Impact of Prenatal Cannabis Use Disorder on Perinatal Outcomes

Abstract

ObjectivesWith legislative changes to cannabis legalization and increasing prevalence of use, cannabis is the most commonly used federally illicit drug in pregnancy. Our study aims to assess the perinatal outcomes associated with prenatal cannabis use disorder.MethodsWe conducted a retrospective cohort study using California linked hospital discharge-vital statistics data and included singleton, nonanomalous births occurring between 23 and 42 weeks of gestational age. χ2 Test and multivariable logistic regression were used for statistical analyses.ResultsA total of 2,380,446 patients were included, and 9144 (0.38%) were identified as using cannabis during pregnancy. There was a significantly increased risk for adverse birthing person outcomes, including gestational hypertension (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.06–1.34; P = 0.004), preeclampsia (AOR, 1.16; 95% CI, 1.0–1.28; P = 0.006), preterm delivery (AOR, 1.45; 95% CI, 1.35–1.55; P < 0.001), and severe maternal morbidity (AOR, 1.22; 95% CI, 1.02–1.47; P = 0.033). Prenatal cannabis use disorder was also associated with an increased risk of neonatal outcomes including respiratory distress syndrome (AOR, 1.16; 95% CI, 1.07–1.27; P < 0.001), small for gestational age (AOR, 1.47; 95% CI, 1.38–1.56; P < 0.001), neonatal intensive care unit admission (AOR, 1.24; 95% CI, 1.16–1.33; P < 0.001), and infant death (AOR, 1.86; 95% CI, 1.44–2.41; P < 0.001). There was no statistically significant difference in stillbirth (AOR, 0.96; 95% CI, 0.69–1.34; P = 0.80) and hypoglycemia (AOR, 1.22; 95% CI, 1.00–1.49; P = 0.045)ConclusionsOur study suggests that prenatal cannabis use disorder is associated with increased maternal and neonatal morbidity and mortality. As cannabis use disorder in pregnancy is becoming more prevalent, our findings can help guide preconception and prenatal counseling.

Cannabis and Pregnancy: A Review

“…Some studies have reported no association, 110–112 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) 113 . Similarly, another retrospective cohort study also found increased odds of gestational hypertension (adjusted OR [aOR], 1.19; 95% CI, 1.06–1.34), preeclampsia (aOR, 1.16; 95% CI, 1.0–1.28), and severe maternal morbidity (aOR, 1.22; 95% CI, 1.02–1.47) with maternal cannabis use 114 . Co-use of cannabis with cigarette smoking in pregnancy has also been linked to increased odds of preeclampsia (aOR, 2.5; 95% CI, 1.4–5.0) and maternal asthma (aOR, 2.4; 95% CI, 1.0–5.9) 112 …”

“…113 Similarly, another retrospective cohort study also found increased odds of gestational hypertension (adjusted OR [aOR], 1.19; 95% CI, 1.06-1.34), preeclampsia (aOR, 1.16; 95% CI, 1.0-1.28), and severe maternal morbidity (aOR, 1.22; 95% CI, 1.02-1.47) with maternal cannabis use. 114 Co-use of cannabis with cigarette smoking in pregnancy has also been linked to increased odds of preeclampsia (aOR, 2.5; 95% CI, 1.4-5.0) and maternal asthma (aOR, 2.4; 95% CI, 1.0-5.9). 112 Data on associations of cannabis use with gestational diabetes are similarly mixed.…”

Marijuana use disorder among adults with functional disabilities—A US population‐based cross‐sectional study

“…For example, vulnerable groups such as US military veterans with psychiatric comorbidities have a greater likelihood of marijuana use disorder, which can increase psychotic symptoms and exacerbate posttraumatic stress disorder 15 . Pregnant women with marijuana use disorder are more likely to experience severe morbidity and preterm delivery as well as have infants with higher odds of respiratory distress syndrome and infant death 16 …”

“…15 Pregnant women with marijuana use disorder are more likely to experience severe morbidity and preterm delivery as well as have infants with higher odds of respiratory distress syndrome and infant death. 16 Recent studies have also examined the association between disability, marijuana use, and marijuana use disorder. For instance, Compton and colleagues found that adults who were unable to work because of disability were 1.2 times more likely to report marijuana use and marijuana use disorder in the past year compared to those who had a full-time job in their analyses of 2002-2014 NSDUH data.…”

Prenatal cannabis exposure alters offspring DNA methylation at genes involved in neurodevelopment, across the life course

“…Recent epidemiological studies indicate an impact of PCE on neonatal health and neurodevelopment 18 . Specifically, PCE is associated with physical neonatal health metrics such as birth weight, birth timing and infant growth restriction 2, [19][20][21] but also traits related to childhood and adolescent neurodevelopment and brain function, for example, higher order executive function 22,23 , and psycosocial and neurobehavioural traits such as psycopathy 24 and behavioural development 25 .…”