Associations of first trimester co-use of tobacco and Cannabis with prenatal immune response and psychosocial well-being

Abstract

Purpose.-This study aims to describe the association of first trimester co-use of tobacco and cannabis with maternal immune response and psychosocial well-being, relative to tobacco use only. Methods.-A preliminary midpoint analysis included 138 pregnant women with biologically verified tobacco use, 38 of whom (28%) also tested positive for recent cannabis use. Maternal perceived stress (Perceived Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and serum immune markers (IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, CRP, MMP8), were collected, although cytokine data were only available for 122 women. Results.-Participant average age was 29.1 years, approximately half had a high school education or less, and half were unemployed. Compared to tobacco only users, co-users were more likely to be non-White, younger and more economically disadvantaged. In the adjusted linear regression models, TNF-α levels were significantly lower among co-users relative to tobacco only users, after adjusting for age, race/ethnicity, body mass index and tobacco use group (tobacco cigarettes, electronic nicotine delivery devices [ENDS] or both). TNF-α was the only immune marker found to be significant in this analysis. Measured stress levels (M=5.9, SD=3.3; potential range 0-16) and depression scores (M=7.8, SD=5.8; potential range 0-30) were low across all participants and did not differ as a function of co-use.

Impact of Acute and Chronic Cannabis Use on Stress Response Regulation: Challenging the Belief That Cannabis Is an Effective Method for Coping

“…Further, a prospective examination of the relationship between symptoms of PTSD and cannabis use in pregnant women using ecological momentary assessments found that peak PTSD symptoms were significantly and temporally related to cannabis use (Sanjuan et al, 2019). In contrast, however, a cross-sectional examination of perceived stress scores with self-reported cannabis use during the first trimester indicated a null relationship (Ashford et al, 2019), perhaps due to overall low perceived stress scores, lack of variability, or reliance on self-reported use. Similarly, Ellis and colleagues (Ellis et al, 2019) did not observe a link between psychological distress and cannabis use during pregnancy among justice-involved women.…”

“…Similarly, Ellis and colleagues (Ellis et al, 2019) did not observe a link between psychological distress and cannabis use during pregnancy among justice-involved women. Together, these three studies (Ashford et al, 2019;Ellis et al, 2019;Sanjuan et al, 2019) suggest that the relationship between subjective stress and cannabis use may be complicated with daily fluctuation that may not be detectable via onetime assessments. Numerous demographic variables (e.g., younger age, lower education, lower income), use of other substances (e.g., nicotine, alcohol) during pregnancy, and depression are known predictors of cannabis use during pregnancy.…”

“…Specifically, 70% of pregnant women reported perceiving that there was "no risk" or "slight risk" if women use cannabis 1-2 times per week during pregnancy (Ko et al, 2018;Corsi et al, 2020). Perceived risk has declined over the past two decades, while both the acceptance and prevalence of use by pregnant women has increased (Ashford et al, 2019). Among pregnant women who have used cannabis in the past 30 days, in 2005 25.8% of them reported "no risk" related to in utero cannabis exposure whereas in 2015, 65.4% reported the same (Jarlenski et al, 2017).…”

Monitoring Perinatal Exposure to Cannabis and Synthetic Cannabinoids

“…Low fatty acid amide hydrolase and high anandamide levels were initially associated with lower rates of embryo implantation, impaired decidualization, and higher risks of spontaneous miscarriage 56,68 . Recently, Ashford et al 69 examined the effects of cannabis and tobacco coexposure on the immune response of 138 women in the United States, during their first trimester of pregnancy. They observed decreased proinflammatory immune responses, as reflected by decreased tumor necrosis factor-a (TNF-a) levels, which may affect fetal outcomes.…”

“…No significant differences (P , 0.05) were observed in the levels of other inflammatory markers [interleukin-1b (IL-1b), IL-2, IL-6, IL-8, and IL-10, C-reactive proteins, and matrix metalloproteinase-8 (MMP-8)]. In the absence of a cannabis-only group, it was impossible to conclude if the observed inflammatory effects resulted from cannabis only or a synergistic action with tobacco 69 .…”