In light of increasing cannabis use among pregnant women, the US Surgeon General recently issued an advisory against the use of marijuana during pregnancy.OBJECTIVE To evaluate whether cannabis use during pregnancy is associated with adverse outcomes among offspring. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, data were obtained from the baseline session of the ongoing longitudinal Adolescent Brain and Cognitive Development Study, which recruited 11 875 children aged 9 to 11 years, as well as a parent or caregiver, from 22 sites across the United States between June 1, 2016, and October 15, 2018. EXPOSURE Prenatal cannabis exposure prior to and after maternal knowledge of pregnancy.MAIN OUTCOMES AND MEASURES Symptoms of psychopathology in children (ie, psychotic-like experiences [PLEs] and internalizing, externalizing, attention, thought, and social problems), cognition, sleep, birth weight, gestational age at birth, body mass index, and brain structure (ie, total intracranial volume, white matter volume, and gray matter volume). Covariates included familial (eg, income and familial psychopathology), pregnancy (eg, prenatal exposure to alcohol and tobacco), and child (eg, substance use) variables. RESULTS Among 11 489 children (5997 boys [52.2%]; mean [SD] age, 9.9 [0.6] years) with nonmissing prenatal cannabis exposure data, 655 (5.7%) were exposed to cannabis prenatally. Relative to no exposure, cannabis exposure only before (413 [3.6%]) and after (242 [2.1%]) maternal knowledge of pregnancy were associated with greater offspring psychopathology characteristics (ie, PLEs and internalizing, externalizing, attention, thought and, social problems), sleep problems, and body mass index, as well as lower cognition and gray matter volume (all |β| > 0.02; all false discovery rate [FDR]-corrected P < .03). Only exposure after knowledge of pregnancy was associated with lower birth weight as well as total intracranial volume and white matter volumes relative to no exposure and exposure only before knowledge (all |β| > 0.02; all FDR-corrected P < .04). When including potentially confounding covariates, exposure after maternal knowledge of pregnancy remained associated with greater PLEs and externalizing, attention, thought, and social problems (all β > 0.02; FDR-corrected P < .02). Exposure only prior to maternal knowledge of pregnancy did not differ from no exposure on any outcomes when considering potentially confounding variables (all |β| < 0.02; FDR-corrected P > .70). CONCLUSIONS AND RELEVANCEThis study suggests that prenatal cannabis exposure and its correlated factors are associated with greater risk for psychopathology during middle childhood. Cannabis use during pregnancy should be discouraged.

Objective To estimate the effect of group prenatal care on perinatal outcomes compared with traditional prenatal care. Data Sources We searched MEDLINE through PubMed, EMBASE, Scopus, Cumulative Index of Nursing and Allied Health literature [CINAHL], the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects [DARE], the Cochrane Central Register of Controlled Trials [CENTRAL]) and clinicaltrials.gov. Methods of Study Selection We searched electronic databases for randomized controlled trials (RCT) and observational studies comparing group care with traditional prenatal care. The primary outcome was preterm birth. Secondary outcomes were low birthweight (LBW), neonatal intensive care unit (NICU) admission, and breastfeeding initiation. Heterogeneity was assessed using the Q test and I2 statistic. Pooled relative risks (RRs) and weighted mean differences were calculated using random-effects models. Tabulations, Integration, and Results Four RCTs and ten observational studies met inclusion criteria. The rate of preterm birth was not significantly different with group care compared with traditional care (11 studies: pooled rates 7.9% vs. 9.3%, pooled RR 0.87; 95% CI 0.70–1.09). Group care was associated with a decreased rate of LBW overall (9 studies: pooled rate 7.5% group care vs. 9.5% traditional care; pooled RR 0.81; 95% CI 0.69–0.96), but not among RCTs (4 studies: 7.9% group care vs. 8.7% traditional care, pooled RR 0.92; 95% CI 0.73–1.16). There were no significant differences in NICU admission or breastfeeding initiation. Conclusion Available data suggest that women who participate in group care have similar rates of preterm birth, NICU admission, and breastfeeding.

Background SARS-CoV-2 infection appears to increase the risk of adverse pregnancy outcomes such as preeclampsia in pregnant women. The mechanism(s) by which this occurs remains unclear. Methods We investigated the pathophysiology of SARS-CoV-2 at maternal-fetal interface in pregnant women who tested positive for the virus using RNA in situ hybridization (viral RNA), immunohistochemistry, and hematoxylin and eosin staining. To investigate whether viral infection alters the renin angiotensin system (RAS) in placenta which controls blood pressure, we treated human trophoblasts with recombinant Spike protein or a live modified virus with a vesicular stomatitis viral backbone expressing Spike protein (VSV-S). Findings Viral colonization was highest in maternal decidua, fetal trophoblasts, Hofbauer cells, and in placentas delivered prematurely. We localized SARS-CoV-2 to cells expressing Angiotensin-converting enzyme 2 (ACE2), and demonstrate that infected placentas had significantly reduced ACE2. In response to both Spike protein and VSV-S, cellular ACE2 decreased while Angiotensin II receptor type 1 (AT 1 R) increased with concomitant increase in soluble fms-like tyrosine kinase-1(sFlt1). Viral infection decreased pro-angiogenic factors, AT 2 R and Placental growth factor, which competitively binds to sFlt1. Sera from infected pregnant women had elevated levels of sFlt1 and Angiotensin II type 1-Receptor Autoantibodies prior to delivery, both signatory markers of preeclampsia. Conclusions SARS-CoV-2 colonizes ACE2-expressing maternal and fetal cells in the placenta. Infection in pregnant women correlates with alteration of placental RAS. As RAS regulates blood pressure, SARS-CoV-2 infection may thus increase adverse hemodynamic outcomes such as preeclampsia in pregnant women. Funding NIH/NICHD grants R01 HD091218 and 3R01HD091218-04S1 (RADx-UP Supplement)

Coronavirus disease 2019 or COVID-19 is an emerging viral disease caused by a member of the betacoronavirus family, SARS-CoV-2. Since its' emergence in December 2019, it has rapidly caused close to half a million fatalities globally. Data regarding the impact of COVID-19 on pregnancy are limited. Here, we review pathological findings in placentas from women who tested positive for SARS-CoV-2 as well as information on pregnancy outcomes associated with related and highly pathogenic coronaviruses (ie, severe acute respiratory syndrome (SARS-COV) and the Middle East respiratory syndrome, MERS). We present immune-inflammatory correlates of COVID-19 in pregnancy and review the role of the Renin Angiotensin System in the pathogenesis of COVID-19 in pregnancy. Greater understanding of the pathogenesis of SARS-CoV-2 in the placenta will yield important insight into potential therapeutic interventions for pregnant women with COVID-19.

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ObjectiveWe investigated the association between number of prenatal visits (PNV) and pregnancy outcomes.Study DesignA retrospective cohort of 12,092 consecutive, uncomplicated term births was included. Exclusion criteria included unknown or 3rd trimester pregnancy dating, pre-existing medical conditions, and common pregnancy complications. Patients with ≤10 PNV were compared to those with > 10. The primary outcome was a neonatal composite including NICU admission, low APGAR score (<7), low umbilical cord pH (<7.10), and neonatal demise. Secondary outcomes included components of the composite as well as vaginal delivery, induction and cesarean delivery. Logistic regression was used to adjust for potential confounders.ResultsOf 7256 patients in the cohort meeting inclusion criteria, 30% (N=2163) had >10 PNV and the remaining 70% (N=5093) had ≤10. There was no difference in the neonatal composite between the two groups. However, women with > 10 PNV were more likely to undergo induction of labor and cesarean delivery.ConclusionLow-risk women with ≥ 10 PNV had higher rates of pregnancy interventions without improvement in neonatal outcomes.

Background: We designed and tested the validity of a questionnaire to characterize maternal recall of pregnancy complications associated with increased future cardiovascular disease risk, based on the 2011 American Heart Association (AHA) guidelines. Methods: A maternal recall questionnaire of pregnancy history was administered to 971 patients who had participated in a previous cohort study of 1,608 pregnant women. Medical records from the study pregnancy served as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV), and/or Spearman's correlation coefficients (r) were calculated for each question. Results: A total of 526 (54%) individuals recontacted responded. Respondents were more likely to be older, white, educated, and nulliparous and were less likely to deliver low-birthweight infants in the study pregnancy than were individuals who did not respond. Mean length of recall was 4.35 years (standard deviation [SD] 0.46) postpartum. Maternal recall was most accurate for gestational diabetes (sens: 92%, spec: 98%, PPV: 79%, NPV: 99%), infant birthweight (r = 0.95), and gestation length (r = 0.85). Maternal recall was modest for preeclampsia (sens: 79%, spec: 97%, PPV: 68%, NPV: 98%) and pregnancy-associated hypertension, including preeclampsia or gestational hypertension (sens: 60%, spec: 95%, PPV: 64%, NPV: 94%).Conclusions: This validation study demonstrated that the majority of women could accurately recall a history of gestational diabetes, infant birthweight, and gestational age at delivery, 4 years postpartum on average. Recall of preeclampsia and pregnancy-associated hypertension overall was modest. Maternal report of these pregnancy conditions may help clinicians identify women at increased risk for cardiovascular disease.

Importance: In light of increasing cannabis use among pregnant women, the Surgeon General of the United States issued an advisory against the use of marijuana during pregnancy on August 29th, 2019. Objective: To determine whether cannabis use during pregnancy is associated with adverse outcomes among offspring. Design: Cross-sectional analysis of the baseline session of the ongoing longitudinal Adolescent Brain and Cognitive Development (ABCD) study. Setting: Data were collected from 22 sites across the United States between 2016 and 2018. Participants: Children ages 9-11 (n=11,489) and their parent or caregiver. Exposure: Prenatal marijuana exposure prior to and following maternal knowledge of pregnancy. Main Outcomes and Measures: Child psychopathology symptomatology (i.e., psychotic-like experiences and internalizing, externalizing, attention, thought, and social problems), cognition, sleep, birth weight, gestational age at birth, body mass index (BMI), and brain structure (i.e., total intracranial volume, white matter volume, gray matter volume). Covariates included familial (e.g., income, familial psychopathology), pregnancy (e.g., prenatal vitamin use, whether the pregnancy was planned), and child (e.g., birth weight, substance use) variables. Results: Among 11,489 children (age 9.9±0.6 years; 47.78% female), 655 (5.70%) were prenatally exposed to cannabis in total. Marijuana use prior to (n=648; 5.64%) and following (n=242; 2.11%) maternal knowledge of pregnancy were associated with increased offspring psychopathology characteristics (i.e., psychotic-like experiences and internalizing, externalizing, attention, thought, social, and sleep problems) and BMI as well as reduced cognition, birth weight, and brain structure (i.e., total white and gray mater volumes; all psfdr<.007), but not gestational age at birth. Exposure following maternal knowledge of pregnancy remained significantly associated with psychopathology, cognition, and birth weight outcomes when including potentially confounding variables (all ps<0.046). All associations with exposure prior to maternal knowledge of pregnancy were nonsignificant when considering potentially confounding variables (all ps>0.06). Conclusions and Relevance: Prenatal cannabis exposure, and its correlated factors, may increase risk for psychopathology and reduced cognition during middle childhood as well as reduced birthweight. Consistent with recent recommendations by the Surgeon General, marijuana use during pregnancy should be discouraged.