Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes

Bandoli, Gretchen; Jelliffe‐Pawlowski, Laura L.; Schumacher, Benjamin T.; Baer, Rebecca J.; Felder, Jennifer N.; Fuchs, Jonathan; Oltman, Scott P.; Steurer, Martina A.; Marienfeld, Carla

doi:10.1016/j.drugalcdep.2021.108757

Cited by 29 publications

(54 citation statements)

References 44 publications

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“…Maternal alcohol‐related diagnoses during pregnancy and maternal comorbidities (preexisting diabetes, non‐alcohol substance‐related diagnoses during pregnancy, and mental health diagnoses complicating pregnancy) were identified from ICD‐9 and ICD‐10 codes in a hospital discharge, emergency department, or ambulatory surgery records during pregnancy or delivery as has been utilized in previous studies (Table S1 ). 18 , 19 , 20 …”

Section: Methodsmentioning

confidence: 99%

“…Thus, we calculated the e‐value, or the strength of an unmeasured confounder necessary to negate the observed multivariable exposure‐outcome association, as has been previously reported. 18 E‐values were computed for “any cardiac defect,” “endocardial cushion defect,” and “abnormalities of the cardiac outflow tract” in fully adjusted models both with and without nicotine adjustment (R package episensr ). The e‐value is the minimum strength of the association, on the risk ratio scale, that an unmeasured confounder would need to have with both the treatment and outcome, conditional on the measured covariates, to fully explain away the observed exposure‐outcome association.…”

Section: Methodsmentioning

confidence: 99%

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Association of Alcohol Use Diagnostic Codes in Pregnancy and Offspring Conotruncal and Endocardial Cushion Heart Defects

Harvey

Baer

Bandoli

et al. 2022

JAHA

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Background The pathogenesis of congenital heart disease (CHD) remains largely unknown, with only a small percentage explained solely by genetic causes. Modifiable environmental risk factors, such as alcohol, are suggested to play an important role in CHD pathogenesis. We sought to evaluate the association between prenatal alcohol exposure and CHD to gain insight into which components of cardiac development may be most vulnerable to the teratogenic effects of alcohol. Methods and Results This was a retrospective analysis of hospital discharge records from the California Office of Statewide Health Planning and Development and linked birth certificate records restricted to singleton, live‐born infants from 2005 to 2017. Of the 5 820 961 births included, 16 953 had an alcohol‐related International Classification of Diseases , Ninth and Tenth Revisions (ICD‐9; ICD‐10 ) code during pregnancy. Log linear regression was used to calculate risk ratios (RR) for CHD among individuals with an alcohol‐related ICD ‐9 and ICD10 code during pregnancy versus those without. Three models were created: (1) unadjusted, (2) adjusted for maternal demographic factors, and (3) adjusted for maternal demographic factors and comorbidities. Maternal alcohol‐related code was associated with an increased risk for CHD in all models (RR, 1.33 to 1.84); conotruncal (RR, 1.62 to 2.11) and endocardial cushion (RR, 2.71 to 3.59) defects were individually associated with elevated risk in all models. Conclusions Alcohol‐related diagnostic codes in pregnancy were associated with an increased risk of an offspring with a CHD, with a particular risk for endocardial cushion and conotruncal defects. The mechanistic basis for this phenotypic enrichment requires further investigation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association of Alcohol Use Diagnostic Codes in Pregnancy and Offspring Conotruncal and Endocardial Cushion Heart Defects

Harvey

Baer

Bandoli

et al. 2022

JAHA

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“…and ICD-10 (n=1)] as a measure of abuse, addiction, or mental or behavioral disorder associated with cannabis use during pregnancy 26,[46][47][48] , childbirth [46][47][48][49][50] or in the period from the twelve months before pregnancy to delivery 51 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…51 The prevalence of cannabis use during pregnancy ranged from 0.005 26 to 39%. 31 Six studies 24,29,35,46,49,50 evaluated the trend of use. Five identified an increase in the prevalence of cannabis use during pregnancy, 24,35,46,49,50 while Straub et al 29 did not identify any difference in prevalence rates in the pre-and postlegalization periods of recreational use of cannabis.…”

Section: Cannabis Assessmentmentioning

confidence: 99%

“…Five studies assessed the gestational age in weeks stratifying PTB into different categories, 27,28,32,39,46 and five studies 27,28,34,35,40 indicated the type of preterm delivery (spontaneous or provider initiated). The studies that stratified PTB by weeks of gestation found a higher risk of early PTB (<34 weeks of gestation) 39 and of very PTB (<32 weeks of gestation) 27,28,32,46 in cannabis users. The five studies 27,28,34,35,40 that assessed the type of preterm delivery identified a higher risk of spontaneous preterm birth (SPTB) in cannabis users, irrespective of cigarette smoking.…”

Section: Specific Aspects Regarding Preterm Birthmentioning

confidence: 99%

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The Effects of Cannabis Use during Pregnancy on Low Birth Weight and Preterm Birth: A Systematic Review and Meta-analysis

Baía

Domingues

2022

Am J Perinatol

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Objective: to summarize literature regarding the effects of cannabis use during pregnancy on low birthweight (LBW), preterm birth (PTB) and small for gestational age (SGA). Study Design: 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 was synthesized using a narrative summary and pooled adjusted estimates and 95% confidence intervals (CI) were calculated for each outcome. Data was analyzed using Stata 13.0 with METAN software package, using random effects. Statistical heterogeneity was assessed using the Cochran´s Q and Higgins I2 tests. Results: 32 studies were included with data from approximately 5.5 million women for the LBW outcome and 23 million for the PTB and SGA outcomes. Pregnant women using cannabis are at increased risk for LBW (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 type of preterm birth and gestational age at birth indicate higher risks of spontaneous PTB and of early or very-early preterm births 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 trimester of gestation. Conclusion: There is an effect of cannabis irrespectively 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.

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Prenatal Cannabis Use and Maternal Pregnancy Outcomes

Young-Wolff,

Adams,

Alexeeff

et al. 2024

JAMA Intern Med

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ImportanceMany studies have evaluated whether in utero cannabis exposure is associated with fetal and neonatal outcomes, yet little is known about whether prenatal cannabis use is associated with maternal health outcomes during pregnancy.ObjectiveTo evaluate whether prenatal cannabis use is associated with maternal health outcomes during pregnancy.Design, Setting, and ParticipantsThis population-based retrospective cohort study included pregnancies in Northern California from January 2011 to December 2019 that lasted 20 weeks or longer and were screened for prenatal cannabis use.ExposuresPrenatal cannabis use was defined as any self-reported use during early pregnancy or a positive toxicology test result based on universal screening at entrance to prenatal care (approximately 8-10 weeks’ gestation). Self-reported frequency of use (daily, weekly, monthly or less, never, unknown), use defined only by self-report, and use defined only by toxicology test results were examined.Main Outcomes and MeasuresElectronic health record data were used to define the following outcomes: gestational hypertension, preeclampsia, eclampsia, gestational diabetes, gestational weight gain greater and less than guidelines, placenta previa, placental abruption, placenta accreta, and severe maternal morbidity. Adjusted risk ratios (aRRs) were calculated using a modified Poisson regression.ResultsThe sample (n = 316 722 pregnancies; 250 221 unique individuals) included 84 039 (26.5%) Asian/Pacific Islander, 20 053 (6.3%) Black, 83 145 (26.3%) Hispanic, and 118 333 (37.4%) White individuals; the mean (SD) age was 30.6 (5.4) years. Overall, 20 053 (6.3%) screened positive for prenatal cannabis use; 2.9% were positive by self-report, 5.3% by toxicology testing, and 1.8% by both. The frequency of cannabis use was 1930 (0.6%) daily, 2345 (0.7%) weekly, 4892 (1.5%) monthly or less, and 10 886 (3.4%) unknown. Prenatal cannabis use was associated with greater risk of gestational hypertension (aRR, 1.17; 95% CI, 1.13-1.21), preeclampsia (aRR, 1.08; 95% CI, 1.01-1.15), weight gain less than (aRR, 1.05; 95% CI, 1.01-1.08) and greater than (aRR, 1.09; 95% CI, 1.08-1.10) guidelines, and placental abruption (aRR, 1.19; 95% CI, 1.05-1.36). The pattern of results was similar when defining prenatal cannabis use only by self-report or only by toxicology testing, and associations between the frequency of prenatal cannabis use and outcomes varied with outcome.Conclusions and RelevanceThe results of this cohort study suggest that prenatal cannabis use was associated with several adverse maternal health outcomes during pregnancy. Continued research is needed to understand whether characteristics of prenatal cannabis use (eg, dose, mode, and timing) moderate these associations.

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Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes

Cited by 29 publications

References 44 publications

Association of Alcohol Use Diagnostic Codes in Pregnancy and Offspring Conotruncal and Endocardial Cushion Heart Defects

Association of Alcohol Use Diagnostic Codes in Pregnancy and Offspring Conotruncal and Endocardial Cushion Heart Defects

The Effects of Cannabis Use during Pregnancy on Low Birth Weight and Preterm Birth: A Systematic Review and Meta-analysis

Prenatal Cannabis Use and Maternal Pregnancy Outcomes

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