Placenta as alternative specimen to detect in utero cannabis exposure: A systematic review of the literature

Marchetti, Daniela; Masi, Gerardo Di; Cittadini, Francesca; G, La Monaca; Giovanni, Nadia De

doi:10.1016/j.reprotox.2017.06.049

Cited by 11 publications

(18 citation statements)

References 52 publications

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“…Emerging research indicates the female reproductive system is influenced by the endocannabinoid system, meaning chronic exposure to cannabis could lead to disruption of menstrual cycles, depression of ovarian follicular maturation, and reductions in key hormones needed for ovulation [29]. The pharmacokinetics of other substances in cannabis, such as cannabidiol (CBD), during the preconception, prenatal, and postpartum periods have been scarcely studied [30]. Additional research indicates that CBD influences estrogen signaling, crosses through the placenta and is transferred into breast milk [31,32].…”

Section: Introductionmentioning

confidence: 99%

Recreational Cannabis Legalization in the US and Maternal Use during the Preconception, Prenatal, and Postpartum Periods

Skelton

Hecht

Benjamin‐Neelon

2020

IJERPH

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In the United States (US), recreational cannabis use is on the rise. Since 2011, 11 states and the District of Columbia have legalized cannabis for adult recreational use. As additional states consider legalizing, there is an urgent need to assess associations between recreational cannabis legalization and maternal use in the preconception, prenatal, and postpartum periods—all critical windows for maternal and child health. Using cross-sectional data from the 2016 Pregnancy Risk Assessment Monitoring System, we assessed associations between state cannabis legalization and self-reported maternal cannabis use. Using logistic regression, we estimated the adjusted prevalence ratio (PR) of cannabis use during the preconception, prenatal, and postpartum period for women delivering a live-born infant in three states that had legalized recreational cannabis (Alaska, Colorado, and Washington) and three states that had not legalized (Maine, Michigan, and New Hampshire) by 2016. Our final sample size was 7258 women. We utilized 95% confidence intervals (CI) and a significance level of alpha = 0.05. After adjustment for potential confounders, women who resided in states with legalized recreational cannabis were significantly more likely to use cannabis during the preconception (PR 1.52; 95%CI ranging from 1.28–1.80; p < 0.001), prenatal (PR 2.21; 95% CI ranging from 1.67–2.94; p < 0.001), and postpartum (PR 1.73; 95%CI ranging from 1.30–2.30; p < 0.001) periods, compared to women who resided in states without legalized recreational cannabis. Although evidence about the effect of marijuana use during these periods is nascent, these findings show potential for increased incidence of child exposure to cannabis. Longitudinal research is needed to assess immediate and sustained impacts of maternal use before and after state legalization of recreational cannabis.

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Section: Introductionmentioning

confidence: 99%

Recreational Cannabis Legalization in the US and Maternal Use during the Preconception, Prenatal, and Postpartum Periods

Skelton

Hecht

Benjamin‐Neelon

2020

IJERPH

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“…29,59 Prior marijuana pharmacokinetic studies have primarily focused on nonpregnant adults smoking marijuana, with few reports on newer marijuana product use during pregnancy. [25][26][27][28] Previous rodent and rabbit studies performed in the 1960-1980s have provided some information on the pharmacokinetics and placental transfer of THC, but at a lower historical dose. 25,[60][61][62][63][64][65][66][67][68][69][70][71] In the rat, it has been shown that following maternal ingestion THC concentrations in fetal blood are approximately 1/10th of maternal concentrations 11,37 compared with one-third after intravenous or inhaled THC delivery.…”

Section: Marijuana Pharmakokineticsmentioning

confidence: 99%

“…Moreover, most of the literature reflects marijuana exposure almost exclusively through smoking, with few reports on more contemporary routes of administration. [25][26][27][28][29] Alternative vehicles for marijuana delivery, such as edibles, have become more popular especially in states with legalized marijuana use; increased interest can be attributed to perceptions shared by users that edibles and other forms of marijuana are a discreet and more convenient way to consume marijuana while avoiding the harmful toxins and health risks associated with smoking. 30 However, the effects of contemporary marijuana products on pregnancy outcomes are difficult to study because they often lack consistency in formulation and labeling, resulting in potentially greater THC exposure; additionally, they also have higher quantities of THC than in the 1980s when much of the marijuana research, including animal studies, was performed.…”

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confidence: 99%

Marijuana Use in Pregnancy: A Review

Thompson¹,

DeJong²,

2019

Obstetrical &Amp; Gynecological Survey

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Importance: Marijuana is the most commonly used dependent substance in pregnancy. The main active chemical of marijuana ) readily crosses the placenta, and cannabinoid receptors have been identified in fetal brain and placenta. As a result, prenatal marijuana use could potentially have detrimental impact on fetal development.Objective: This review aims to summarize the existing literature and current recommendations for marijuana use while pregnant or lactating. Evidence Acquisition: A PubMed literature search using the following terms was performed to gather relevant data: "cannabis," "cannabinoids," "marijuana," "fetal outcomes," "perinatal outcomes," "pregnancy," "lactation."Results: Available studies on marijuana exposure in pregnancy were reviewed and support some degree of developmental disruption, including an increased risk of fetal growth restriction and adverse neurodevelopmental consequences. However, much of the existing prenatal marijuana research was performed in the 1980s, when quantities of THC were lower and the frequency of use was less. Additionally, most human studies are also limited and conflicting as most studies have been observational or retrospective, relying primarily on patient self-report and confounded by polysubstance abuse and small sample sizes, precluding determination of a causal effect specific for marijuana. Given the paucity of evidence, it is currently recommended to avoid using marijuana while pregnant or when breastfeeding. Conclusion and Relevance:There is a critical need for research on effects in pregnancy using present-day THC doses. Once the adverse perinatal effects of marijuana exposure are identified and well characterized, patient education and antenatal surveillance can be developed to predict and mitigate its impact on maternal and fetal health.

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“…THC, CBD, and CBN are lipophilic compounds that readily cross the blood/placenta and blood/breast milk barriers, exposing the fetus or offspring to cannabinoids when cannabis is used during pregnancy or breastfeeding . Preclinical and clinical studies have shown that THC concentration in placenta, cord blood, and fetal tissue is lower than that in maternal plasma at the same collection time, suggesting that the fetus has a lower level of exposure than the mother 35,55 . However, cannabinoids can alter endocannabinoid signaling involved in immune regulation, which is important during pregnancy and fundamental gestational events such as decidualization, embryo implantation, and fetal development 56 .…”

Section: Cannabis Risks Associated With Cannabis Use During Pregnancymentioning

confidence: 99%

“…Investigations on placenta cannabinoid disposition started in the late 1960s, after acute intravenous, intraperitoneal, or subcutaneous administration of THC to animal models (rodents and dogs). Studies showed that THC concentration was higher in the placenta than in fetal tissue but lower than that in maternal plasma, suggesting that the fetus is less exposed to cannabinoids compared with the mother 55 . In 2010, Joya et al 50 reported the first human placenta cannabinoid concentration after induced abortion in the first trimester of pregnancy.…”

Section: Umbilical Cord and Placenta Testingmentioning

confidence: 99%

Monitoring Perinatal Exposure to Cannabis and Synthetic Cannabinoids

Carlier

Huestis

Zaami

et al. 2020

Therapeutic Drug Monitoring

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Purpose: Drug use during pregnancy is a critical global challenge, capable of severe impacts on neonatal development. However, the consumption of cannabis and synthetic cannabinoids is on the rise in pregnant women. Obstetric complications with increased risks of miscarriage, fetal growth restriction, and brain development impairment have been associated with perinatal cannabis exposure, but data on synthetic cannabinoid use during pregnancy are limited. Methods: We reviewed studies that investigated the risks associated with cannabis and synthetic cannabinoid use and those that reported the concentrations of cannabinoids and synthetic cannabinoids in maternal (breast milk) and neonatal (placenta, umbilical cord, meconium, and hair) matrices during human pregnancy. A MEDLINE and EMBASE literature search to identify all relevant articles published in English from January 1998 to April 2019 was performed. Results: Cannabis use during pregnancy is associated with increased risks of adverse obstetrical outcomes, although neurobehavioral effects are still unclear. Analyses of cannabinoids in meconium are well documented, but further research on other unconventional matrices is needed. Adverse effects due to perinatal synthetic cannabinoid exposure are still unknown, and analytical data are scarce. Conclusions: Awareness of the hazards of drug use during pregnancy should be improved to encourage health care providers to urge pregnant women to abstain from cannabis and, if cannabis-dependent, seek treatment. Moreover, substances used throughout pregnancy should be monitored as a deterrent to cannabis use, and potential cannabis-dependent women should be identified, so as to limit cannabis-fetal exposure during gestation, and provided appropriate treatment.

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Placenta as alternative specimen to detect in utero cannabis exposure: A systematic review of the literature

Cited by 11 publications

References 52 publications

Recreational Cannabis Legalization in the US and Maternal Use during the Preconception, Prenatal, and Postpartum Periods

Recreational Cannabis Legalization in the US and Maternal Use during the Preconception, Prenatal, and Postpartum Periods

Marijuana Use in Pregnancy: A Review

Monitoring Perinatal Exposure to Cannabis and Synthetic Cannabinoids

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