Cannabis Abuse or Dependence During Pregnancy: A Population-Based Cohort Study on 12 Million Births

doi:10.1016/j.jogc.2018.09.009

Journal of Obstetrics and Gynaecology Canada

Volume 41, Issue 5, May 2019, Pages 623-630

https://doi.org/10.1016/j.jogc.2018.09.009 Get rights and content

Abstract

Objective

Cannabis is the most commonly used recreational drug during pregnancy in the United States. This study aimed to describe the rate of cannabis dependence or abuse use during pregnancy and its effect on obstetrical and neonatal outcomes.

Methods

A retrospective population-based cohort of births in the United States between 1999 and 2013 was created using data from the National Inpatient Sample. Births to mothers who reported cannabis dependence or abuse were identified using ICD-9 codes, and the effect on various obstetrical and neonatal outcomes was assessed using logistic regression, adjusting for relevant confounders (Canadian Task Force Classification II-2).

Results

A total of 12 578 557 births were included in our analysis. The incidence of cannabis abuse or dependence rose from 3.22 in 1000 births in 1999 to 8.55 in 1000 births in 2013 (P < 0.0001). Women reporting cannabis dependence or abuse were more likely to have a preterm premature rupture of membranes (odds ratio [OR] 1.46; 95% confidence interval [CI] 1.35–1.58), a hospital stay of >7 days (OR 1.17; 95% CI 1.11–1.23), and an intrauterine fetal demise (OR 1.50; 95% CI 1.39–1.62). Neonates born to exposed mothers had a higher risk of prematurity (OR 1.40; 95% CI 1.36–1.43) and growth restriction (OR 1.35; 95% CI 1.30–1.41).

Conclusion

Cannabis use during pregnancy steadily increased over the study period. Users of cannabis during gestation were more likely to have adverse outcomes during delivery and require longer periods of hospitalization. Neonates born to exposed mothers were more likely to be born preterm and underweight.

Résumé

Objectif

Aux États-Unis, le cannabis est la drogue à usage récréatif la plus fréquemment consommée pendant la grossesse. Cette étude avait pour buts de calculer le taux de femmes enceintes ayant une dépendance au cannabis ou abusant de celui-ci et de présenter l’incidence du cannabis sur les issues obstétricales et néonatales.

Méthodologie

Une étude de cohorte rétrospective basée sur la population et portant sur les naissances survenues aux États-Unis entre 1999 et 2013 a été menée au moyen de données issues du National Inpatient Sample. Les naissances issues de mères ayant déclaré être dépendantes aux cannabis ou avoir abusé de celui-ci ont été codées selon la CIM-9, et les effets du cannabis sur les diverses issues obstétricales et néonatales ont été évalués au moyen de régressions logistiques tenant compte des facteurs de confusion potentiels (classification II-2 du Groupe d’étude canadien).

Résultats

Au total, 12 578 557 naissances ont été retenues pour l’analyse. L’incidence de la dépendance au cannabis ou de l’abus de celui-ci est passée de 3,22 par 1 000 naissances en 1999 à 8,55 par 1 000 naissances en 2013 (P < 0,0001). Les femmes dépendantes au cannabis ou ayant abusé de celui-ci étaient plus susceptibles de vivre une rupture prématurée des membranes (RC : 1,46; IC à 95 % : 1,35–1,58), d’être hospitalisées plus de sept jours (RC : 1,17; IC à 95 % : 1,11–1,23) et de présenter un décès fœtal intra-utérin (RC : 1,50; IC à 95 % : 1,39–1,62). Les nouveau-nés de mères exposées au cannabis couraient un risque accru de naissance prématurée (RC : 1,40; IC à 95 % : 1,36–1,43) et de retard de croissance (RC : 1,35; IC à 95 % : 1,30–1,41).

Conclusion

La consommation de cannabis pendant la grossesse a augmenté de façon constante au cours de la période à l’étude. Les femmes enceintes qui en consommaient couraient un risque accru d’hospitalisation prolongée et d’issues indésirables à l’accouchement. Les nouveau-nés de mères exposées au cannabis étaient plus susceptibles de naître prématurément et de présenter un poids insuffisant.

Section snippets

INTRODUCTION

Cannabis sativa, colloquially known as cannabis or marijuana, is the most commonly used illicit substance in the United States and Canada. Its use has noticeably increased in the last two decades. For example, the 2014 version of the National Survey of Drug Use and Health estimated that 8.4% of the U.S. population were current users of the drug, a finding reflecting an important increase from the 2002 survey, which reported a use prevalence of 6.2%.¹ The use of cannabis is expected to become

MATERIALS AND METHODS

We conducted a retrospective cohort study using the National Inpatient Sample (NIS), the largest publicly available database of hospital admissions in the United States. Under the management of the Health Care Utilization Project, the NIS aggregates sociodemographic, resource utilization, and clinical-level information for approximately 7 million hospital admissions in 44 participating states annually, representing over 20% of the admissions to community hospitals nationwide.⁷ Information is

RESULTS

Our cohort consisted of 12 578 557 women who were delivered between 1999 and 2013, of whom 66 925 were identified as having reported cannabis dependence or abuse. The overall prevalence of cannabis dependence or abuse was 5.32 per 1000 births over the study period. Annual prevalence estimates are displayed in Figure 1. The prevalence of cannabis dependence or abuse in delivering mothers nearly tripled from 3.22 in 1000 deliveries in 1999 to 8.5 in 1000 deliveries in 2013. Prevalence estimates

DISCUSSION

Cannabis use in pregnant women is a growing public health concern, as population-level data have shown that its use has increased significantly in recent decades. Both the American College of Obstetricians and Gynecologists and the U.S. Centers for Disease Control and Prevention discourage cannabis use during gestation, yet previous cohort studies have estimated that 3.3% to 20.5% of pregnant women have used the substance over the course of their pregnancy.¹^,8, 9, 10, 11, 12 Although the use of

CONCLUSION

The prevalence of the use of cannabis during pregnancy is increasing, thus highlighting the importance of understanding its effects in gestating women. Our study demonstrates that maternal cannabis use is associated with important adverse outcomes for both the mother and the neonate. Importantly, mothers with a history of cannabis use during pregnancy were more likely to be hospitalized for longer periods of time following parturition, and their neonates were more likely to be born preterm and

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In this cumulative meta-analysis, thirty-six observational studies, consisting of 18 case-control and 18 cohort studies, with 230, 816 cases of birth defects and 18,049,013 controls (healthy babies) were included in the final analysis. We found that offspring exposed to maternal prenatal cannabis are at greater risks of a wide range of structural birth defects: cardiovascular/heart [OR = 2.35: 95 % CI 1.63 – 3.39], gastrointestinal [OR = 2.42: 95 % CI 1.61 – 3.64], central nervous system [OR = 2.87: 95 % CI 1.51 – 5.46], genitourinary [OR = 2.39: 95 % CI 1.11 – 5.17], and any (unclassified) birth defects [OR = 1.25: 95 % CI 1.12 – 1.41].
The findings from the current study suggest that maternal prenatal cannabis exposure is associated with a higher risk of different forms of structural birth defects in offspring. The findings underscore the significance of implementing preventive strategies, including enhanced preconception counselling, to address cannabis use during pregnancy and mitigate the risk of birth defects in offspring.
Metagenomic investigation of 16S rRNA marker gene samples to analyze the role of race, ethnicity, and location in preterm birth: A comprehensive vaginal microbiome meta-analysis
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The vaginal microbiome is essential to women's reproductive health and numerous studies have demonstrated that any microbial dysbiosis can increase the risk of Preterm Birth (PTB). The present study utilized an integrated computational methodology to conduct a meta-analysis of PTB vaginal microbiome samples from women of different racial, ethnic, and geographical locations, across multiple studies derived from public repositories. Taxonomic classification, functional profiling, and statistical analysis of the PTB samples revealed that Finegoldia, Haemophilus, and Lactobacillus showed the highest variation in their microbial abundances while the Sensory system pathway, Substance dependence pathway, and Circulatory system pathway showed the highest variation in their expression levels based on race, ethnicity, and locations respectively. All of these factors cause subsequent variations in the etiology of PTB across the aforementioned demographic attributes. LEfSE and ANCOM-BC approaches were performed to identify race, ethnicity, and geographic location-specific microbial biomarkers. To the best of our knowledge, our work is one of the first to provide a detailed analysis of the complex delineations between socioeconomic constructs of race and ethnicity at a global scale, considering the eight racial groups and the geographical location of the participants who faced PTB. We believe these findings will have significant implications for the development of more targeted and efficacious strategies for the prevention and treatment of PTB.
Substance use and treatment characteristics among pregnant and non-pregnant females, 2015–2019
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In the United States (US), pregnant females who use substances face increased morbidity and mortality risks compared to non-pregnant females. This study provides a national snapshot of substance use and treatment characteristics among US reproductive-aged females, including those who are pregnant.
Our sample included females aged 15–44 years (n=97,830) from the 2015–2019 National Survey on Drug Use and Health (NSDUH) data. We calculated weighted percentages of past-month alcohol or drug use and past-year substance use disorder (SUD), stratified by pregnancy status. We also calculated weighted percentages of past-year treatment setting and payer. Pearson chi-square tests were conducted to determine if percentages were statistically significantly different.
Compared to non-pregnant females, pregnant females had lower prevalence of past-month illicit drug use excluding cannabis (1.6% vs. 4.3%, p<0.01), cannabis use (5.3% vs. 12.5%, p<0.01), binge drinking (4.5% vs. 29.3%, p<0.01) and past-year SUD (7.1 vs. 8.8%, p<0.01). Less than 13% of females with SUD received treatment regardless of pregnancy status, but treatment use was higher among pregnant females compared to non-pregnant females (12.8% vs. 10.5%). However, there were no statistically significant differences in past-year treatment use, setting, or treatment payer.
The prevalence of substance use and SUD was lower among pregnant females compared to non-pregnant females in 2015–2019. Low uptake of substance use treatment suggests that barriers exist to treatment-seeking among reproductive-aged women. Further exploration of stigma, payment, and access to treatment, and how they differ by pregnancy status, is needed.
Exploring the associations between serious psychological distress and the quantity or frequency of tobacco, alcohol, and cannabis use among pregnant women in the United States
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Serious Psychological Distress (SPD) and prenatal exposure to substances are associated with adverse outcomes for pregnant individuals and their developing offspring. This study aims to examine the relationship between SPD and quantity, or frequency of substance use among pregnant women in the United States (US). Descriptive and negative binomial regression analyses of the 2015–2019 National Survey on Drug Use and Health (NSDUH) were conducted among 3373 pregnant women (18 to 44 years old) to examine the association between SPD and (1) average number of cigarettes smoked in the past 30 days, (2) number of days of binge drinking in the past 30 days, and (3) number of days of cannabis use in the past 30 days. About 6% of the study population experienced SPD in the past 30 days. Compared to pregnant women who did not report SPD, pregnant women experiencing SPD showed greater rates in the number of cigarettes smoked during the past 30 days (IRR = 2.1, 95%CI = 1.1, 4.5), the number of days of binge drinking in the past 30 days (IRR = 5.1, 95%CI = 1.7, 15.4), and the number of days of cannabis use in the past 30 days (IRR = 2.9, 95%CI = 1.3, 6.5). Our results extend findings from prior research by documenting an association between SPD and the quantity and frequency of substance use among pregnant women in the US. Individual and structural interventions addressing SPD and/or substance might help reduce the impact of these comorbid conditions on expectant parents and their offspring.
Implementation of State Laws Giving Pregnant People Priority Access to Drug Treatment Programs in the Context of Coexisting Punitive Laws
2023, Women's Health Issues
In response to increased prenatal drug use since the 2000s, states have adopted treatment-oriented laws giving pregnant and postpartum people priority access to public drug treatment programs as well as multiple punitive policy responses. No prior studies have systematically characterized these state statutes or examined implementation of state priority access laws in the context of co-existing punitive laws.
We conducted legal mapping to examine state priority access laws and their overlap with state laws deeming prenatal drug use to be child maltreatment, mandating reporting of prenatal drug use to child protective services, or criminalizing prenatal drug use. We also conducted interviews with 51 state leaders with expertise on their states’ prenatal drug use laws to understand how priority access laws were implemented.
Thirty-three states and the District of Columbia have a priority access law, and more than 80% of these jurisdictions also have one of the punitive prenatal drug use laws described. Leaders reported major barriers to implementing state priority access laws, including the lack of drug treatment programs, stigma, and conflicts with punitive prenatal drug use laws.
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Citation Excerpt :
Given the differences in exposure assessment (clinician diagnosis, self-report via surveys, molecular testing), it is challenging to directly compare our findings to previous studies. A study of births in the National Inpatient Sample in the United States between 1999–2013 is likely the most directly comparable (Petrangelo et al., 2019). ICD9 codes were used to identify CRD, which rose from 3.2 to 8.5 per 1000 births over the study period.
Cannabis use and cannabis use disorders are increasing in prevalence, including among pregnant women. The objective was to evaluate the association of a cannabis-related diagnosis (CRD) in pregnancy and adverse maternal and infant outcomes.
We queried an administrative birth cohort of singleton deliveries in California between 2011–2017 linked to maternal and infant hospital discharge records. We classified pregnancies with CRD from International Classification of Disease codes. We identified nicotine and other substance-related diagnoses (SRD) in the same manner. Outcomes of interest included maternal (hypertensive disorders) and infant (prematurity, small for gestational age, NICU admission, major structural malformations) adverse outcomes.
From 3,067,069 pregnancies resulting in live births, 29,112 (1.0 %) had a CRD. CRD was associated with an increased risk of all outcomes studied; the strongest risks observed were for very preterm birth (aRR 1.4, 95 % CI 1.3, 1.6) and small for gestational age (aRR 1.4, 95 % CI 1.3, 1.4). When analyzed with or without co-exposure diagnoses, CRD alone conferred increased risk for all outcomes compared to no use. The strongest effects were seen for CRD with other SRD (preterm birth aRR 2.3, 95 % CI 2.2, 2.5; very preterm birth aRR 2.6, 95 % CI 2.3, 3.0; gastrointestinal malformations aRR 2.0, 95 % CI 1.6, 2.6). The findings were generally robust to unmeasured confounding and misclassification analyses.
CRD in pregnancy was associated with increased risk of adverse maternal and infant outcomes. Providing education and effective treatment for women with a CRD during prenatal care may improve maternal and infant health.

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OBSTETRICSCannabis Abuse or Dependence During Pregnancy: A Population-Based Cohort Study on 12 Million Births

Abstract

Objective

Methods

Results

Conclusion

Résumé

Objectif

Méthodologie

Résultats

Conclusion

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

Prev Med

Drug Alcohol Depend

BJOG

Patient Educ Couns

Complement Ther Clin Pract

Toxicol Appl Pharmacol

Trends Pharmacol Sci

J Am Acad Child Adolesc Psychiatry

Neurotoxicol Teratol

Neurotoxicol Teratol

Life Sci

Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health

Clearing the smoke on cannabis maternal cannabis use during pregnancy – an update

Committee opinion no. 637: marijuana use during pregnancy and lactation

Obstet Gynecol

No. 349-substance use in pregnancy

J Obstet Gynaecol Can

Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age

Am J Obstet Gynecol

Healthcare Cost and Utilization Project (HCUP). Overview of the State Inpatient Databases (SID)

OBSTETRICS
Cannabis Abuse or Dependence During Pregnancy: A Population-Based Cohort Study on 12 Million Births