Cannabis Use in Pregnancy and Neonatal Outcomes: A Systematic Review and Meta-Analysis

Lo, Jamie O.; Shaw, Beth; Robalino, Shannon; Ayers, Chelsea; Durbin, Shauna; Rushkin, Megan C.; Olyaei, Amy; Kansagara, Devan; Harrod, Curtis S.

doi:10.1089/can.2022.0262

Cited by 15 publications

(33 citation statements)

References 77 publications

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“…The data on prenatal cannabis use on maternal health are limited, but overall do not consistently support any pregnancy-related adverse maternal outcomes. [10][11][12]109 Several prior studies have examined the association between cannabis use in pregnancy and hypertensive disorders with conflicting results. Some studies have reported no association, [110][111][112] whereas others, including a retrospective cohort study of singleton deliveries in California from 2011 to 2017, noted that cannabis-related diagnoses were associated with an increased odds of hypertensive disorders (OR, 1.2; 95% CI, 1.2-1.3).…”

Section: Maternal Outcomes From Prenatal Cannabis Usementioning

confidence: 99%

“…Currently, the evidence suggests that prenatal cannabis exposure is associated with small for gestational age, defined as a birth weight less than the 10th percentile. [9][10][11][12] Although some studies did not adjust for confounders such as prenatal nicotine exposure, the most recently published systematic review observed that prenatal cannabis use significantly increased the likelihood of small for gestational age. 10 Lo et al 10 reported in unadjusted (18 studies; n = 1,774,485) and adjusted (6 studies; n = 686,336) meta-analyses that prenatal cannabis use significantly increased the odds of small for gestational age (unadjusted OR, 2.06; 95% CI, 1.76-2.41; aOR, 1.76; 95% CI, 1.52-2.05; I 2 = 86%).…”

Section: Fetal Growthmentioning

confidence: 99%

“…[9][10][11][12] Although some studies did not adjust for confounders such as prenatal nicotine exposure, the most recently published systematic review observed that prenatal cannabis use significantly increased the likelihood of small for gestational age. 10 Lo et al 10 reported in unadjusted (18 studies; n = 1,774,485) and adjusted (6 studies; n = 686,336) meta-analyses that prenatal cannabis use significantly increased the odds of small for gestational age (unadjusted OR, 2.06; 95% CI, 1.76-2.41; aOR, 1.76; 95% CI, 1.52-2.05; I 2 = 86%). There is less consistent literature supporting the association between maternal cannabis use and fetal growth restriction, defined as an overall estimated fetal weight or an abdominal circumference measurement of less than the 10th percentile.…”

Section: Fetal Growthmentioning

confidence: 99%

“…Many studies have consistently reported that prenatal cannabis use is associated with an increased risk of preterm birth, defined as delivery before 37 weeks' gestation, even after adjusting for confounders such as tobacco use. [9][10][11][12]152 In general, most studies reported the results of any preterm birth, but only a few stratified results by spontaneous versus indicated preterm births.…”

Section: Preterm Birthmentioning

confidence: 99%

“…8 The limited available evidence suggests that prenatal cannabis exposure is associated with stillbirth, fetal growth restriction, impaired fetal neurodevelopment, preterm delivery, increased neonatal intensive care unit admissions, and small-forgestational-age infants. [9][10][11][12] However, there is still a paucity of knowledge related to the safety of using cannabis in pregnancy because the majority of published studies are limited by a retrospective or observational study design, rely primarily on patient self-report, are confounded by polysubstance use, have a small sample size, lack biological drug testing, have inconsistent dose information, and mostly focus on the effects of smoking cannabis rather than other contemporary forms of cannabis use. 13 In addition, it is difficult to compare the different modes of delivery and concentration of cannabis consumption.…”

mentioning

confidence: 99%

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Cannabis and Pregnancy: A Review

Hayer,

Mandelbaum,

Watch

et al. 2023

Obstetrical &Amp; Gynecological Survey

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Importance Prenatal cannabis use is rising and is a major public health issue. Cannabis use in pregnancy and during lactation has been associated with increased maternal and offspring morbidity and mortality. Objective This review aims to summarize the existing literature and current recommendations for cannabis use during pregnancy or lactation. Evidence Acquisition A PubMed, Cochrane Library, and Google Scholar literature search using the following terms was performed to gather relevant data: “cannabis,” “cannabinoid,” “delta-9-tetrahydrocannabinol,” “THC,” “cannabidiol,” “fetal outcomes,” “perinatal outcomes,” “pregnancy,” and “lactation.” Results Available studies on cannabis use in pregnancy and during lactation were reviewed and support an association with increased risk of preterm birth, neonatal intensive care unit admission, low birth weight, and small-for-gestational-age infants. Conclusion and Relevance There is a critical need for research on the effects of cannabis use in pregnancy and during lactation. This is a necessary first step before furthering patient education, developing interventions, and targeting antenatal surveillance to ameliorate the adverse impacts on maternal and fetal health. Target Audience Obstetricians and gynecologists, family physicians, pediatricians Learning Objectives After participating in this activity, the learner should be better able to describe options for treatment of cannabis use disorder; explain common forms of cannabinoids available for use; and discuss screening options for cannabis use in pregnancy.

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Section: Maternal Outcomes From Prenatal Cannabis Usementioning

confidence: 99%

Section: Fetal Growthmentioning

confidence: 99%

Section: Fetal Growthmentioning

confidence: 99%

Section: Preterm Birthmentioning

confidence: 99%

mentioning

confidence: 99%

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Cannabis and Pregnancy: A Review

Hayer,

Mandelbaum,

Watch

et al. 2023

Obstetrical &Amp; Gynecological Survey

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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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Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure

Crosland,

Garg,

Bandoli

et al. 2024

JAMA Netw Open

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ImportanceThe prevalence of cannabis use in pregnancy is rising and is associated with adverse perinatal outcomes. In parallel, combined prenatal use of cannabis and nicotine is also increasing, but little is known about the combined impact of both substances on pregnancy and offspring outcomes compared with each substance alone.ObjectiveTo assess the perinatal outcomes associated with combined cannabis and nicotine exposure compared with each substance alone during pregnancy.Design, Setting, and ParticipantsThis retrospective population-based cohort study included linked hospital discharge data (obtained from the California Department of Health Care Access and Information) and vital statistics (obtained from the California Department of Public Health) from January 1, 2012, through December 31, 2019. Pregnant individuals with singleton gestations and gestational ages of 23 to 42 weeks were included. Data were analyzed from October 14, 2023, to March 4, 2024.ExposuresCannabis-related diagnosis and prenatal nicotine product use were captured using codes from International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification.Main Outcome and MeasuresThe main outcomes were infant and neonatal death, infants small for gestational age, and preterm delivery. Results were analyzed by multivariable Poisson regression models.ResultsA total of 3 129 259 pregnant individuals were included (mean [SD] maternal age 29.3 [6.0] years), of whom 23 007 (0.7%) had a cannabis-related diagnosis, 56 811 (1.8%) had a nicotine-use diagnosis, and 10 312 (0.3%) had both in pregnancy. Compared with nonusers, those with cannabis or nicotine use diagnoses alone had increased rates of infant (0.7% for both) and neonatal (0.3% for both) death, small for gestational age (14.3% and 13.7%, respectively), and preterm delivery (&lt;37 weeks) (12.2% and 12.0%, respectively). Moreover, risks in those with both cannabis and nicotine use were higher for infant death (1.2%; adjusted risk ratio [ARR], 2.18 [95% CI, 1.82-2.62]), neonatal death (0.6%; ARR, 1.76 [95% CI, 1.36-2.28]), small for gestational age (18.0%; ARR, 1.94 [95% CI, 1.86-2.02]), and preterm delivery (17.5%; ARR, 1.83 [95% CI, 1.75-1.91]).Conclusions and RelevanceThese findings suggest that co-occurring maternal use of cannabis and nicotine products in pregnancy is associated with an increased risk of infant and neonatal death and maternal and neonatal morbidity compared with use of either substance alone. Given the increasing prevalence of combined cannabis and nicotine use in pregnancy, these findings can help guide health care practitioners with preconception and prenatal counseling, especially regarding the benefits of cessation.

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Cannabis Use in Pregnancy and Neonatal Outcomes: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 77 publications

Cannabis and Pregnancy: A Review

Cannabis and Pregnancy: A Review

Prenatal Cannabis Use and Maternal Pregnancy Outcomes

Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure

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