Pregnancy Outcomes Associated With Use of Tobacco and Marijuana

Layoun, Vanessa R.; Ohnona, Ashley; Tolosa, Jorge E.

doi:10.1097/grf.0000000000000699

Cited by 5 publications

(8 citation statements)

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“…The findings for the latter two studies need to be treated with caution as they simultaneously reported no significant difference in risk for exclusive-vaping and non-use. This implies that smoking does not pose an elevated risk, when it has been well established that smoking poses an increased risk [ 1 ], and therefore raises questions about the validity of their findings for vaping. One study observed that vapers (combining exclusive-vapers and dual-users) had a greater risk of depression symptoms during pregnancy than non-users or exclusive-smokers [ 51 ].…”

Section: Resultsmentioning

confidence: 99%

“…We excluded studies without full texts (e.g., abstract only). Although we sought all health outcomes, we anticipated including most of the important clinical outcomes for pregnant women, fetuses and infants identified in reviews of the health consequences of NTR and smoking [ 1 , 4 , 21 ], including miscarriage, stillbirth, preterm birth, birthweight, low birthweight, small for gestational age, admission to neonatal intensive care, caesarean section, congenital abnormalities and neonatal death. We also anticipated that biomarker studies would include most of the biomarkers of toxicants and carcinogens that have been assessed in studies of vaping among non-pregnant populations [ 12 ], including nitrosamines, VOCs, PAHs and heavy metals.…”

Section: Methodsmentioning

confidence: 99%

“…Smoking during pregnancy is harmful to maternal, fetal and child health; increases the risk of adverse birth outcomes such as preterm birth, low birthweight, stillbirth, and miscarriage [ 1 ]; and is a global public health issue [ 1 , 2 ]. Effective smoking cessation interventions for pregnant individuals are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

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Vaping during pregnancy: a systematic review of health outcomes

Ussher,

Fleming,

Brose

2024

BMC Pregnancy Childbirth

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Introduction Smoking during pregnancy is harmful to maternal and child health. Vaping is used for smoking cessation but evidence on health effects during pregnancy is scarce. We conducted a systematic review of health outcomes of vaping during pregnancy. Methods We searched six databases for maternal/fetal/infant outcomes and vaping, including quantitative, English language, human studies of vaping during pregnancy, to November 10th, 2023. We assessed study quality with the Mixed-Methods Appraisal Tool. We focused on comparisons of exclusive-vaping with non-use of nicotine and tobacco products and with smoking. Presentation is narrative as the studies were of insufficient quality to conduct meta-analysis. Results We included 26 studies, with 765,527 women, with one randomised controlled trial (RCT) comparing vaping and nicotine replacement therapy for smoking cessation, 23 cohort studies and two case–control studies. While the RCT met 4/5 quality criteria, the quality of the cohort studies and case–control studies was poor; none adequately assessed exposure to smoking and vaping. For studies comparing exclusive-vaping with ‘non-use’, more reported no increased risk for vaping (three studies) than reported increased risk for maternal pregnancy/postpartum outcomes (one study) and for fetal and infant outcomes (20 studies no increased risk, four increased risk), except for birth-weight and neurological outcomes where two studies each observed increased and no increased risk. When the RCT compared non-users with those not smoking but vaping or using NRT, irrespective of randomisation, they reported no evidence of risk for vaping/NRT. For studies comparing exclusive-vaping and exclusive-smoking, most studies provided evidence for a comparable risk for different outcomes. One maternal biomarker study revealed a lower risk for vaping. For small-for-gestational-age/mean-birth-centile equal numbers of studies found lower risk for vaping than for smoking as found similar risk for the two groups (two each). Conclusions While more studies found no evidence of increased risk of exclusive-vaping compared with non-use and evidence of comparable risk for exclusive-vaping and exclusive-smoking, the quality of the evidence limits conclusions. Without adequate assessment of exposure to vaping and smoking, findings cannot be attributed to behaviour as many who vape will have smoked and many who vape may do so at low levels. Study registration https://osf.io/rfx4q/.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Vaping during pregnancy: a systematic review of health outcomes

Ussher,

Fleming,

Brose

2024

BMC Pregnancy Childbirth

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“…While retrospective observational studies suggest that outcomes like preterm birth and small for gestational age (SGA, defined as birthweight less than 10 th percentile by gestational age) are associated with prenatal cannabis use, these are also well-characterized as a sequelae of prenatal tobacco use. [12][13][14] We sought to prospectively evaluate the impact of PCU on outcomes in birthing persons with pre-pregnancy cannabis use and negative self-report of nicotine use, who either continued cannabis in pregnancy or did not. We examined whether PCU, as well as intensity of use, was associated with adverse outcomes for the pregnant person or neonate.…”

Section: Introductionmentioning

confidence: 99%

Perinatal Impacts of Cannabis and Nicotine: An Analysis of the Cannabis Use During Development and Early Life Study

Trammel,

Agrawal,

Bogdan

et al. 2024

Preprint

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OBJECTIVE: Evaluate associations between prenatal cannabis use (PCU) and perinatal outcomes. METHODS: We performed an interval analysis of a prospective cohort study of pregnant individuals with pre-pregnancy cannabis use and negative self-report of nicotine use, comparing those who continued cannabis through pregnancy with those who stopped. Patients underwent interviews and urine drug screening for cannabis and cotinine, a nicotine metabolite, in each trimester. The primary outcome was small for gestational age (SGA) at delivery. Secondary outcomes included antenatal and postpartum complications, mode of delivery, and neonatal outcomes. Secondary analyses included stratification by intensity of cannabis use and urinary cotinine positivity. RESULTS: Birthing persons with PCU differed in age (25.5 vs 27.8 years, p=0.001), body mass index (BMI; 27.4 vs 30.9, p=0.001), area deprivation index percentiles (92% PCU vs 88%, p=0.013), cotinine positivity (42.8% vs 10.8%, p<0.001), Hispanic ethnicity (2% vs 7.2%, p=0.009), and education attainment beyond high school (29.4% vs 50%, p<0.001) compared to controls. Birthing person outcomes did not differ. Risks of SGA and other neonatal outcomes did not differ when adjusted for confounders on initial analysis, or with stratification by intensity of cannabis use. Despite negative self-report for nicotine, 42.8% of PCU patients tested positive for cotinine (PCU+c). PCU+c was associated with increased risk of SGA and birthweight less than the 5th percentile, compared to PCU cases without nicotine exposure (17.4% vs 8.3%, aRR 2.7 [1.21-5.38], 35.8% vs 18.6%, aRR 2.4 [1.51-3.48]), and controls (35.8% vs 12.9%, aRR 2.75 [1.64-4.13]). Cotinine-negative PCU patients and controls did not differ. CONCLUSION: PCU was not independently associated with adverse birthing person outcomes. Many patients demonstrated nicotine exposure, either via inadvertent exposure or undisclosed use. While neonates exposed to cannabis alone did not differ from unexposed neonates, those exposed to both cannabis and nicotine were at increased risk of SGA.

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“…For example, among pregnant individuals, cannabis and tobacco co-use is up to three times more common than cannabisonly use (Coleman-Cowger et al, 2017;Ko et al, 2018), a majority of pregnant individuals who smoke cigarettes also report use of cannabis (Ko et al, 2015), and women who report co-use in pregnancy are more likely to continue using both or either substance during pregnancy or postpartum (Coleman-Cowger et al, 2017;De Genna et al, 2018;England et al, 2020;Ko et al, 2020;Qato et al, 2020). Use of tobacco or cannabis across the perinatal period is associated with numerous negative birth outcomes, such as low birth weight, premature birth, respiratory illness, cognitive deficits, and increased secondhand smoke exposure (Centers for Disease Control and Prevention, 2001;Duko et al, 2023;Lin et al, 2023;Regan et al, 2021), with co-use associated with worse neurobehavioral and birth outcomes (Coleman-Cowger et al, 2018;De Genna et al, 2019;Layoun et al, 2022;Stroud et al, 2018Stroud et al, , 2020.…”

mentioning

confidence: 99%

Use and co-use of tobacco and cannabis before, during, and after pregnancy: A longitudinal analysis of waves 1–5 of the Population Assessment of Tobacco and Health (PATH) study.

Powers,

Maloney,

Sharma

et al. 2024

Psychology of Addictive Behaviors

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Objective: Co-use of tobacco and cannabis may be prevalent in pregnancy, potentially leading to additional adverse health outcomes. Utilizing a national sample of women followed prospectively before, during, and after pregnancy, this study tested whether prepregnancy co-use of tobacco and cannabis (vs. tobacco-only use and cannabis-only use) was associated with greater likelihood of continuing to use tobacco and/or cannabis during pregnancy and postpartum. Method: Data were drawn from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study. Prepregnancy, pregnancy, and postpartum data were captured and stacked over three intervals (Waves 1-3, 2-4, and 3-5). Participants were N = 686 U.S. women (72% White, 46% age 25-34) who were currently pregnant during the middle wave of an interval. Rates of tobacco-only use, cannabis-only use, and tobacco and cannabis co-use at all three time points were examined. Results: Generalized estimating equation models demonstrated that pregnant women who reported prepregnancy tobacco and cannabis co-use (vs. tobacco-only or cannabis-only use) were more likely to continue to use tobacco and/or cannabis during pregnancy and relapse in postpartum ( p < .05). Among women who endorsed prepregnancy co-use and continued to use tobacco and/or cannabis in pregnancy, about half transitioned to tobacco-only use (45.16%). Conclusions: Findings underscore the need for further clinical and empirical focus on dynamic patterns of use/co-use of tobacco and cannabis across the perinatal period, including cessation interventions to reduce tobacco and cannabis use in pregnancy and protect against relapse in postpartum. Public Health Significance StatementThis study indicates that co-use of tobacco and cannabis is a predictor of continued substance use into pregnancy and relapse in postpartum, and that many individuals transition to exclusive tobacco use in pregnancy. These findings highlight the importance of assessing co-use of tobacco and cannabis across the perinatal period, including the need for cessation and relapse prevention interventions among this population.

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Pregnancy Outcomes Associated With Use of Tobacco and Marijuana

Cited by 5 publications

References 46 publications

Vaping during pregnancy: a systematic review of health outcomes

Vaping during pregnancy: a systematic review of health outcomes

Perinatal Impacts of Cannabis and Nicotine: An Analysis of the Cannabis Use During Development and Early Life Study

Use and co-use of tobacco and cannabis before, during, and after pregnancy: A longitudinal analysis of waves 1–5 of the Population Assessment of Tobacco and Health (PATH) study.

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