Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis

Gunn, Jayleen K. L.; Rosales, Cecilia; Núñez, Annabelle; Gibson, Steven J.; Christ, Cara; Ehiri, John E.

doi:10.1136/bmjopen-2015-009986

Cited by 487 publications

(472 citation statements)

References 41 publications

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“…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: 55%

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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Section: Commentmentioning

confidence: 55%

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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“…Cannabis use poses other significant health risks, which increase with the frequency and intensity of use: 1) central nervous system impairment, acute (e.g., judgment, coordination) and chronic (e.g., memory, cognition), 29 2) exacerbation and persistence of psychiatric symptoms (e.g., depression, psychosis), 30 3) development of other drug use disorders, including nicotine and alcohol 31 4) prescription medication interactions (e.g., antidepressants, opioids), 32 5) prenatal exposure during pregnancy, 33 6) pulmonary symptoms 29 and 7) accidents, particularly motor vehicle accidents. 34 Finally, frequent use of cannabis can cause significant withdrawal, which appears clinically similar to tobacco and opioid withdrawal, with symptoms of anxiety, irritability, depressed mood, disturbed sleep, decreased appetite and restlessness.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Cannabis Use Among Primary Care Patients in Washington State

et al. 2017

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Background and Objectives Over 12% of U.S. adults report past-year cannabis use, and among those who use daily, 25% or more have a cannabis use disorder. Use is increasing as legal access expands. Yet, cannabis use is not routinely assessed in primary care, and little is known about use among primary care patients and relevant demographic and behavioral health subgroups. This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit. Methods This observational cohort study included adults who made a visit to primary care clinics with annual behavioral health screening, including a single-item question about frequency past-year cannabis use (March 2015-February 2016; n=29,857). Depression, alcohol and other drug use were also assessed by behavioral health screening. Screening results, tobacco use, and diagnoses for past-year behavioral health conditions (e.g., mental health and substance use disorders) were obtained from EHRs. Results Among patients who completed the cannabis use question (n=22,095; 74% of eligible patients), 15.3% (14.8–15.8%) reported any past-year use: 12.2% (11.8%–12.6%) less than daily and 3.1% (2.9%–3.3%) daily. Among 2,228 patients 18–29 years, 36.0% (34.0%–38.0%) reported any cannabis use and 8.1% (7.0%–9.3%) daily use. Daily cannabis use was common among men 18–29 who used tobacco or screened positive for depression: 25.5% (18.8%–32.1%) and 31.7% (23.3%–40.0%), respectively. Conclusions Cannabis use was common in adult primary care patients, especially among younger patients and those with behavioral health conditions. Results highlight the need for primary care approaches to address cannabis use.

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“…While some studies of in utero cannabis exposure have indicated low birth weight and stunted growth trajectories, others have found that these results depend upon the trimester during which the fetus was exposed [2,3,36,37] . In humans, low birth weight has been associated with an increased incidence of intraventricular hemorrhage, necrotizing enterocolitis, risk factors for infections, and respiratory distress, as well as neurodevelopmental and behavioral problems [38] .…”

Section: Discussionmentioning

confidence: 99%

“…As more states and countries throughout the world come to legalize medical and recreational use of marijuana, these figures are anticipated to rise. Cannabis use during pregnancy has been linked to low birth weight for age and smaller head circumferences in the offspring [2,3] . Although smaller head circumferences were noted, there was no difference noted in transcerebellar diameter in fetuses exposed to cannabis [3] .…”

Section: Introductionmentioning

confidence: 99%

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Maternal Cannabinoid Use Alters Cannabinoid (CB<sub>1</sub>) and Endothelin (ET<sub>B</sub>) Receptor Expression in the Brains of Dams but Not Their Offspring

Amlani

Hornick²,

Cooper

et al. 2017

Dev Neurosci

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According to the 2015 National Survey on Drug Use and Health, cannabis (marijuana) is the most commonly used recreational drug in the US. Among pregnant women aged 14-55 years, 3.4% were cannabis users. Presently, little is known about the neurodevelopmental effect of cannabis use during pregnancy and/or nursing on neonates. Endothelin (ET) is essential for normal development of the central nervous system (CNS). Decreases in ET_B receptor expression correlate with a decline in nerve growth factor (NGF) and an increase in vascular endothelial growth factor (VEGF) in postnatal brain. Activation of ET_B and cannabinoid 1 (CB₁) receptors each promote neurogenesis and enhance angiogenesis, indicating that both ET and CB systems play a critical role during early CNS development. Hence the purpose of this study was to determine whether maternal CB abuse during pregnancy and lactation alters the expression of ET_B receptors, CB₁ receptors, VEGF, and NGF in the postnatal rat brain. Sixteen pregnant Sprague-Dawley rats were administered either saline or anandamide (AEA) at a dose of 3 mg/kg/day i.p. from gestational day 7 and continued through weaning on postnatal day (PND) 21. Rat pups were subdivided into 4 subgroups and sacrificed on PND 2, 7, 14, and 28. Brain tissue of the pups and dams (sacrificed on PND 21) was analyzed via Western blot for the expression of ET_B receptors, CB₁ receptors, VEGF, and NGF. AEA-exposed dams had significantly fewer live births (p = 0.027), and their pups presented with significantly lower body weights on PND 7 (p = 0.013) and PND 28 (p = 0.018). There was no significant difference noted in ET_B receptor, CB₁ receptor, NGF, or VEGF expression in the pup brains. In all pups, brain ET_B receptor expression decreased and CB₁ receptor expression increased with age. In the AEA-exposed dam brain, however, there was a decrease in ET_B receptor (p = 0.043) and an increase in CB₁ receptor expression (p = 0.033). AEA exposure during pregnancy appears to affect fetal viability and postnatal weight gain in offspring while not altering the expression patterns of ET_B receptors, CB₁ receptors, NGF, or VEGF in the pup brain. The observed trend to an increase in CB₁ receptor expression concurrent with a decrease in ET_B receptor expression in both dams and pups may point to a homeostatic regulation between these 2 systems in CNS development and neuroprotection.

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Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis

Cited by 487 publications

References 41 publications

Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity

Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity

Frequency of Cannabis Use Among Primary Care Patients in Washington State

Maternal Cannabinoid Use Alters Cannabinoid (CB<sub>1</sub>) and Endothelin (ET<sub>B</sub>) Receptor Expression in the Brains of Dams but Not Their Offspring

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