Association between marijuana use and adverse obstetrical and neonatal outcomes

Warshak, Carri R.; Regan, Jodi; Moore, Brooke; Magner, Kristin; Kritzer, Sara; Hook, James Van

doi:10.1038/jp.2015.120

Cited by 112 publications

(102 citation statements)

References 15 publications

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“…After duplicates were removed, 6542 publications were screened by title and abstract. Of these, 109 were retrieved for full‐text review and 41 studies were included in our scoping review …”

Section: Resultsmentioning

confidence: 99%

Prevalence and outcomes of prenatal recreational cannabis use in high‐income countries: a scoping review

Singh

Filion

Abenhaim

et al. 2019

BJOG

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Background With expanding recreational cannabis legalisation, pregnant women and their offspring are at risk of potentially harmful consequences. Objectives To assess the prevalence of recreational cannabis use among pregnant women, health outcomes associated with prenatal recreational cannabis use, and the potential impact of recreational cannabis legalisation on this population. Search strategy Five databases and the grey literature were systematically searched (2000–2019). Selection criteria Human studies published in English or French reporting on the prevalence of prenatal recreational cannabis use in high‐income countries. Data collection and analysis Data on study characteristics, prenatal substance use, and health outcomes were extracted and qualitatively synthesised. Main results Forty‐one publications met our inclusion criteria. The overall prevalence of prenatal cannabis use varied substantially (min–max: 0.24–22.6%), with the greatest use in the first trimester. In the three studies with temporal data available, rates of prenatal cannabis use increased across years. Only 7/41 and 5/41 studies provided information on gestational age of exposure and frequency of use, respectively. The concomitant use of alcohol, illicit drugs, and tobacco was higher among cannabis users than nonusers. Prenatal cannabis use was associated with select neonatal, but not maternal, health outcomes. There were insufficient data to compare prenatal cannabis use between the pre‐ and post‐legalisation periods. Conclusion Cannabis use among pregnant women is prevalent and may be associated with adverse neonatal outcomes. Future studies should assess the gestational age and frequency of cannabis exposure, and usage patterns prior to and following legalisation. Tweetable abstract Women who consume cannabis during pregnancy could risk predisposing their newborns to poor birth outcomes.

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Section: Resultsmentioning

confidence: 99%

Prevalence and outcomes of prenatal recreational cannabis use in high‐income countries: a scoping review

Singh

Filion

Abenhaim

et al. 2019

BJOG

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“…The rates of NICU admission in our study are similar to those published by Warshak et al who identified an increased rate of NICU admission among women (N=6468) who use cannabis compared to non-users (17.2 versus 12.5%). 28 A recent systematic review and meta-analysis also noted an increase in NICU admission among neonates exposed to cannabis in utero (pooled OR 2.02, 95% CI 1.27–3.21). 6 The observed increased risk of NICU admission in these and other studies 29 , coupled with our finding of increased neonatal morbidity, emphasizes the need to rigorously evaluate neonatal morbidity in this population.…”

Section: Commentmentioning

confidence: 96%

Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity

Metz

Allshouse

Hogue

et al. 2017

American Journal of Obstetrics and Gynecology

117

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Background The NICHD Stillbirth Collaborative Research Network (SCRN) previously demonstrated an association between stillbirth and maternal marijuana use as defined by the presence of 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC) in the umbilical cord homogenate. However, the relationship between marijuana use and perinatal complications in live births is uncertain. Objective Our aim was to examine if maternal marijuana use is associated with increased odds of adverse pregnancy outcomes and neonatal morbidity among liveborn controls in the SCRN cohort. Study Design Secondary analysis of singleton, liveborn controls in the SCRN dataset. Marijuana use was measured by self-report and/or the presence of THC in umbilical cord homogenate. Tobacco use was measured by self-report and/or presence of any cotinine in maternal serum. Adverse pregnancy outcome was a composite of small for gestational age (SGA), spontaneous preterm birth resulting from preterm labor with or without intact membranes (SPTB), and hypertensive disorders of pregnancy (HTN). Neonatal morbidity included neonatal intensive care unit (NICU) admission and composite neonatal morbidity (pulmonary morbidity, necrotizing enterocolitis, seizures, retinopathy of prematurity, infection morbidity, anemia requiring blood transfusion, neonatal surgery, hyperbilirubinemia, neurological morbidity or death prior to hospital discharge). Effect of maternal marijuana use on the probability of an adverse outcome was estimated using weighted methodology to account for over-sampling in the original study. THC cord homogenate analysis was performed in the subset of women for whom biospecimens were available. Comparisons using logistic modeling, chi-square, and t-tests were weighted to account for oversampling of preterm births and non-Hispanic blacks. Results are reported as weighted percent and unweighted frequencies. Results Maternal marijuana use was identified in 2.7% (unweighted frequency 48/1610) of live births. Use was self-reported by 1.6% (34/1610) and detected by THC in cord homogenate for 1.9% (17/897), n=3 overlapping. Rate of tobacco use was 12.9% (217/1610), with 10.7% (167/1607) by self-report and 9.5% (141/1313) by serum cotinine. The composite adverse pregnancy outcome was not significantly increased in women with marijuana use compared to non-users (31.2% versus 21.2%, p=0.14). After adjustment for tobacco, clinical and socioeconomic factors, marijuana use was not associated with the composite adverse pregnancy outcome (aOR 1.29, 95% CI 0.56–2.96). Similarly, among women with umbilical cord homogenate and serum cotinine data (n=765), marijuana use was not associated with adverse pregnancy outcomes (aOR 1.02, 95% CI 0.18–5.66). NICU admission rates were not statistically different between groups (16.9% users versus 9.5% non-users, p=0.12). Composite neonatal morbidity or death was more frequent among neonates of mothers with marijuana use compared to non-users (14.1% versus 4.5%, p=0.002). In univariate comparisons, the components of...

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“…In a retrospective records study, maternal use of cannabis, as determined by either self-report or a positive urine assay for THC, was associated with decrements in fetal growth (e.g. small-for-gestational age) and an increase of 54% in neonatal intensive care unit admissions (Warshak et al, 2015). This investigation is particularly noteworthy as women who used tobacco during pregnancy were not included in the study population.…”

Section: Impact Of Prenatal Cannabis Exposure On Neurodevelopmental Omentioning

confidence: 99%

Cannabis use during pregnancy: Pharmacokinetics and effects on child development

Grant

Petroff

Isoherranen

et al. 2018

Pharmacology & Therapeutics

192

159

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The broad-based legalization of cannabis use has created a strong need to understand its impact on human health and behavior. The risks that may be associated with cannabis use, particularly for sensitive subgroups such as pregnant women, are difficult to define because of a paucity of dose-response data and the recent increase in cannabis potency. Although there is a large body of evidence detailing the mode of action of Δ9‐tetrahydrocannabinol (THC) in adults, little work has focused on understanding how cannabis use during pregnancy may impact the development of the fetal nervous system and whether additional plant-derived cannabinoids might participate. This manuscript presents an overview of the historical and contemporary literature focused on the mode of action of THC in the developing brain, comparative pharmacokinetics in both pregnant and nonpregnant model systems and neurodevelopmental outcomes in exposed offspring. Despite growing public health significance, pharmacokinetic studies of THC have focused on nonpregnant adult subjects and there are few published reports on disposition parameters during pregnancy. Data from preclinical species show that THC readily crosses the placenta although fetal exposures appear lower than maternal exposures. The neurodevelopmental data in human and preclinical species suggest that prenatal exposure to THC may lead to subtle, persistent changes in targeted aspects of higher-level cognition and psychological well-being. There is an urgent need for well-controlled studies in humans and preclinical models on THC as a developmental neurotoxicant. Until more information is available, pregnant women should not assume that using cannabis during pregnancy is safe.

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Association between marijuana use and adverse obstetrical and neonatal outcomes

Abstract: Maternal marijuana use does not increase the risk of adverse obstetrical outcomes or fetal anomalies, but does increase the risk for small for gestational age and neonatal intensive care unit admission.

Cited by 112 publications

References 15 publications

Prevalence and outcomes of prenatal recreational cannabis use in high‐income countries: a scoping review

Prevalence and outcomes of prenatal recreational cannabis use in high‐income countries: a scoping review

Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity

Cannabis use during pregnancy: Pharmacokinetics and effects on child development

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