INTRODUCTION: To identify adverse pregnancy outcomes associated with marijuana use during pregnancy. METHODS: We conducted a secondary analysis of the prospective cohort study, “Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be” (nuMoM2b), which recruited 10,038 nulliparous women with singleton pregnancies from eight U.S. medical centers. Information regarding marijuana use was obtained using direct questionnaires during in-person interview. The composite adverse outcome included stillbirth, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age births. Secondary outcomes assessed neonatal morbidity, specifically examining neonatal intensive care unit admission, respiratory distress syndrome, neonatal sepsis, and neonatal death. Other secondary outcomes included mode of delivery and suspected intrauterine fetal growth restriction. RESULTS: Marijuana use during pregnancy was identified in 1.3% of the nulliparous women with singleton pregnancies. Marijuana users during pregnancy were found to have an increased risk of the composite adverse outcome compared to nonusers (27.6% vs 20.4%; P=.049) with an increase small-for-gestational-age births (16.6% vs 9.5%; P=.021). After adjustment for age, BMI, race, and chronic hypertension, marijuana use was not associated with the composite adverse pregnancy outcome (adjusted odds ratio 1.27; 95% CI 0.84–1.89). CONCLUSION: Maternal marijuana use is potentially associated with an increased risk of composite adverse pregnancy outcome of stillbirth, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age births. However, the association was not significant when controlling for possible confounders. Future studies should focus on biologic evidence of marijuana consumption as compared to self-report.

between Pitocin, double lumen cervical ripening balloon (CRB) and prostaglandins (PGs). Since mechanical manipulation might affect the cervix, we aimed to investigate differences in cervical recuperation following different methods of induction and other cervical manipulations. STUDY DESIGN: The study was conducted between june 2016 to june 2018. Following informed consent, cervical length (CL) measurements were performed trans-vaginally following spontaneous and induced vaginal deliveries. All measurements were performed by a single observer (R.L) at 8, 24 and 48 hours postpartum. CL at the second trimester, demographic characteristics, obstetric history, parity, delivery outcomes, previous cervical manipulations and induction mode, were obtained from the patient's' medical records. RESULTS: Our cohort included 498 women. The average CL, 48 hours postpartum, following spontaneous term deliveries (254 women) was 35.2AE3.5 mm. 79 patients were induced with Dinoprostone, 77 with Pitocin and 88 by CRB. Significant abnormal cervical recovery was demonstrated in the CRB group compared to the Pitocin and the PGs groups (26.3AE1.9 mm vs. 35.9AE2.3 mm vs. 34.4AE3.1 mm, respectively (P¼0.012)) ( Fig 1a). One hundred twenty six patients had history of D&Cs, 49 had one D&C, 35 had two D&Cs and 43 patients had more than 2 D&Cs. Patients with more than 2 D&Cs demonstrated abnormal cervical recovery compared to patients that had 2 or 1 D&C (27.9AE2.3 mm vs. 32.6AE2.7 mm vs. 38.5AE1.8 mm, respectively (P¼0.028)) (Fig 1b). CONCLUSION: Cervical manipulations such as mechanical inductions and repeated D&Cs may cause damage to the cervix and increase its`recovery time. This has only been proven for the double lumen cervical ripening balloon and has not been evaluated for a Foley catheter. Although the clinical significance of delayed cervical recuperation postpartum has not been elucidated yet, these results might imply future cervical insufficiency and possible risk of preterm birth. Our results raise the question whether mechanical modes of induction have a negative and possibly long-term effect on the cervix. OBJECTIVE:The objective of this study was to determine if polydioxanone suture compared to polyglactin suture reduced the incidence of wound and fascial complications after cesarean deliveries.ajog.org