Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. This highlights the need for improved diagnostic practices and prospective studies evaluating treatments for this high-risk population.
Objective
To evaluate the association between marijuana use and a composite adverse pregnancy outcome using biological sampling.
Design
Retrospective cohort study.
Setting
Single tertiary center.
Population
Young women (13–22 years old) with singleton, non‐anomalous pregnancies delivered from September 2011 to May 2017.
Methods
Exposure was defined as marijuana detected on universal urine toxicology testing or by self‐report. Multivariable logistic regression modelling was used to estimate the effect of any marijuana use on the primary composite outcome. The effect of marijuana exposure was also estimated for self‐reported use, toxicology‐detected use, and multiple use detected by toxicology.
Main outcome measure
The primary composite outcome included spontaneous preterm birth, hypertensive disorders of pregnancy, stillbirth, or small for gestational age.
Results
Of 1206 pregnant young women, 17.5% (n = 211) used marijuana. Among the women who used marijuana, 8.5% (n = 18) were identified by self‐report alone, 63% (n = 133) by urine toxicology alone, and 28.4% (n = 60) by both. Urine toxicology testing results were available for 1092 (90.5%) births. The composite outcome occurred more frequently in pregnancies exposed to marijuana (46 versus 34%, P < 0.001). This remained significant after adjusting for race/ethnicity and tobacco in the multivariable model (adjusted OR 1.50, 95% CI 1.09–2.05). When marijuana exposure was defined by self‐report only, the association with adverse pregnancy outcome became non‐significant (adjusted OR 1.01, 95% CI 0.62–1.64).
Conclusion
In a population of young women with nearly universal biological sampling, marijuana exposure was associated with adverse pregnancy outcomes. The heterogeneity of findings in existing studies evaluating the impact of marijuana on mothers and neonates may result from the incomplete ascertainment of exposure.
Tweetable abstract
Marijuana use, as detected by universal urine testing, was associated with a composite adverse pregnancy outcome among young mothers.
In many centers presurgical term neonates with prostaglandin (PGE 1 )-dependent cardiac lesions experience nutritional deficiency due to postponed enteral feeds. We recently adopted early enteral feeding in these infants. This retrospective study reveals feeding tolerance in 33 of 34 neonates fed enterally while receiving PGE 1 , suggesting the safety of this practice.
Objective:
To compare self-reported maternal marijuana use to quantitative biological sampling for a marijuana metabolite, 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH), in umbilical cord homogenate in a state with legalized marijuana.
Methods:
Cross-sectional study of women approached at time of admission for delivery with live, singleton pregnancies ≥ 24 weeks at two urban medical centers in Colorado. Maternal marijuana use was estimated by (1) report to health care provider on admission history and physical, (2) survey of self-reported use, and (3) liquid chromatography tandem mass spectrometry analysis of umbilical cord homogenate for THC-COOH. Women were categorized by survey-reported last use (≤30 days ago, 30 days to 1 year, more than 1 year, never), and proportion of women with cord results above the limit of detection and limit of quantification for THC-COOH was reported for each group. Comparisons between groups were made using contingency tables. Correlation between survey-reported frequency of use and quantitative THC-COOH cord homogenate results was evaluated.
Results:
We included 116 women with self-report surveys linked to cord assay results. Six percent (95% CI 2.5–12.0%) of participants reported use in the last 30 days on survey and 2.6% (95% CI 0.5–7.4%) of participants reported marijuana use to health care providers. On umbilical cord assay, 22.4% (95% CI 15.2–31.1%) had detectable THC-COOH. The proportion of women with detectable THC-COOH increased with more recent self-reported use. Survey-reported frequency of use in the past 30 days had moderate correlation with quantified umbilical cord THC-COOH (correlation coefficient 0.44, 95% CI 0.28–0.58, p<0.001).
Conclusions:
Umbilical cord sampling results in higher estimates of prenatal marijuana use than self-report even in the setting of legalization. Umbilical cord assays for THC-COOH demonstrate promise for quantifying use. Future studies should examine how the use of biological sampling informs the association between marijuana use and perinatal outcomes.
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