithelial protein marker E-cadherin for CBD and CBD plus THC treatments, and decrease of mesenchymal intermediate filament vimentin for all treatments. The gene expression of the metalloproteinases MMP2 and MMP9, and of their inhibitors TIMP1 and TIMP2 was increased, except the latter for THC treatment. Moreover, CBD reduced cell migration and invasion, an effect that was enhanced by its combination with THC. CBD with or without THC also upregulated the gene expression of PGF, while the anti-angiogenic factor sFLT1 was increased for all treatments. VEGFA and FLT1 were not affected. Alone or combined CBD and THC also decreased tube segments' length. Additionally, ERK1/2 and STAT3 phosphorylation was increased in the CBD and CBD plus THC-treated cells, while THC only activated STAT3. AKT activation was only affected by CBD. This work demonstrates that the exposure to cannabinoid-based products containing CBD and/or THC, may interfere with key processes of EVTs differentiation. Therefore, crucial phases of placental development can be affected, compromising pregnancy success.
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Affiliation(s)
- Patrícia Alves
- UCIBIO.REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Cristina Amaral
- UCIBIO.REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Natércia Teixeira
- UCIBIO.REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Georgina Correia-da-Silva
- UCIBIO.REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal.
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Ainiti DF, Lykeridou A, Nanou C, Deltsidou A. Cannabis use during pregnancy and its effect on the fetus, newborn and later childhood: A systematic review. Eur J Midwifery 2023; 7:19. [PMID: 37547668 PMCID: PMC10401888 DOI: 10.18332/ejm/168727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/01/2022] [Accepted: 06/23/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Cannabis and its derivatives are becoming increasingly popular in women's preferences during pregnancy in order to relieve nausea. The present study examines cannabis use during pregnancy and its effects on the fetus, newborn and later childhood. METHODS All primary studies were searched in the databases: PubMed, Scopus, Medline during the period June 2019 to August 2020. The keywords used were 'pregnancy', 'pregnant women', 'cannabis', 'marijuana', 'fetus', 'newborn', 'childhood', and combined with 'AND' and 'OR' Boolean operators. Inclusion criteria were: pregnant users of cannabis as the study group and pregnant non-users of cannabis as the control group; the articles could be in English or in Greek. The exclusion criteria were: unpublished studies, reviews, presentations at conferences, and animal studies. RESULTS From the systematic review of the literature, the study included 13 primary research studies in which it was found that the children of mother-user faced: disorders in the sleep cycle, memory problems, hyperactivity, increased chances of low birth weight, prematurity with lower Apgar score in the 1st and 5th minutes and hospitalization in an NICU, DNA methylation at the position CpG.32, and modifications in the brain, especially in the amygdala. In addition, girls had more aggressive behavior at the age of 18 months, shorter breastfeeding period, and neonatal death. CONCLUSIONS The use of cannabis during the gestation period by the mother, aggravates the physical and mental development of the fetus, the newborn and the later childhood.
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Affiliation(s)
| | | | - Christina Nanou
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Anna Deltsidou
- Department of Midwifery, University of West Attica, Athens, Greece
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14
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Zucchi A, Innocenzi E, Onorato A, Dolci S, Colopi A, Balistreri CR, Grimaldi P. PRENATAL EXPOSURE TO CB 2 RECEPTORS AGONIST DIFFERENTIALLY IMPACTS MALE AND FEMALE GERM CELLS VIA HISTONE MODIFICATION. Mech Ageing Dev 2023:111840. [PMID: 37385302 DOI: 10.1016/j.mad.2023.111840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
Cannabis use during pregnancy is increasing in the last few years potentially because of decreased perception of the risk of harm. Regardless, recent evidence demonstrated that prenatal cannabis exposure is associated with adverse outcomes. To date there is limited evidence of the impact of cannabis exposure during pregnancy on the reproductive health of the offspring. The biological effects of cannabis are mediated by two cannabinoid receptors, CB1 and CB2. We previously demonstrated that CB2 is highly expressed in mouse male and female fetal germ cells. In this study, we investigated the effects of prenatal exposure to a selective CB2 agonist, JWH-133, on the long-term reproductive health of male and female offspring and on the involved molecular epigenetic mechanisms. Notably, we focused on epigenetic histone modifications that can silence or activate gene expression, playing a pivotal role in cell differentiation. We reported that prenatal activation of CB2 has a sex-specific impact on germ cell development of the offspring. In male it determines a delay of germ cell differentiation coinciding with an enrichment of H3K27me3, while in female it causes a reduction of the follicles number through an increased apoptotic process not linked to modified H3K27me3 level.
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Affiliation(s)
- Alice Zucchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Innocenzi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Angelo Onorato
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Dolci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ambra Colopi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Carmela Rita Balistreri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Paola Grimaldi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
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15
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Santacruz-Márquez R, Neff AM, Mourikes VE, Fletcher EJ, Flaws JA. The effects of inhaled pollutants on reproduction in marginalized communities: a contemporary review. Inhal Toxicol 2023:1-18. [PMID: 37075037 PMCID: PMC10584991 DOI: 10.1080/08958378.2023.2197941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/25/2023] [Indexed: 04/20/2023]
Abstract
Important differences in health that are closely linked with social disadvantage exist within and between countries. According to the World Health Organization, life expectancy and good health continue to increase in many parts of the world, but fail to improve in other parts of the world, indicating that differences in life expectancy and health arise due to the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. Marginalized communities experience higher rates of certain diseases and more deaths compared to the general population, indicating a profound disparity in health status. Although several factors place marginalized communities at high risk for poor health outcomes, one important factor is exposure to air pollutants. Marginalized communities and minorities are exposed to higher levels of air pollutants than the majority population. Interestingly, a link exists between air pollutant exposure and adverse reproductive outcomes, suggesting that marginalized communities may have increased reproductive disorders due to increased exposure to air pollutants compared to the general population. This review summarizes different studies showing that marginalized communities have higher exposure to air pollutants, the types of air pollutants present in our environment, and the associations between air pollution and adverse reproductive outcomes, focusing on marginalized communities.
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Affiliation(s)
| | - Alison M. Neff
- Department of Comparative Biosciences, University of Illinois Urbana-Champaign
| | | | - Endia J. Fletcher
- Department of Comparative Biosciences, University of Illinois Urbana-Champaign
| | - Jodi A. Flaws
- Department of Comparative Biosciences, University of Illinois Urbana-Champaign
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16
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Sarathy L, Chou JH, Lerou PH, Terplan M, Mark K, Dorfman S, Wilens TE, Bernstein SN, Schiff DM. Limited Utility of Toxicology Testing at Delivery for Perinatal Cannabis Use. Hosp Pediatr 2023; 13:317-325. [PMID: 36855896 PMCID: PMC10071432 DOI: 10.1542/hpeds.2022-006897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To describe the characteristics of individuals undergoing toxicology testing at delivery for a sole indication of cannabis use and to evaluate the rate of unexpected positive toxicology testing results among this cohort. METHODS This retrospective cohort study included dyads with a maternal history of cannabis use who underwent peripartum toxicology testing between 2016 and 2020 at 5 birthing hospitals in Massachusetts. We collected information on maternal demographic characteristics and toxicology test results and reviewed records of dyads with unexpected positive results to identify additional social risk factors and clinical outcomes. RESULTS Of 60 608 live births reviewed, 1924 dyads underwent toxicology testing, including 614 (31.9%) for a sole indication of cannabis use. Significantly greater percentages of patients in the cannabis cohort were <25 years old (32.4% vs 6.1% of the birthing population, P <.001), non-Hispanic Black (32.4% vs 8.1%, P < .001), Hispanic or Latino (30.5% vs 15.5%), American Indian/Alaskan (0.7% vs 0.1%), and publicly insured (39.9% vs 15.6%, P <.001). Eight of the 614 dyads (1.3%) had an unexpected positive toxicology test result, including 2 (0.3%) unexpectedly positive for opioids. Seven dyads (1.1%) had false positive test results for unexpected substances. Only 1 test result changed clinical management; a urine test positive for opioids prompted monitoring (but not medication) for neonatal opioid withdrawal syndrome. CONCLUSIONS Toxicology testing of patients for a sole indication of cannabis use, without other risk factors, may be of limited utility in elucidating other substance use and may exacerbate existing disparities in perinatal outcomes.
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Affiliation(s)
- Leela Sarathy
- Departments of Pediatrics
- Harvard Medical School, Boston, Massachusetts
| | - Joseph H. Chou
- Departments of Pediatrics
- Harvard Medical School, Boston, Massachusetts
| | - Paul H. Lerou
- Departments of Pediatrics
- Harvard Medical School, Boston, Massachusetts
| | - Mishka Terplan
- Friends Research Institute, Baltimore, Maryland
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Katrina Mark
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Maryland
| | | | | | - Sarah N. Bernstein
- Obstetrics, Gynecology and Reproductive Biology, Division of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Davida M. Schiff
- Departments of Pediatrics
- Harvard Medical School, Boston, Massachusetts
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17
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Duko B, Dachew BA, Pereira G, Alati R. The effect of prenatal cannabis exposure on offspring preterm birth: a cumulative meta-analysis. Addiction 2023; 118:607-619. [PMID: 36305657 DOI: 10.1111/add.16072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Mixed results have been reported on the association between prenatal cannabis exposure and preterm birth. This study aimed to examine the magnitude and consistency of associations reported between prenatal cannabis exposure and preterm birth. METHODS This review was guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We performed a comprehensive search of the literature on the following electronic databases: PubMed, EMBASE, SCOPUS, Psych-INFO and Web of Science. The revised version of the Newcastle-Ottawa Scale (NOS) was used to appraise the methodological quality of the studies included in this review. Inverse variance weighted random-effects cumulative meta-analysis was undertaken to pool adjusted odds ratios (aOR) after sequential inclusion of each newly published study over time. The OR and 95% confidence interval (CI) limits required (stability threshold) for a new study to move the cumulative odds ratio to the null were also computed. RESULTS A total of 27 observational studies published between 1986 and 2022 were included in the final cumulative meta-analysis. The sample size of the studies ranged from 304 to 4.83 million births. Prenatal cannabis exposure was associated with an increased risk of preterm birth (pooled aOR = 1.35, 95% CI = 1.24-1.48). The stability threshold was 0.74 (95% CI limit = 0.81) by the end of 2022. CONCLUSIONS Offspring exposed to maternal prenatal cannabis use was associated with higher risk of preterm birth, which warrants public health messages to avoid such exposure, particularly during pregnancy.
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Affiliation(s)
- Bereket Duko
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,enAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Berihun Assefa Dachew
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,enAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Rosa Alati
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,Institute for Social Sciences Research, The University of Queensland, Indooroopilly, Queensland, Australia
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18
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Rokeby ACE, Natale BV, Natale DRC. Cannabinoids and the placenta: Receptors, signaling and outcomes. Placenta 2023; 135:51-61. [PMID: 36965349 DOI: 10.1016/j.placenta.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023]
Abstract
Cannabis use during pregnancy is increasing. The improvement of pregnancy-related symptoms including morning sickness and management of mood and stress are among the most reported reasons for its use. Δ9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) are the most abundant cannabinoids found within the cannabis flower. The concentration of these components has drastically increased in the past 20 years. Additionally, many edibles contain only one cannabinoid and are marketed to achieve a specific goal, meaning there are an increasing number of pregnancies that are exposed to isolated cannabinoids. Both Δ9-THC and CBD cross the placenta and can impact the fetus directly, but the receptors through which cannabinoids act are also expressed throughout the placenta, suggesting that the effects of in-utero cannabinoid exposure may include indirect effects from the placenta. In-utero cannabis research focuses on short and long-term fetal health and development; however, these studies include little to no placenta analysis. Prenatal cannabinoid exposure is linked to small for gestational age and fetal growth-restricted babies. Compromised placental development is also associated with fetal growth restriction and the few studies (clinical and animal models) that included placental analysis, identify changes in placental vasculature and function in these cannabinoid-exposed pregnancies. In vitro studies further support cannabinoid impact on cell function in the different populations that comprise the placenta. In this article, we aim to summarize how phytocannabinoids can impact placental development and function. Specifically, the cannabinoids and their actions at the different receptors are described, with receptor localization throughout the human and murine placenta discussed. Findings from studies that included placental analysis and how cannabinoid signaling may modulate critical developmental processing including cell proliferation, angiogenesis and migration are described. Considering the current research, prenatal cannabinoid exposure may significantly impact placental development, and, as such, identifying windows of placental vulnerability for each cannabinoid will be critical to elucidate the etiology of fetal outcome studies.
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Affiliation(s)
- Abbey C E Rokeby
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bryony V Natale
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON, Canada
| | - David R C Natale
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
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Blayac L, Ponte C, Lavaud M, Micallef J, Lapeyre-Mestre M. Increase of cannabis and cocaine use by pregnant women in France from 2005 to 2018: Insights of the annual cross sectional OPPIDUM survey. Therapie 2023; 78:201-211. [PMID: 36283856 DOI: 10.1016/j.therap.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Substance use disorders during pregnancy are associated with antenatal, neonatal and long-term adverse drug reactions in children. The aim of this study was to describe, using data from OPPIDUM survey, the evolution of illicit substance use or diverted prescription drug use among pregnant women visiting French addiction care centres from 2005 to 2018. MATERIAL AND METHOD The current study focused on women of childbearing age (15-44years old) identified as pregnant, and included in the OPPIDUM survey from 2005 to 2018. OPPIDUM is a French nationwide survey repeated each year since 1995, which anonymously collects information on drug abuse and dependence observed in patients recruited in addiction care centres. Patterns of illicit substance use, psychoactive medications, and opioid maintenance treatment (OMT) were described over time (by period of 2 years) and changes between 2005-2006 and 2017-2018 were investigated. RESULTS From 2005 to 2018, 784 pregnant women were included in the OPPIDUM survey (median age 28, interquartile range (IQR): 25-33). The proportion of women using exclusively cannabis (1.2% vs. 17.1%, P=0.0004) and cocaine (including crack) use (4.7% vs. 14.3%, P=0.0384) significantly increased over the period. Considering the first substance reported as leading to dependence, heroin significantly decreased (78.8% vs. 50.0%, P=0.0002) whereas cannabis significantly increased (5.9% vs. 25.7%, P=0.0005). CONCLUSION This study highlighted an important change of patterns of drug use by French pregnant women over a 14-year-period. Health professionals must be aware of these changes to adapt prevention and care among women of childbearing age and pregnant women.
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Affiliation(s)
- Léna Blayac
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse - UFR santé, université de Toulouse, 31000 Toulouse, France.
| | - Camille Ponte
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse - UFR santé, université de Toulouse, 31000 Toulouse, France
| | - Monique Lavaud
- École de sages-femmes, université de Toulouse, 31059 Toulouse, France
| | - Joëlle Micallef
- UMR 1106, Inserm, service de pharmacologie clinique, centre d'addictovigilance, AP-HM, Aix-Marseille université, 13005 Marseille, France
| | - Maryse Lapeyre-Mestre
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse - UFR santé, université de Toulouse, 31000 Toulouse, France
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Lee AHX, Tse EK, Nightingale TE, Sachdeva R, Walter M, Krassioukov AV. Cannabis health survey on usage in women with spinal cord injury and knowledge among physicians: A cross-sectional study. J Spinal Cord Med 2023; 46:291-297. [PMID: 35349394 PMCID: PMC9987743 DOI: 10.1080/10790268.2022.2038049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Individuals with spinal cord injury (SCI) report using cannabis to self-manage chronic pain and spasticity. However, its safety and efficacy are not well understood. As more women with SCI are pursuing motherhood, clinicians must consider the possibility of maternal cannabis use and its impact on fetal development. Moreover, due to the lack of current evidence for cannabis, it is important to characterize the perceptions and knowledge of physicians towards both recreational and synthetic cannabinoids. DESIGN Two anonymous surveys (10-items each) were conducted. SETTING AND PARTICIPANTS Women with SCI (n = 20) completed an anonymous, online survey regarding cannabis use. Physicians at a Canadian SCI rehabilitation center (n = 15) completed a survey on their knowledge of recreational and synthetic cannabinoids among individuals with SCI. OUTCOME MEASURES Survey 1 evaluated cannabis use patterns and perceptions before/after SCI in women, including during pregnancy and breastfeeding. The aim of Survey 2 was to understand the perception and current knowledge of physicians regarding recreational cannabis and synthetic cannabinoid use by patients with SCI. RESULTS At the time of survey, 7 women with SCI reported use of cannabis, only 4 of them used prior to injury. Managing tone/spasticity (n = 5) was the major reported benefit of cannabis use. Women used cannabis during pregnancy and/or breastfeeding as a sleep aid or relief for morning sickness (n = 1 pregnancy, n = 1 breastfeeding, n = 1 both). The most-reported challenge with cannabis use was difficulty obtaining consistent, desirable effects (n = 5). Almost all physicians (n = 13) described their knowledge on recreational cannabis products as "none, very little or poor", with greater overall comfort and knowledge of synthetic cannabinoids. CONCLUSION Due to the reported use of cannabis during pregnancy/breastfeeding and current impoverishment of physicians' knowledge (particularly regarding recreational cannabis products), it is imperative to further investigate the safety and efficacy of cannabis use in women with SCI.
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Affiliation(s)
- Amanda H X Lee
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuel K Tse
- MD Undergraduate Program, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Thomas E Nightingale
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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21
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Mulligan MK, Hamre KM. Influence of prenatal cannabinoid exposure on early development and beyond. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:10981. [PMID: 38389825 PMCID: PMC10880766 DOI: 10.3389/adar.2023.10981] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2024]
Abstract
Public perception surrounding whether cannabis use is harmful during pregnancy often diverges greatly from the recommendations of doctors and healthcare providers. In contrast to the medical guidance of abstinence before, during, and after pregnancy, many women of reproductive age believe cannabis use during pregnancy is associated with little potential harm. Legalization and social cues support public perceptions that cannabis use during pregnancy is safe. Moreover, pregnant women may consider cannabis to be a safe alternative for treating pregnancy related ailments, including morning sickness. Compounding the problem is a lack of medical and federal guidance on safe, low, or high-risk levels of cannabis use. These issues mirror the continuing debate surrounding alcohol use and health, in particular, whether there are safe or lower risk levels of alcohol consumption during pregnancy. Clinical studies to date suffer from several limitations. First, most human studies are correlative in nature, meaning that causal associations cannot be made between in utero cannabis exposure and health and behavioral outcomes later in life. Due to obvious ethical constraints, it is not possible to randomly assign pregnant mothers to cannabis or other drug exposure conditions-a requirement needed to establish causality. In addition, clinical studies often lack quantitative information on maternal exposure (i.e., dose, frequency, and duration), include a small number of individuals, lack replication of outcome measures across cohorts, rely on self-report to establish maternal drug use, and suffer from unmeasured or residual confounding factors. Causal associations between maternal cannabis exposure and offspring outcomes are possible in preclinical cohorts but there is a large amount of heterogeneity across study designs and developmental differences between rodents and humans may limit translatability. In this review, we summarize research from human and preclinical models to provide insight into potential risks associated with prenatal cannabinoid exposure (PCE). Finally, we highlight gaps in knowledge likely to contribute to the growing divide between medical guidance and public attitudes regarding cannabis use during pregnancy.
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Affiliation(s)
- Megan K Mulligan
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center (UTHSC), Memphis, TN, United States
| | - Kristin M Hamre
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center (UTHSC), Memphis, TN, United States
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22
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Dunn ML, Bradley C, Ayonrinde OA, Van Rooyen DM, Tait RJ, White SW, Fisher P, Sunanda G, Mehta S, Ayonrinde OT. The prevalence and significance of gestational cannabis use at an Australian tertiary hospital. Aust N Z J Obstet Gynaecol 2023; 63:6-12. [PMID: 35851950 DOI: 10.1111/ajo.13589] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cannabis is one of the most common non-prescribed psychoactive substances used in pregnancy. The prevalence of gestational cannabis use is increasing. AIM The aim was to examine the prevalence of gestational cannabis use and associated pregnancy and neonate outcomes. MATERIALS AND METHODS A retrospective observational study involving pregnant women delivering in 2019 was conducted at a tertiary hospital in Perth, Western Australia. Gestational cannabis and other substance use records were based on maternal self-report. Pregnancy outcomes included neonatal gestational age, birthweight, birth length, head circumference, resuscitation measures, special care nursery admission, 5-min Apgar score and initial neonatal feeding method. RESULTS Among 3104 pregnant women (mean age: 31 years), gestational cannabis use was reported by 1.6% (n = 50). Cannabis users were younger, more likely to use other substances and experience mental illness or domestic violence compared with non-users. Neonates born to cannabis users had a lower mean gestational age, birthweight and birth length compared to those born to non-cannabis users. Gestational cannabis use (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6-6.7) and tobacco smoking (OR 2.2, 95% CI 1.5-3.6) were associated with increased odds of a low-birthweight neonate. Combined cannabis and tobacco use during pregnancy further increased the likelihood of low birthweight (LBW, adjusted OR 3.9, 95% CI 1.6-9.3). Multivariate logistic regression analysis adjusted for maternal sociodemographical characteristics, mental illness, alcohol, tobacco and other substance use demonstrated gestational cannabis use to be independently associated with LBW (OR 2.3, 95% CI 1.1-5.2). CONCLUSION Gestational cannabis use was independently associated with low birthweight, synergistically affected by tobacco smoking.
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Affiliation(s)
- Mikaela L Dunn
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Clare Bradley
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Oyedeji A Ayonrinde
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Providence Care Hospital, Kingston, Ontario, Canada
| | - Derrick M Van Rooyen
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Robert J Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Scott W White
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Obstetrics and Gynaecology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Petrovia Fisher
- Department of Obstetrics and Gynaecology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gargeswari Sunanda
- Department of Obstetrics and Gynaecology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Shailender Mehta
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.,Department of Neonatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Oyekoya T Ayonrinde
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
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23
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Towobola A, Towobola B, Nair B, Makwana A. The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review. BJPsych Bull 2023; 47:28-37. [PMID: 34749839 PMCID: PMC10028554 DOI: 10.1192/bjb.2021.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS AND METHOD As drug policies pertaining to cannabis use become more liberalised, the prevalence of cannabis use in pregnancy could increase. However, there is limited guidance available for clinicians. This paper presents a narrative review of literature published in the past 16 years (2006-2021) to (a) address the impact of legalisation and decriminalisation on the risks, ethics and support of women who use cannabis during pregnancy and (b) develop guidance for clinicians. RESULTS Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. CLINICAL IMPLICATIONS This review confirmed that the recommendation of cannabinoid-based products for pregnant and breast-feeding women is currently premature. More research is needed to address safety concerns. We discussed navigating ethical concerns and suggest targeted management strategies for clinicians treating pregnant women who choose to use cannabis.
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Affiliation(s)
| | | | - Bosky Nair
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| | - Arti Makwana
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
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24
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Faraj MM, Evanski J, Zundel CG, Peters C, Brummelte S, Lundahl L, Marusak H. Impact of prenatal cannabis exposure on functional connectivity of the salience network in children. J Neurosci Res 2023; 101:162-171. [PMID: 36226844 PMCID: PMC10015638 DOI: 10.1002/jnr.25136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022]
Abstract
Cannabis use among pregnant people has increased over the past decade. This is of concern as prenatal cannabis exposure (PCE) is associated with cognitive, motor, and social deficits among offspring. Here, we examined resting-state functional connectivity (rsFC) of the salience network (SN)-a core neurocognitive network that integrates emotional and sensory information-in children with (vs. without) PCE. Using neuroimaging and developmental history data collected from 10,719 children (M ± SD = 9.92 ± 0.62 years; 47.9% female) from the Adolescent Brain Cognitive Development study, we assessed the impact of parent-reported PCE (before or after knowledge of pregnancy) on rsFC within and between the SN and five other core neurocognitive networks. We also evaluated whether SN rsFC mediated the association between PCE and child psychopathology. Results showed that PCE before (but not after) knowledge of pregnancy was associated with lower SN-ventral attention network (VAN) rsFC. Furthermore, psychotic-like experiences mediated the association between PCE and SN-VAN rsFC, and reversal of the model was also significant, such that SN-VAN rsFC mediated the association between PCE and psychotic-like symptoms. However, these mediation effects were no longer significant after the inclusion of covariates. Taken together, these findings suggest that developmental alterations in SN-VAN interactions may explain the previously reported association between PCE and elevated risk of child psychopathology.
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Affiliation(s)
- Mohammed M. Faraj
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan, USA, 48201
- School of Medicine, Wayne State University, Detroit, Michigan, USA, 48201
| | - Julia Evanski
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan, USA, 48201
| | - Clara G. Zundel
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan, USA, 48201
| | - Craig Peters
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan, USA, 48201
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, Michigan, USA, 48201
| | - Leslie Lundahl
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan, USA, 48201
| | - Hilary Marusak
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan, USA, 48201
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, Michigan, USA, 48201
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25
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Ramlawi S, Murphy MSQ, Dingwall-Harvey ALJ, Rennicks White R, Gaudet LM, McGee A, DeGrace A, Cantin C, El-Chaâr D, Walker MC, Corsi DJ. Cannabis Use in Pregnancy and Downstream effects on maternal and infant health (CUPiD): a protocol for a birth cohort pilot study. BMJ Open 2022; 12:e066196. [PMID: 36549747 PMCID: PMC9791409 DOI: 10.1136/bmjopen-2022-066196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Cannabis use in pregnancy and post partum is increasing. Accessibility to cannabis has expanded due to the legalisation of cannabis in Canada. Therefore, there is a critical need to monitor the impact of cannabis on pregnancy outcomes and infant neurodevelopment. This pilot study will assess the feasibility of modern recruitment and data collection strategies adapted to the current cannabis environment and inform the design of a multicentre prospective birth cohort. METHODS AND ANALYSIS We will establish a pregnancy and birth cohort of 50 cannabis users and 50 non-users recruited before delivery. We will follow the participants at regular visits from recruitment to 12 weeks post partum. Participants will provide demographic and socioeconomic data, report their cannabis use patterns, and provide biological samples. Biological samples include maternal and infant urine and blood, breastmilk/chestmilk, cord blood, cord tissue, placenta and meconium. All samples will be processed and stored at -80°C until analysis by immunoassay or liquid chromatography-tandem mass spectrometry to determine the presence of cannabis metabolites. In addition, partners will be invited to provide additional socioeconomic and substance use data. ETHICS AND DISSEMINATION Ethics was obtained from Ottawa Health Science Network Research Ethics Board through Clinical Trials Ontario (3791). Our findings will be published in peer-reviewed journals, presented at scientific conferences and shared broadly with patients, healthcare decision-makers, and project partners online and through social media. TRIAL REGISTRATION NUMBER NCT05309226.Cite Now.
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Affiliation(s)
- Serine Ramlawi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Malia S Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Laura M Gaudet
- Department of Obstetrics and Gynecology, Queen's University, Kingston, Ontario, Canada
- Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Amy McGee
- Division of Midwifery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amanda DeGrace
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christina Cantin
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Champlain Maternal Newborn Regional Program, Ottawa, Ontario, Canada
| | - Darine El-Chaâr
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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26
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Reece AS, Hulse GK. Epigenomic and Other Evidence for Cannabis-Induced Aging Contextualized in a Synthetic Epidemiologic Overview of Cannabinoid-Related Teratogenesis and Cannabinoid-Related Carcinogenesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416721. [PMID: 36554603 PMCID: PMC9778714 DOI: 10.3390/ijerph192416721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Twelve separate streams of empirical data make a strong case for cannabis-induced accelerated aging including hormonal, mitochondriopathic, cardiovascular, hepatotoxic, immunological, genotoxic, epigenotoxic, disruption of chromosomal physiology, congenital anomalies, cancers including inheritable tumorigenesis, telomerase inhibition and elevated mortality. METHODS Results from a recently published longitudinal epigenomic screen were analyzed with regard to the results of recent large epidemiological studies of the causal impacts of cannabis. We also integrate theoretical syntheses with prior studies into these combined epigenomic and epidemiological results. RESULTS Cannabis dependence not only recapitulates many of the key features of aging, but is characterized by both age-defining and age-generating illnesses including immunomodulation, hepatic inflammation, many psychiatric syndromes with a neuroinflammatory basis, genotoxicity and epigenotoxicity. DNA breaks, chromosomal breakage-fusion-bridge morphologies and likely cycles, and altered intergenerational DNA methylation and disruption of both the histone and tubulin codes in the context of increased clinical congenital anomalies, cancers and heritable tumors imply widespread disruption of the genome and epigenome. Modern epigenomic clocks indicate that, in cannabis-dependent patients, cannabis advances cellular DNA methylation age by 25-30% at age 30 years. Data have implications not only for somatic but also stem cell and germ line tissues including post-fertilization zygotes. This effect is likely increases with the square of chronological age. CONCLUSION Recent epigenomic studies of cannabis exposure provide many explanations for the broad spectrum of cannabis-related teratogenicity and carcinogenicity and appear to account for many epidemiologically observed findings. Further research is indicated on the role of cannabinoids in the aging process both developmentally and longitudinally, from stem cell to germ cell to blastocystoids to embryoid bodies and beyond.
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Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
- Correspondence:
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
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27
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Simoncic V, Deguen S, Enaux C, Vandentorren S, Kihal-Talantikite W. A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416592. [PMID: 36554473 PMCID: PMC9779203 DOI: 10.3390/ijerph192416592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/12/2023]
Abstract
Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.
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Affiliation(s)
- Valentin Simoncic
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
- Correspondence:
| | - Séverine Deguen
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
| | - Christophe Enaux
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| | - Stéphanie Vandentorren
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
- Santé Publique France, French National Public Health Agency, 94410 Saint-Maurice, France
| | - Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
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28
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Logue TC, Wen T, Friedman AM. Demographic trends associated with substance use disorder and risk for adverse obstetric outcomes with cannabis and opioid use disorders. J Matern Fetal Neonatal Med 2022; 35:2128658. [PMID: 36617462 DOI: 10.1080/14767058.2022.2128658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are increasing in the obstetric population, vary with demographic characteristics, and are associated with adverse pregnancy outcomes. Cannabis use disorder and opioid use disorder are two of the most common SUDs during pregnancy. OBJECTIVE This study had two objectives. The first objective was to assess trends in any SUD diagnosis during delivery hospitalizations from 2000 to 2018 by maternal age, ZIP code income quartile, and hospital location and teaching status. The second objective was to determine risk for adverse pregnancy outcomes during delivery hospitalizations specifically in the presence of cannabis and opioid use disorder diagnoses. STUDY DESIGN We conducted a serial cross-sectional analysis of the 2000-2018 National Inpatient Sample. Delivery hospitalizations to women aged 15-54 years with substance use disorder diagnoses were identified. SUD included (i) cannabis use disorder; (ii) opioid use disorder; (iii) alcohol use disorder; and (iv) other drug use disorder. We used joinpoint regression to estimate the average annual percent change (AAPC) in any substance use disorder diagnoses with 95% confidence intervals (CIs) by (i) ZIP code income quartile, (ii) hospital location and teaching status, and (iii) maternal age. We used unadjusted and adjusted log-linear regression to evaluate the relationship between cannabis use disorder and opioid use disorder several adverse maternal outcomes. We report unadjusted and adjusted risk ratios (aRRs) as measures of effect. RESULTS From 2000 to 2018, trends analyses broadly demonstrated increasing risk for SUD across demographic categories. In trends analyses stratified by ZIP code-income quartile, the proportion of deliveries with any SUD diagnosis increased across each income quartile with significant increases in the lowest income quartile (AAPC 4.6%, 95% CI 0.4%, 8.9%), second lowest quartile (AAPC 6.3%, 95% CI 5.3%, 7.4%), second highest quartile (AAPC 5.4%, 95% CI 4.1%, 6.8%), and highest quartile (AAPC 4.4%, 95% CI 2.1%, 6.8%). A larger increasing AAPC for SUD was present for deliveries in rural hospitals (AAPC 12.3%, 95% CI 9.8%, 14.9%) as compared to teaching (AAPC 5.7%, 95% CI 5.2%, 6.3%) and non-teaching urban hospitals (AAPC 7.0%, 95% CI 5.9%, 8.1%). By maternal age group, there was a significant larger AAPC for SUD for women aged 15-19 years (AAPC 8.5%, 95% CI 6.6%, 10.4%), 20-24 years (AAPC 9.0%, 95% CI 6.9%, 11.1%) and 25-29 years (AAPC 9.8%, 95% CI 9.1%, 10.6%) than women ≥30 years of age. Cannabis use disorder was associated with increased adjusted risk for preterm delivery (aRR 1.44, 95% CI 1.43, 1.45) and abruption and antepartum hemorrhage (aRR 1.77, 95% CI 1.75, 1.80). Opioid use disorder was associated with risk for non-transfusion severe maternal morbidity (aRR 1.73, 95% CI 1.67, 1.79), preterm delivery (aRR 1.75, 95% CI 1.74, 1.77), and abruption and antepartum hemorrhage (aRR 2.15, 95% CI 2.11, 2.19). CONCLUSION While substance use disorders are increasing in pregnancy across rural and urban settings, age groups, and income quartiles, several populations are associated with higher increased risks and trends. These findings support that SUDs are likely to continue to be of public health significance in diverse geographic and demographic settings.
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Affiliation(s)
- Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Timothy Wen
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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29
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Klasner C, Brown J, Gopalakrishnan M, Metwally DE, Besse M, Mark K. Effect of maternal adverse childhood experiences (ACE) and cannabis use on pregnancy outcomes. Arch Womens Ment Health 2022; 25:1097-1104. [PMID: 36203114 DOI: 10.1007/s00737-022-01269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to characterize the relationship between cannabis use, ACE score, and pregnancy outcomes. Pregnant patients in Baltimore, MD, completed the 17-point ACE checklist. Charts of the birth parent and neonate were reviewed for urine toxicology testing at initiation of care and delivery, prenatal care metrics, and birth statistics. Multivariable logistic regression analysis was performed to assess the relationship between ACE score, cannabis use, and pregnancy outcomes. Of 256 birth parents, 87 (34.0%) tested positive for cannabis at initial visit and 39 (15.2%) tested positive for cannabis at delivery. Testing positive for cannabis at initial visit or delivery was associated with higher ACE score (15.1 vs 13.7, p = 0.04; 16.2 vs 13.8, p = 0.01). Of those who tested positive for cannabis at initial visit, 39/87 (45.0%) tested positive at delivery. Continued cannabis use at delivery was associated with lower maternal weight gain (7.9 kg vs 13.3 kg, p = 0.003), fewer prenatal visits (7 vs 8, p = 0.010), and numerically higher mean ACE score. Cannabis use at delivery was associated with 10% lower birthweight (2665 g vs 3014 g p < 0.05) but not with pre-term birth. Total ACE score was not significantly associated with any birth outcome. Worse pregnancy outcomes were associated with cannabis use throughout pregnancy but not with cannabis use at prenatal care initiation. The interplay of ACE and continued cannabis use during pregnancy warrants further research on the physiologic effects of cannabis and interventions to decrease substance use during pregnancy.
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Affiliation(s)
- Carson Klasner
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA
| | - Jessica Brown
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA
| | - Mathangi Gopalakrishnan
- Department of Pharmacy Practice and Science, Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Dina El Metwally
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA
| | - Margaret Besse
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA
| | - Katrina Mark
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 S Paca, Suite 400, Baltimore, MD, 21201, USA.
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Kiel L, Hsu C, Wartko PD, Albertson-Junkans L, Ewing J, Lapham GT. Perspectives from women who engaged in prenatal and postpartum cannabis use in a U.S. State with legal non-medical use. Prev Med Rep 2022; 31:102075. [PMID: 36820379 PMCID: PMC9938312 DOI: 10.1016/j.pmedr.2022.102075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
Evidence suggests fetal risks are associated with cannabis use during pregnancy. Yet, insights into women's decision-making and cannabis use during pregnancy are limited. This study explored these concepts with postpartum women who used cannabis during and after pregnancy. We conducted interviews with 15 women (4 self-identifying a race other than White and 4 self-identifying Hispanic ethnicity) who: 1) lived in the Puget Sound region of Washington State, 2) reported past-year cannabis use on a routine screen, and 3) had documented pregnancy and delivery March 2015-May 2017. Semi-structured interviews asked about decision-making and cannabis use during pregnancy and postpartum. We used template analysis for coding and analysis. The key findings included that women: 1) gathered information about cannabis use during pregnancy primarily through internet searches and discussions with peers; 2) were reluctant to talk with health care providers about cannabis; 3) used cannabis while pregnant to treat health issues, including morning sickness, pain, and mental health conditions; 4) were comfortable with their decision to use cannabis while pregnant, but had questions about long-term effects; and 5) tried to mitigate transmission through breastmilk. Women decided about cannabis during pregnancy based on their experience, health symptoms, and information gathered from the internet and peers, often without guidance from their health care provider. Results point to opportunities for providers to become informed about and engage in discussion with patients about cannabis use during preconception, pregnancy, and postpartum.
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Affiliation(s)
- Linda Kiel
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States,Corresponding author.
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States
| | - Paige D. Wartko
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States
| | - Ladia Albertson-Junkans
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States
| | - John Ewing
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States
| | - Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle WA 98101, United States,Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Fourth Floor, Seattle, WA 98195, United States
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31
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Wicken C, Walia A, Solhjoo S, Mark K. Prevalence of cannabis use disorder among pregnant people who test positive for cannabis at time of delivery. AJOG GLOBAL REPORTS 2022; 2:100095. [DOI: 10.1016/j.xagr.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sparks JR, Ghildayal N, Hivert MF, Redman LM. Lifestyle interventions in pregnancy targeting GDM prevention: looking ahead to precision medicine. Diabetologia 2022; 65:1814-1824. [PMID: 35150287 PMCID: PMC10994387 DOI: 10.1007/s00125-022-05658-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022]
Abstract
Gestational diabetes mellitus (GDM) is the most prevalent pregnancy-related endocrinopathy, affecting up to 25% of pregnancies worldwide. Pregnant individuals who develop GDM have an increased risk of complications during pregnancy and birth, as well as future development of type 2 diabetes mellitus and CVD. This increased risk is subsequently passed along to the offspring, perpetuating a cycle of metabolic dysfunction across generations. GDM prevention strategies have had mixed results for many years, but more recent systematic reviews and meta-analyses have suggested potential new avenues of prevention. The objective of this review is to summarise the literature examining the efficacy of lifestyle interventions for the prevention of GDM and to uncover if specific individual-level characteristics influence this outcome. Based on the present literature, we determined that future trials should be designed to understand if initiation of lifestyle intervention in the preconception period is more effective to reduce GDM. Furthermore, trials initiated during pregnancy should be developed through the lens of precision prevention. That is, trials should tailor intervention approaches based on individual-level risk defined by the presence of modifiable and non-modifiable risk factors. Finally, future interventions might also benefit from just-in-time adaptive intervention designs, which allow for interventions to be modified in real-time based on objective assessments of an individual's response.
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Affiliation(s)
- Joshua R Sparks
- Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Nidhi Ghildayal
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, Boston, MA, USA
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, Boston, MA, USA.
| | - Leanne M Redman
- Reproductive Endocrinology and Women's Health Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
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33
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Chanal C, Mazurier E, Doray B. Use of Psychoactive Substances during the Perinatal Period: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S17-S37. [PMID: 36480661 DOI: 10.1111/jmwh.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Based on their clinical practice and an extensive review of the literature, the authors propose a framework of procedures to be followed to provide services to all women of childbearing age who use psychoactive substances (alcohol, cannabis, cocaine, amphetamines, and opioids), especially during pregnancy or during the postpartum and breastfeeding periods, in view of their individual situations and environmental contexts.
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Affiliation(s)
- Corinne Chanal
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 avenue du Doyen Gaston Giraud cedex 5, Montpellier, 34295, France.,Réseau de Périnatalité Occitanie Espace Henri BERTIN SANS, Bat A, 59 avenue de Fès-34080, Montpellier, France
| | - Evelyne Mazurier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 avenue du Doyen Gaston Giraud cedex 5, Montpellier, 34295, France
| | - Bérénice Doray
- Service de génétique, CHU de La Réunion, allée des Topazes, cedex, 97405, SAINT-DENIS.,Centre Ressource Troubles du Spectre de l'Alcoolisation Fœtale (TSAF) - Fondation Père Favron - 43 rue du Four à Chaux, Saint-Pierre, 97410, Réunion
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McKenzie LB, Keim SA, Klebanoff MA. Risk Perceptions about Cannabis Use and Receipt of Health-Related Information during Pregnancy. Am J Health Promot 2022; 36:1316-1325. [PMID: 35512115 PMCID: PMC9617780 DOI: 10.1177/08901171221099496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To understand risk perception about cannabis use during pregnancy. DESIGN Mixed -Methods. Setting: Focus groups. Participants: Mothers. METHOD Focus groups were conducted to learn about person's experiences with pregnancy, health-related behaviors, perception of risky behaviors (cannabis use), and receipt of health-related information during pregnancy. Participants completed the Electronic Health Literacy Scale, the Single Item Literacy Screener, and questions about whether topics were discussed during their prenatal care. Data were coded and analyzed iteratively for emerging themes. Descriptive statistics were used to characterize the sample. RESULTS Twenty-one persons (mean age = 34.4, 57% African American, 38% White, 5% Multi-racial) participated in 4 focus groups. One-third of the participants used cannabis; 24% used alcohol; and 48% used tobacco during pregnancy. Participant's perceptions and use of cannabis during pregnancy were shaped by relief from pregnancy-related symptoms, recommendations from health care providers that cannabis is safe, anecdotal stories from friends and family, fear associated with prescription medications, and preference for "natural" remedies. The context of distrust of providers permeated these themes. The sample displayed poor e-health literacy compared to other adult samples. CONCLUSION Inter-related factors that influence cannabis use among persons who are pregnant should be considered when establishing trust between patients and providers, creating messages for patients about cannabis use during pregnancy, and when implementing interventions to improve provider-patient communication about health risk behaviors.
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Affiliation(s)
- Lara B. McKenzie
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sarah A. Keim
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA,Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Mark A. Klebanoff
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA,Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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35
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Smith PA, Kilgour C, Rice D, Callaway LK, Martin EK. Implementation barriers and enablers of midwifery group practice for vulnerable women: a qualitative study in a tertiary urban Australian health service. BMC Health Serv Res 2022; 22:1265. [PMID: 36261823 PMCID: PMC9583548 DOI: 10.1186/s12913-022-08633-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Maternity services have limited formalised guidance on planning new services such as midwifery group practice for vulnerable women, for example women with a history of substance abuse (alcohol, tobacco and other drugs), mental health challenges, complex social issues or other vulnerability. Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. We therefore aimed to identify the barriers and enablers that might impact the implementation of a midwifery group practice for vulnerable women. Methods A qualitative context analysis using the Consolidated Framework for Implementation Research was conducted at a single-site tertiary health facility in Queensland, Australia. An interdisciplinary group of stakeholders from a purposeful sample of 31 people participated in semi-structured interviews. Data were analysed using manual and then Leximancer computer assisted methods. Themes were compared and mapped to the Framework. Results Themes identified were the woman’s experience, midwifery workforce capabilities, identifying “gold standard care”, the interdisciplinary team and costs. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Potential barriers were: potential isolation of the interdisciplinary team, costs and the potential for vicarious trauma for midwives. Conclusion There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. An interdisciplinary team structure is also an essential component of the service design. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08633-8.
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Affiliation(s)
- Patricia A Smith
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.
| | - Catherine Kilgour
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, 4072, Brisbane, QLD, Australia
| | - Deann Rice
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia
| | - Leonie K Callaway
- Women, Children and Families Stream Metro North Health, Butterfield Street, 4029, Herston, Brisbane, QLD, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Butterfield St, 4029, Herston, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston Road, 4006, Herston, Brisbane, QLD, Australia
| | - Elizabeth K Martin
- Mater Research Institute, Faculty of Medicine, University of Queensland, Raymond Terrace, 4101, South Brisbane, Brisbane, QLD, Australia
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36
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Yu Y, Ma Q, Hollenbach S, Zhu Y, Groth S. Pregnant Women Following Bariatric Surgery: a Focus on Maternal Mental Health and Its Impact on Birth Outcomes. Obes Surg 2022; 32:3696-3704. [PMID: 36136169 DOI: 10.1007/s11695-022-06283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Bariatric surgery is associated with elevated risks for adverse birth outcomes, such as small-for-gestational-age infants (SGA). Maternal mental health is a critical regulator of fetal growth, but it is largely overlooked in pregnant women post-surgery. This study aimed to examine the associations between maternal mental health and birth outcomes in pregnant women post-bariatric surgery. MATERIALS AND METHODS This was a retrospective analysis of medical records of women who had a singleton delivery following Roux-en-Y gastric bypass or sleeve gastrectomy. Mental health measures included depression/anxiety and substance use (cigarettes, alcohol, opioids, and marijuana). Birth outcomes were fetal growth restriction, SGA, low birthweight, and preterm birth. Logistic regressions were used to assess the associations between maternal mental health and each of the birth outcomes. A post hoc logistic regression was conducted to assess factors that influenced maternal marijuana use. RESULTS Participants (N = 179) were mostly white (64.6%), non-Hispanic (84.5%), with a mean age of 32.7 ± 4.6 years, and mean body mass index of 37.2 ± 8.4 kg/m2 at conception. Maternal marijuana use significantly increased the odds for fetal growth restriction, SGA, low birthweight, and preterm birth. Cigarette use increased the risk for low birthweight. Conversely, alcohol use was protective of low birthweight and preterm birth. A post hoc analysis revealed that married women were less likely to use marijuana than those who were single, divorced, or widowed. CONCLUSION This analysis identified marijuana and cigarette use as risk factors for adverse birth outcomes post-bariatric surgery. Future studies with larger sample sizes are needed to confirm study findings.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Qianheng Ma
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd, Stanford, CA, 94305, USA
| | - Stefanie Hollenbach
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Yuansheng Zhu
- Golisano College of Computing and Information Sciences, Rochester Institute of Technology, 20 Lomb Memorial Dr, Rochester, NY, 14623, USA
| | - Susan Groth
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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37
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Yan Y, Jiang L, Li M, Zhang W, Yu L, Zhang Y. Predictive value of combining maternal peripheral blood count indicators for early-onset sepsis in preterm infants: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e30526. [PMID: 36086701 PMCID: PMC10980451 DOI: 10.1097/md.0000000000030526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
To assess the early predictive value of maternal parameters for early-onset sepsis (EOS) in preterm infants, especially including the maternal neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV). The retrospective cohort study examined a total of 231 preterm infants (69 with EOS) from May 2017 to October 2021 of the Fourth Hospital of Hebei Medical University, randomly divided (7:3) into the training set group (n = 162) and validation set group (n = 69). Thirteen clinical variables (including MPV, NLR, and PLR) were included as the research objects. By logistic regression, the factors significantly associated with EOS were distinguished. Additionally, a nomogram was constructed based on the independent risk factors, the validation of which relied on the concordance index, calibration curves, receiver operating characteristic curves, and decision curve analyses. Multivariate logistic regression proved that NLR (OR = 1.67, 95% CI = 1.18-2.36, P = .004), PLR (OR = 1.03, 95% CI = 1.01-1.04, P = .001), and MPV (OR = 1.75, 95% CI = 1.15-2.66, P = .009) were independent risk factors for EOS. The AUC of the nomogram for the training set group was 0.872 (0.814, 0.931) and 0.889 (0.843, 0.935) in the validation set group. The P values of Hosmer-Lemeshow test for the training set and validation set groups were .903 and .752, respectively. The decision curve analyses outcome indicated good clinical practicability. The C-index for the training set and validation set groups were 0.872 and 0.889, respectively. The maternal NLR, PLR, and MPV levels had good predictive value for EOS in premature infants. The nomogram in our study could help clinicians predict the occurrence of EOS.
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Affiliation(s)
- Yiwei Yan
- The Department of Pediatrics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, PR China
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38
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Latiolais E, Morse C, Warnke K, Forest S. Implementing SBIRT to Address Maternal Marijuana Use. Neonatal Netw 2022; 41:263-272. [PMID: 36002279 DOI: 10.1891/nn-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
A quality improvement project conducted at 3 Texas hospitals to implement a new systematic process to address maternal marijuana use among breastfeeding mothers. The new process was created using the evidence-based Screening, Brief Intervention, Referral to Treatment (SBIRT) model to address maternal marijuana use. Nurses screened all postpartum mothers for marijuana use at each of the 3 hospitals. Mothers who reported ever using marijuana were advised to abstain while breastfeeding and given educational materials and a treatment referral card. Among all 3 hospitals, the mean nurses' adherence to the SBIRT process was 69 percent, exceeding the project aim of 50 percent adherence. SBIRT, which has been used extensively with other populations and settings, was easily translated into practice for use with postpartum mothers who reported using marijuana. A systematic process using SBIRT may help mitigate the risk of harm for infants of mothers who use marijuana.
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Rates of substance and polysubstance use through universal maternal testing at the time of delivery. J Perinatol 2022; 42:1026-1031. [PMID: 35177791 PMCID: PMC9356969 DOI: 10.1038/s41372-022-01335-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report substance and polysubstance use at the time of delivery. STUDY DESIGN A cross-sectional study was performed on mothers consented for universal drug testing (99%) during hospital admission at six delivery hospitals in Cincinnati, Ohio. Mass spectrometry urinalysis detected positivity rates of 46 substances. Rates of positive drug tests for individual and common co-occurring substances measured were reported. RESULTS 2531 maternal samples were tested (88%) and 33% contained cotinine, 11.3% THC, 7.2% opioids, 3.8% cocaine, and 1.9% methamphetamines. Polysubstance use prevalence was as high as 15%. Among mothers testing positive for methadone or buprenorphine, 93% also tested positive for cotinine and 39% tested positive for a third substance in addition to cotinine. CONCLUSIONS Substance use at delivery is more prevalent than previously reported. Many mothers testing positive for opioids also test positive for other substances, which may increase overdose risk and exacerbate neonatal opioid withdrawal syndrome (NOWS).
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40
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Impact of converging sociocultural and substance-related trends on US autism rates: combined geospatiotemporal and causal inferential analysis. Eur Arch Psychiatry Clin Neurosci 2022; 273:699-717. [PMID: 35779123 PMCID: PMC10085966 DOI: 10.1007/s00406-022-01446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
Whilst cannabis is known to be toxic to brain development, it is unknown if it is driving rising US autism rates (ASMR). A longitudinal epidemiological study was conducted using national autism census data from the US Department of Education Individuals with Disabilities Act (IDEA) 1991-2011 and nationally representative drug exposure (cigarettes, alcohol, analgesic, and cocaine abuse, and cannabis use monthly, daily, and in pregnancy) datasets from National Survey of Drug Use and Health and US Census (income and ethnicity) and CDC Wonder population and birth data. Analysis was conducted in R. 266,950 were autistic of a population of 40,119,464 8-year-olds in 1994-2011. At national level after adjustment, daily cannabis use was significantly related to ASMR (β estimate = 4.37 (95%C.I. 4.06, 4.68), P < 2.2 × 10-16) as was first pregnancy trimester cannabis exposure (β estimate = 0.12 (0.08, 0.16), P = 1.7 × 10-12). At state level following adjustment for cannabis, cannabigerol (from β estimate = - 13.77 (- 19.41, 8.13), P = 1.8 × 10-6) and Δ9-tetrahydrocannabinol (from β estimate = 1.96 (0.88-3.04), P = 4 × 10-4) were significant. Geospatial state-level modelling showed exponential relationship between ASMR and Δ9-tetrahydrocannabinol and cannabigerol exposure. Exponential coefficients for the relationship between modelled ASMR and Δ9-tetrahydrocannabinol and cannabigerol exposure were 7.053 (6.39-7.71) and 185.334 (167.88-202.79; both P < 2.0 × 10-7). E-values are an instrument related to the evidence for causality in observational studies. High E-values were noted. Dichotomized legal status was linked with elevated ASMR. Data show cannabis use is associated with ASMR, is powerful enough to affect overall trends, and persists after controlling for other major covariates. Cannabinoids are exponentially associated with ASMR. The cannabis-autism relationship satisfies criteria of causal inference.
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Taylor T, Simpson AN, D'Souza R. Avoiding the echo-chamber: embracing qualitative research in obstetrics and gynecology to amplify patient voices. Acta Obstet Gynecol Scand 2022; 101:702-704. [PMID: 35510937 DOI: 10.1111/aogs.14346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Taryn Taylor
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada.,Center for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Andrea N Simpson
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada.,ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynecology and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics and Gynecology and the Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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42
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Macario E, Thomas RM. Reasons Washington State Women Use Marijuana During Pregnancy/Breastfeeding, Their Trusted Information Sources, and Communication Strategies for Informed Decision-Making. J Perinat Neonatal Nurs 2022; 36:243-255. [PMID: 35894721 DOI: 10.1097/jpn.0000000000000663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand reproductive-aged women's marijuana use beliefs and attitudes. METHODS Qualitative research (10 focus groups and 2 bulletin boards) with 95 Washington State women, aged 18 to 44 years, segmented by marijuana-using pregnant/breastfeeding; marijuana-using not-pregnant/breastfeeding; and nonmarijuana users. Participants completed up to 10 survey questions. We used deductive and inductive coding to analyze findings. RESULTS Marijuana-using pregnant/breastfeeding participants use marijuana to manage physical/mental pain and because of stigma, feel guilty, and sometimes hide use. Medicines have failed to address symptoms. Participants perceived marijuana safer than alcohol, tobacco, and illicit substances. Participants believed in the legitimacy of marijuana for health maintenance and want others to take their personally experienced benefits seriously. Participants interpreted lack of conclusive research as marijuana use not being unsafe. They want more information. All segments preferred hearing from other women about marijuana use experiences, with the marijuana-using pregnant/breastfeeding segment feeling strongest about this. CONCLUSIONS Personal experiences with, and anecdotes from family/friends about, the effects of marijuana use during pregnancy/breastfeeding influence marijuana-using participants' decision making. NURSING IMPLICATIONS It is important to speak with perinatal patients in a nonjudgmental/nonthreatening manner that acknowledges why reproductive-aged women may use marijuana and that conveys validation of patients' positive experiences with marijuana and a harm-reduction goal.
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Affiliation(s)
- Everly Macario
- Thomas Opinion Research, Chicago, Illinois (Dr Macario); and Thomas Opinion Research, Woodbridge, Virginia (Dr Thomas)
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Courchesne-Krak NS, Zúñiga ML, Chambers C, Reed MB, Smith LR, Ballas J, Marienfeld C. Substance-related diagnosis type predicts the likelihood and co-occurrence of preterm and cesarean delivery. J Addict Dis 2022; 41:137-148. [PMID: 35762875 PMCID: PMC9794633 DOI: 10.1080/10550887.2022.2082834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article aimed to evaluate whether a substance-related diagnosis (SRD; i.e., alcohol, opioids, cannabis, stimulants, nicotine) predicts the likelihood and co-occurrence of preterm (20-37 weeks' gestation) and cesarean delivery. This study reviewed electronic health record data on women (aged 18-44 years) who delivered a single live or stillbirth at ≥ 20 weeks of gestation from 2012 to 2019. Women with and without an SRD were matched on key demographic characteristics at a 1:1 ratio. Adjusting for covariates, odds ratios and 95% confidence intervals were calculated. Of the 19,346 deliveries, a matched cohort of 2,158 deliveries was identified. Of these, 1,079 (50%) had an SRD, 280 (13%) had a preterm delivery, 833 (39%) had a cesarean delivery, and 166 (8%) had a co-occurring preterm and cesarean delivery. An SRD was significantly associated with preterm and cesarean delivery (AOR = 1.84 [95% CI, 1.41-2.39], p-value= <0.0001; AOR = 1.51 [95% CI, 1.23-1.85], p-value= <0.0001). An alcohol-related diagnosis (AOR = 1.82 [95% CI, 1.01-3.28], p-value= 0.0471), opioid-related diagnosis (AOR = 1.94 [95% CI, 1.26-2.98], p-value= 0.0027), stimulant-related diagnosis (AOR = 1.65 [95% CI, 1.11-2.45], p-value= 0.0142), and nicotine-related diagnosis (AOR = 1.54 [95% CI, 1.05-2.26], p-value= 0.0278) were associated with co-occurring preterm and cesarean delivery. Pregnant women with an SRD experienced disproportionally higher odds of preterm and cesarean delivery compared to pregnant women without an SRD. Substance-type predicts the type of delivery outcome. An SRD in pregnant women should be identified early to reduce potential harm through intervention and treatment.
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Affiliation(s)
| | - María Luisa Zúñiga
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA, USA
| | - Christina Chambers
- Department of Pediatrics, Department of Family and Preventive Medicine, Division of Epidemiology, University of California San Diego, La Jolla, CA, USA
| | - Mark B. Reed
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA, USA
| | - Laramie R. Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jerasimos Ballas
- Department of Obstetrics and Gynecology, University of California San Diego, La Jolla, CA, USA
| | - Carla Marienfeld
- Department of Psychiatry, University of California, San Diego La Jolla, CA, USA
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English F, Greyson D. "You still have that fear": Policy constraints on informed decision making about legalized cannabis use during pregnancy and lactation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103774. [PMID: 35772267 DOI: 10.1016/j.drugpo.2022.103774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cannabis is the most commonly used drug during pregnancy, excluding alcohol and tobacco, in the United States. Cannabis consumption during pregnancy is increasing along with greater legal and social acceptance. METHODS We conducted a qualitative content analysis of 23 in-depth interviews with pregnant and lactating people in Massachusetts, a state that legalized cannabis for adult use in 2016. Our aim was to explore how policy constrains or facilitates people's ability to make informed decisions about cannabis use during pregnancy and lactation. Our analysis was conducted using an ecosocial approach, recognizing that the implementation and interpretation of cannabis policy can be understood at multiple levels, which interact with each other and shape the health and experiences of individuals. Additionally, this analysis was informed by a harm reduction approach in which we acknowledge the complexity surrounding cannabis use during pregnancy and lactation, while attempting to identify ways to reduce potentially harmful consequences. RESULTS Findings revealed that, despite the legal status of cannabis, there continues to be a lack of clarity for pregnant and lactating people regarding the legal implications of cannabis use. Inconsistent state and institutional policies about drug testing of mothers and newborns leave a cloud of fear hanging over the experiences of people who use cannabis and inhibit their ability to obtain expert advice from healthcare providers. CONCLUSION Decision makers in public and institutional policy should work to clarify and update policies regarding substance use during pregnancy following legalization of a new substance, and ensure that pregnant and lactating people are afforded the same legal protections as the general population.
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Affiliation(s)
- Faith English
- Department of Health Promotion and Policy 325 Arnold House, School of Public Health & Health Sciences, University of Massachusetts Amherst, 715 North Pleasant St. Amherst, MA, 01003, USA.
| | - Devon Greyson
- Department of Communication N308 Integrative Learning Center 650 N. Pleasant St. University of Massachusetts Amherst, Amherst, MA, 01003, USA.
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Cajachagua-Torres KN, El Marroun H, Reiss IKM, Jaddoe VWV. Maternal preconception and pregnancy tobacco and cannabis use in relation to placental developmental markers: A population-based study. Reprod Toxicol 2022; 110:70-77. [PMID: 35378220 DOI: 10.1016/j.reprotox.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Maternal tobacco and cannabis use during pregnancy are associated with adverse perinatal outcomes. We hypothesized that maternal tobacco and cannabis use are associated with placental adaptations, which subsequently lead to adverse perinatal outcomes. In a population-based prospective cohort study of 8008 pregnant women, we assessed maternal tobacco and cannabis use by questionnaires. Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured in the first and second trimester and at delivery from blood samples. Placental weight and pregnancy complications were obtained from medical records. We observed that tobacco use before and during first-trimester only was not associated with any angiogenic factors. As compared to no tobacco use, continued use during pregnancy was associated with higher PlGF, lower sFlt-1 concentrations, and lower sFlt-1/PlGF ratio in second trimester (all p-values <0.05). Also, compared to no cannabis use, use before and during pregnancy was associated with higher PlGF concentrations and lower sFlt-1/PlGF ratio in first and second trimester (all p-values <0.05). First trimester only cannabis use was associated with higher sFlt-1 concentrations and higher sFlt-1/PlGF ratio at delivery (all p-values <0.05). Compared to non-use, tobacco use before pregnancy was associated with a higher placental weight, whereas continued tobacco use during pregnancy was associated with a lower placental weight. Continued tobacco or cannabis use was related to higher placental weight to birth weight ratio and higher risk of pregnancy complications (all p-values <0.05). These results suggest that maternal tobacco and cannabis use lead to placental vascular maladaptation predisposing to adverse pregnancy outcomes.
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Affiliation(s)
- Kim N Cajachagua-Torres
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Hanan El Marroun
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; The Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, 3000 CB, Rotterdam, The Netherlands; The Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, 3062 PA, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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DeJong KN, Choby B, Valent AM. Strategies for Prevention or Treatment of Tobacco and Cannabis Use Disorder. Clin Obstet Gynecol 2022; 65:397-419. [PMID: 35318983 DOI: 10.1097/grf.0000000000000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tobacco and cannabis use in pregnancy are associated with increased adverse perinatal and long-term offspring outcomes. Products for both have evolved with various forms available on the market, challenging accurate counseling of risks and quantification of tobacco and cannabis usage during the perinatal period. Health care providers are recommended to screen for any type of use, provide consistent messaging of harms of tobacco and cannabis use in pregnancy, and offer individualized interventions. The journey to cessation can be complicated by barriers and triggers, lack of social supports, and mental health challenges that should be addressed to prevent relapse and withdrawals.
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Affiliation(s)
- Katherine N DeJong
- Department of Obstetrics and Gynecology, Addiction Medicine, Swedish Medical Center, Seattle, Washington
| | - Beth Choby
- Department of Medical Education, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Amy M Valent
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Lo JO, Hedges JC, Girardi G. Impact of cannabinoids on pregnancy, reproductive health and offspring outcomes. Am J Obstet Gynecol 2022; 227:571-581. [PMID: 35662548 DOI: 10.1016/j.ajog.2022.05.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
Cannabis is the most commonly used federally illegal drug in the United States and world, especially among people of reproductive age. In addition, the potency of cannabis products has increased significantly in the past decade. This is concerning because the available evidence suggests an adverse effect from cannabis exposure on male and female reproductive health. Exposure to cannabinoids may have differential impacts on female reproductive health across a woman's lifespan, from preconception to pregnancy, throughout lactation, and during menopause. Even more, cannabis use has been associated an adverse effect on fetal outcomes, and longer-term offspring health and developmental trajectories. Despite the prevalence of cannabis use, there is limited available evidence regarding its safety, especially in regard to reproductive health, pregnancy and lactation. The biological effects of cannabis are mediated by the endocannabinoid system and studies have reported the presence of cannabinoid receptors in the male and female reproductive tract, on sperm and the placenta, suggesting the endocannabinoid system plays a role in regulating reproduction. Cannabis use can impact male and female fertility and has been associated with altered reproductive hormones, menstrual cyclicity and semen parameters. Use of cannabis in males has also been associated with erectile dysfunction, abnormal spermatogenesis, and testicular atrophy. In females, cannabis use has been associated with infertility and abnormal embryo implantation and development. The main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), can also cross the placenta and has been detected in breastmilk. Maternal cannabis use during pregnancy and lactation has been associated with adverse effects including small for gestational age infants, preterm birth, fetal neurodevelopmental consequences, and impaired offspring sociobehavioral and cognitive development. The prevalence of cannabis use to alleviate menopausal symptoms has also increased despite the limited information on its benefits and safety. As cannabis use is on the rise, it is critical to understand its impact on reproductive health and offspring developmental outcomes. This is an understudied, but timely subject, with much needed information to guide healthcare providers and those interested in conceiving, or that are pregnant and lactating, as well as those at the end of their reproductive time span.
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First OK, MacGibbon KW, Cahill CM, Cooper ZD, Gelberg L, Cortessis VK, Mullin PM, Fejzo MS. Patterns of Use and Self-reported Effectiveness of Cannabis for Hyperemesis Gravidarum. Geburtshilfe Frauenheilkd 2022; 82:517-527. [PMID: 35528189 PMCID: PMC9076215 DOI: 10.1055/a-1749-5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/22/2022] [Indexed: 11/01/2022] Open
Abstract
Abstract
Introduction There is limited research on effective treatment of Hyperemesis Gravidarum (HG), the most extreme version of nausea and vomiting during pregnancy (NVP). This paper
examines current patterns of use and self-reported effectiveness of cannabis/cannabis-based products (CBP) to treat HG.
Materials/Methods The study employed a 21-question survey to gather information on demographics, antiemetic prescription use, and experience with cannabis/CBPs among individuals who
experienced extreme nausea and vomiting or HG during their pregnancy. Age-adjusted unconditional logistic regression was used to compare odds of symptom relief and weight gain between
respondents who used prescription antiemetics and those who used cannabis.
Results Of the 550 survey respondents, 84% experienced weight loss during pregnancy; 96% reported using prescription antiemetics and 14% reported cannabis use for HG. Most
respondents reported using cannabis/CBPs (71%) because their prescribed antiemetics were self-reported to be ineffective. More than half of cannabis/CBP users reported using products daily
or multiple times per day (53%), primarily via smoke inhalation (59%), and mainly either delta-9-tetrahydrocannabinol (THC) only or THC dominant preparations (57%). Eighty-two percent of
cannabis/CBP users reported symptom relief, compared to 60% of prescription antiemetic users. Among patients who reported weight loss during pregnancy, 56% of cannabis users reported gaining
weight within two weeks of treatment, compared to 25% of prescription antiemetic users.
Conclusions Respondents reported using cannabis primarily because prescribed medications were self-reported to be ineffective. Although the survey approach has inherent limitations
so results should be interpreted with caution, in this sample, cannabis was self-reported to be more effective than prescription medications in alleviating HG symptoms and enabling pregnancy
weight gain. Therefore, depending on the safety profiles, randomized, double-blinded, placebo-controlled trials of cannabis compared to other antiemetics are warranted to determine whether
cannabinoids may provide an effective alternative treatment for HG.
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Affiliation(s)
- Olivia K. First
- Hyperemesis Education and Research Foundation, Clackamas, OR, USA
| | | | - Catherine M. Cahill
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ziva D. Cooper
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lillian Gelberg
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Patrick M. Mullin
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marlena S. Fejzo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Austin AE, Gest C, Atkeson A, Berkoff MC, Puls HT, Shanahan ME. Prenatal Substance Exposure and Child Maltreatment: A Systematic Review. CHILD MALTREATMENT 2022; 27:290-315. [PMID: 33550839 DOI: 10.1177/1077559521990116] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
State and federal policies regarding substance use in pregnancy, specifically whether a notification to child protective services is required, continue to evolve. To inform practice, policy, and future research, we sought to synthesize and critically evaluate the existing literature regarding the association of prenatal substance exposure with child maltreatment. We conducted a comprehensive electronic search of PubMed, Web of Science, PsycInfo, CHINAL, Social Work Abstracts, Sociological Abstracts, and Social Services Abstracts. We identified 30 studies that examined the association of exposure to any/multiple substances, cocaine, alcohol, opioids, marijuana, and amphetamine/methamphetamine with child maltreatment. Overall, results indicated that substance exposed infants have an increased likelihood of child protective services involvement, maternal self-reported risk of maltreatment behaviors, hospitalizations and clinic visits for suspected maltreatment, and adolescent retrospective self-report of maltreatment compared to unexposed infants. While study results suggest an association of prenatal substance exposure with child maltreatment, there are several methodological considerations that have implications for results and interpretation, including definitions of prenatal substance exposure and maltreatment, study populations used, and potential unmeasured confounding. As each may bias study results, careful interpretation and further research are warranted to appropriately inform programs and policy.
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Affiliation(s)
- Anna E Austin
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, NC, USA
| | - Caitlin Gest
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Alexandra Atkeson
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Molly C Berkoff
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, NC, USA
| | - Meghan E Shanahan
- 359831Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, NC, USA
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Bączkowska M, Kosińska-Kaczyńska K, Zgliczyńska M, Brawura-Biskupski-Samaha R, Rebizant B, Ciebiera M. Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption-Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5148. [PMID: 35564543 PMCID: PMC9101673 DOI: 10.3390/ijerph19095148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 12/10/2022]
Abstract
Placental abruption (PA) is a separation of the placenta from the uterine wall occurring with the fetus still present in the uterine cavity. It contributes to numerous neonatal and maternal complications, increasing morbidity and mortality. We conducted a retrospective study at a tertiary perinatal care center, which included 2210 cases of labor that took place in 2015 with a PA occurrence of 0.7%. No maternal or fetal death during delivery was reported in this period. The identified PA risk factors were uterine malformations, pPROM, placenta previa spectrum, and oligohydramnios. The significant maternal PA complications identified were maternal anemia, uterine rupture, and HELLP syndrome. Preterm delivery occurred significantly more often in the PA group, and the number of weeks of pregnancy and the birth weight at delivery were both significantly lower in the PA group. PA is a relatively rare perinatal complication with very serious consequences, and it still lacks effective prophylaxis and treatment. Despite its rare occurrence, each center should develop a certain strategy for dealing with this pathology or predicting which patients are at risk. Much work is still needed to ensure the proper care of the mother and the baby in this life-threatening condition.
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Affiliation(s)
| | | | | | | | | | - Michał Ciebiera
- Center of Postgraduate Medical Education, Second Department of Obstetrics and Gynecology, 01-813 Warsaw, Poland; (M.B.); (K.K.-K.); (M.Z.); (R.B.-B.-S.); (B.R.)
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