Rates of Prenatal Cannabis Use Among Pregnant Women Before and During the COVID-19 Pandemic

Young-Wolff, Kelly C.; Ray, G. Thomas; Alexeeff, Stacey; Adams, Sara R.; Does, Monique; Ansley, Deborah; Avalos, Lyndsay A.

doi:10.1001/jama.2021.16328

Cited by 51 publications

(55 citation statements)

References 5 publications

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“…Systems that are particularly affected include the cardiovascular, gastrointestinal, chromosomal, genitourinary, limb and body wall systems. Concerns regarding prenatal exposure were provided with heightened salience by reports from many places indicating increased use of cannabis and cannabinoid products by pregnant women in recent times [ 12 ], by rates of cannabis use in pregnancy amongst teenagers as high as 25% [ 13 ], by increased use of cannabis in pregnancy since the COVID-19 pandemic [ 12 ] and by reports that 69% of cannabis dispensaries positively recommend cannabis use to women whilst pregnant [ 14 ]. Moreover, recent reports note a quadruple convergence of rising rates of cannabis use, Δ9-tetrahydrocannabinol (THC) potency, intensity of daily use and cannabis use disorder in Europe, suggesting that the modern era is actually experiencing a confluence of concerning teratogenic trends [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Cannabinoid and substance relationships of European congenital anomaly patterns: a space-time panel regression and causal inferential study

Reece

Hulse

2022

Environmental Epigenetics

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With reports from Australia, Canada, USA, Hawaii and Colorado documenting a link between cannabis and congenital anomalies (CAs), this relationship was investigated in Europe. Data on 90 CAs were accessed from Eurocat. Tobacco and alcohol consumption and median household income data were from the World Bank. Amphetamine, cocaine and last month and daily use of cannabis from the European Monitoring Centre for Drugs and Drug Addiction. Cannabis herb and resin Δ9-tetrahydrocannabinol concentrations were from published reports. Data were processed in R. Twelve thousand three hundred sixty CA rates were sourced across 16 nations of Europe. Nations with a higher or increasing rate of daily cannabis use had a 71.77% higher median CA rates than others [median ± interquartile range 2.13 (0.59, 6.30) v. 1.24 (0.15, 5.14)/10 000 live births (P = 4.74 × 10−17; minimum E-value (mEV) = 1.52]. Eighty-nine out of 90 CAs in bivariate association and 74/90 CAs in additive panel inverse probability weighted space-time regression were cannabis related. In inverse probability weighted interactive panel models lagged to zero, two, four and six years, 76, 31, 50 and 29 CAs had elevated mEVs (< 2.46 × 1039) for cannabis metrics. Cardiovascular, central nervous, gastrointestinal, genital, uronephrology, limb, face and chromosomalgenetic systems along with the multisystem VACTERL syndrome were particularly vulnerable targets. Data reveal that cannabis is related to many CAs and fulfil epidemiological criteria of causality. The triple convergence of rising cannabis use prevalence, intensity of daily use and Δ9-tetrahydrocannabinol concentration in herb and resin is powerfully implicated as a primary driver of European teratogenicity, confirming results from elsewhere.

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Section: Introductionmentioning

confidence: 99%

Cannabinoid and substance relationships of European congenital anomaly patterns: a space-time panel regression and causal inferential study

Reece

Hulse

2022

Environmental Epigenetics

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“…Data from a national survey indicated that 5.4% of pregnant individuals in 2019 reported any past-month cannabis use during their pregnancy. Recent evidence from a different sample found an increase in biochemically-verified cannabis use among pregnant individuals following the onset of the COVID-19 pandemic 24 from 3.4 to 8.1% of individuals testing positive. As prenatal cannabis use becomes more prevalent, coupled with our findings that exposure may complicate mental health outcomes in children, research is needed to identify the specific facets of sleep, or other factors outside of the sleep domain, that can be modified in these children to achieve a similar benefit on their mood.…”

Section: Discussionmentioning

confidence: 99%

The beneficial effect of sleep on behavioral health problems in youth is disrupted by prenatal cannabis exposure: A causal random forest analysis of ABCD data

Spechler

Gutierrez

Tapert

et al. 2022

Preprint

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ImportanceDeclining risk perceptions and touted medicinal claims about cannabis are likely related to the increasing prevalence of cannabis use during pregnancy. Yet, it remains unclear if prenatal cannabis exposure yields lasting neurodevelopmental alterations in children, and which facets of their behavioral health might be affected.ObjectiveTo determine if prenatal cannabis exposure moderates the relationship between changing sleep hours on changing mood and behavioral problems in youth.DesignCausal random forest analysis of ABCD cohort data using baseline (ages 9-10) and year-1 follow up information.Setting11,875 children and their parents were assessed at 21 acquisition sites across the United States between July 2016 to October 2018.ParticipantsParticipants with prenatal drug use data were included, and 94% of the baseline sample also had year-1 follow up data.ExposuresA change in sleep hours from baseline to year-1 was conceptualized as the dimensional “treatment” variable, and self-reported drug uses of the biological mother were conceptualized as moderators of that “treatment”.Main Outcomes and MeasuresA change in internalizing (anxious/depressed mood) and externalizing (disruptive behavior) problems from baseline to year-1 were the two outcome measures. Sociodemographic and other prenatal drug exposures were included as covariates. Given the observational nature of the multi-site ABCD study, all hypotheses tested here were formulated after data collection.ResultsThere were n=9,826 children (4,663 female) included in analyses, of which n=605 (303 female) had any prenatal cannabis exposure. On average, internalizing problems largely remained stable from baseline (M=48.54, SD=10.56) to year-1 (M=48.75, SD=10.64)(t9,825=2.40, p=.016), as did externalizing problems (baseline M=45.64, SD=10.21; year-1 M=45.23, SD=10.09) (t9,825=5.44, p<.001). Significant average treatment effects indicated that participants with more sleep hours reported less internalizing (ATE=-.35, SE=.08, p=.003) and externalizing (ATE=-.28, SE=.07, p=.028) problems over time. However, a significant heterogeneous treatment effect by prenatal cannabis exposure (conditional-ATE=.92, SE=.36, p=.011) was found for the internalizing model, such that participants with this exposure did not show a beneficial effect of changing sleep on changing mood (B=.06, SE=.25). This finding was specific to cannabis, as no such effect was found for any sociodemographics or prenatal alcohol or tobacco exposures for the internalizing or externalizing models.Conclusions and RelevanceThis study uncovers an actionable target (sleep) to improve mood and behavioral problems in typically developing children not prenatally exposed to cannabis. However, changing sleep may not have a similar effect for youth prenatally exposed to cannabis. Given the importance of the endocannabinoid system in regulating perinatal neurodevelopment and sleep, these findings suggest that cannabis exposure may interact with those processes to diminish the beneficial effects of sleep on mood in children, and thus calls into question the safety of cannabis use during pregnancy.KEY POINTSQuestionDo children exposed to cannabis during pregnancy exhibit differences in the effect of sleep on their mood and behavior?FindingsCausal inference analyses of baseline (ages 9-10) and year-1 follow up data of the Adolescent Brain Cognitive Development™ (ABCD) study (N=9,826) suggested that increasing sleep hours lowered mood and behavioral problems in children without prenatal cannabis exposures, however, children with exposures did not exhibit similar beneficial effects of sleep on their mood. This finding was specific to cannabis, as other drug use and sociodemographic information did not influence treatment effects.MeaningPrenatal cannabis exposure likely interferes with neurodevelopmental processes related to sleep, and these differences persist into at least early adolescence to alter the beneficial effects of sleep on mood.

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“…Cannabis is used widely by young people in the reproductive age group. Indeed, one recent study reported that 24% of pregnant Californian teenagers recently tested positive for cannabis [ 13 ], a situation that appears to have deteriorated since the COVID-19 pandemic commenced [ 14 ]. It was recently reported that an estimated 169 000 American women used cannabis while pregnant [ 15–18 ].…”

Section: Introductionmentioning

confidence: 99%

European epidemiological patterns of cannabis- and substance-related congenital cardiovascular anomalies: geospatiotemporal and causal inferential study

Reece

Hulse

2022

Environmental Epigenetics

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As prenatal and community cannabis exposures have recently been linked with congenital heart disease (CHD), it was of interest to explore these associations in Europe in a causal framework and space-time context. Congenital anomaly data from Eurocat, drug-use data from the European Monitoring Centre for Drugs and Drug Addiction, and income from the World Bank. Countries with rising daily cannabis use had in general higher congenital anomaly rates over time than those without (time: status interaction: β-Est. = 0.0267, P = 0.0059). At inverse probability-weighted panel regression, cannabis terms were positive and significant for CHD, severe CHD, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, tetralogy of Fallot, vascular disruptions, double outlet right ventricle, transposition of the great vessels, hypoplastic right heart, and mitral valve anomalies from 1.75 × 10−19, 4.20 × 10−11, <2.2 × 10−16, <2.2 × 10−16, 1.58 × 10−12, 4.30 × 10−9, 4.36 × 10−16, 3.50 × 10−8, 5.35 × 10−12, <2.2 × 10−16, 5.65 × 10−5 and 6.06 × 10−10. At spatial regression, terms including cannabis were positive and significant for this same list of anomalies from 0.0038, 1.05 × 10−10, 0.0215, 8.94 × 10−6, 1.23 × 10−5, 2.05 × 10−5, 1.07 × 10−6, 8.77 × 10−5, 9.11 × 10−6, 0.0001, 3.10 × 10−7 and 2.17 × 10−7. 92.6% and 75.2% of 149 E-value estimates and minimum E-values were in high zone >9; 100.0% and 98.7% >1.25. Data show many congenital cardiac anomalies exhibit strong bivariate relationships with metrics of cannabis exposure. Causal inferential modelling for the twelve anomalies selected demonstrated convincing evidence of robust relationships to cannabis which survived adjustment and fulfilled epidemiological criteria for causal relationships. Space-time regression was similarly confirmatory. Epigenomic pathways constitute viable potential mechanisms. Given exponential genotoxic dose-response effects, careful and astute control of cannabinoid penetration is indicated.

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Rates of Prenatal Cannabis Use Among Pregnant Women Before and During the COVID-19 Pandemic

Cited by 51 publications

References 5 publications

Cannabinoid and substance relationships of European congenital anomaly patterns: a space-time panel regression and causal inferential study

Cannabinoid and substance relationships of European congenital anomaly patterns: a space-time panel regression and causal inferential study

The beneficial effect of sleep on behavioral health problems in youth is disrupted by prenatal cannabis exposure: A causal random forest analysis of ABCD data

European epidemiological patterns of cannabis- and substance-related congenital cardiovascular anomalies: geospatiotemporal and causal inferential study

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