Abstract
Objective
Cannabis is the most commonly used recreational drug during pregnancy in the United
States. This study aimed to describe the rate of cannabis dependence or abuse use
during pregnancy and its effect on obstetrical and neonatal outcomes.
Methods
A retrospective population-based cohort of births in the United States between 1999
and 2013 was created using data from the National Inpatient Sample. Births to mothers
who reported cannabis dependence or abuse were identified using ICD-9 codes, and the
effect on various obstetrical and neonatal outcomes was assessed using logistic regression,
adjusting for relevant confounders (Canadian Task Force Classification II-2).
Results
A total of 12 578 557 births were included in our analysis. The incidence of cannabis
abuse or dependence rose from 3.22 in 1000 births in 1999 to 8.55 in 1000 births in
2013 (P < 0.0001). Women reporting cannabis dependence or abuse were more likely to have
a preterm premature rupture of membranes (odds ratio [OR] 1.46; 95% confidence interval
[CI] 1.35–1.58), a hospital stay of >7 days (OR 1.17; 95% CI 1.11–1.23), and an intrauterine
fetal demise (OR 1.50; 95% CI 1.39–1.62). Neonates born to exposed mothers had a higher
risk of prematurity (OR 1.40; 95% CI 1.36–1.43) and growth restriction (OR 1.35; 95%
CI 1.30–1.41).
Conclusion
Cannabis use during pregnancy steadily increased over the study period. Users of cannabis
during gestation were more likely to have adverse outcomes during delivery and require
longer periods of hospitalization. Neonates born to exposed mothers were more likely
to be born preterm and underweight.
Résumé
Objectif
Aux États-Unis, le cannabis est la drogue à usage récréatif la plus fréquemment consommée
pendant la grossesse. Cette étude avait pour buts de calculer le taux de femmes enceintes
ayant une dépendance au cannabis ou abusant de celui-ci et de présenter l’incidence
du cannabis sur les issues obstétricales et néonatales.
Méthodologie
Une étude de cohorte rétrospective basée sur la population et portant sur les naissances
survenues aux États-Unis entre 1999 et 2013 a été menée au moyen de données issues
du National Inpatient Sample. Les naissances issues de mères ayant déclaré être dépendantes
aux cannabis ou avoir abusé de celui-ci ont été codées selon la CIM-9, et les effets
du cannabis sur les diverses issues obstétricales et néonatales ont été évalués au
moyen de régressions logistiques tenant compte des facteurs de confusion potentiels
(classification II-2 du Groupe d’étude canadien).
Résultats
Au total, 12 578 557 naissances ont été retenues pour l’analyse. L’incidence de la
dépendance au cannabis ou de l’abus de celui-ci est passée de 3,22 par 1 000 naissances
en 1999 à 8,55 par 1 000 naissances en 2013 (P < 0,0001). Les femmes dépendantes au cannabis ou ayant abusé de celui-ci étaient
plus susceptibles de vivre une rupture prématurée des membranes (RC : 1,46; IC à 95 % :
1,35–1,58), d’être hospitalisées plus de sept jours (RC : 1,17; IC à 95 % : 1,11–1,23)
et de présenter un décès fœtal intra-utérin (RC : 1,50; IC à 95 % : 1,39–1,62). Les
nouveau-nés de mères exposées au cannabis couraient un risque accru de naissance prématurée
(RC : 1,40; IC à 95 % : 1,36–1,43) et de retard de croissance (RC : 1,35; IC à 95 % :
1,30–1,41).
Conclusion
La consommation de cannabis pendant la grossesse a augmenté de façon constante au
cours de la période à l’étude. Les femmes enceintes qui en consommaient couraient
un risque accru d’hospitalisation prolongée et d’issues indésirables à l’accouchement.
Les nouveau-nés de mères exposées au cannabis étaient plus susceptibles de naître
prématurément et de présenter un poids insuffisant.
Key Words
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REFERENCES
- Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health.(HHS Publication No. SMA 15-4927, NSDUH Series H-50), 2015 (Retrieved from)
- Cannabis and pregnancy: maternal child health implications during a period of drug policy liberalization.Prev Med. 2017; 104: 46-49
- Clearing the smoke on cannabis maternal cannabis use during pregnancy – an update.Canadian Centre on Substance Abuse and Addiction, Ottawa2015
- Committee opinion no. 637: marijuana use during pregnancy and lactation.Obstet Gynecol. 2015; 126: 234-238
- No. 349-substance use in pregnancy.J Obstet Gynaecol Can. 2017; 39 (922–37e2)
- Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age.Am J Obstet Gynecol. 2015; 213: 201e1-20110
- Healthcare Cost and Utilization Project (HCUP). Overview of the State Inpatient Databases (SID).Agency for Health Research and Quality, Rockville, MD2006
- Use of cannabis during pregnancy and birth outcomes in an Aboriginal birth cohort: a cross-sectional, population-based study.BMJ Open. 2016; 6e010286
- Illicit drug use and adverse birth outcomes: is it drugs or context?.J Urban Health. 2008; 85: 858-873
- Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study.Drug Alcohol Depend. 2010; 109: 243-247
- Maternal use of cannabis and pregnancy outcome.BJOG. 2002; 109: 21-27
- Marijuana use and pregnancy: prevalence, associated characteristics, and birth outcomes.Arch Womens Ment Health. 2016; 19: 105-111
- Comprehensive treatment program for pregnant substance users in a family medicine clinic.Can Fam Physician. 2011; 57: e430-e435
- “Anything above marijuana takes priority”: obstetric providers’ attitudes and counseling strategies regarding perinatal marijuana use.Patient Educ Couns. 2016; 99: 1446-1451
- Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against ‘morning sickness’.Complement Ther Clin Pract. 2006; 12: 27-33
- Fetal disposition of delta 9-tetrahydrocannabinol (THC) during late pregnancy in the rhesus monkey.Toxicol Appl Pharmacol. 1987; 90: 315-321
- The role of the endocannabinoid system in gametogenesis, implantation and early pregnancy.Hum Reprod Update. 2007; 13: 501-513
- The emerging functions of endocannabinoid signaling during CNS development.Trends Pharmacol Sci. 2007; 28: 83-92
- A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions.Chem Res Toxicol. 2008; 21: 494-502
- Cannabidiol enhances xenobiotic permeability through the human placental barrier by direct inhibition of breast cancer resistance protein: an ex vivo study.Am J Obstet Gynecol. 2013; 209: 573e1-57315
- Guidelines for operative vaginal birth.J Obstet Gynaecol Can. 2004; 26: 747-761
- Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study.J Am Acad Child Adolesc Psychiatry. 2009; 48: 1173-1181
- Effects of maternal drinking and marijuana use on fetal growth and development.Pediatrics. 1982; 70: 539-546
- Prenatal marijuana use and neonatal outcome.Neurotoxicol Teratol. 1991; 13: 329-334
- Effects of maternal marijuana and cocaine use on fetal growth.N Engl J Med. 1989; 320: 762-768
- Marijuana: prenatal and postnatal exposure in the human.NIDA Res Monogr. 1985; 59: 48-60
- Marijuana impairs growth in mid-gestation fetuses.Neurotoxicol Teratol. 2005; 27: 221-229
- Birth outcomes associated with cannabis use before and during pregnancy.Pediatr Res. 2012; 71: 215-219
- Maternal marijuana use and adverse neonatal outcomes: a systematic review and meta-analysis.Obstet Gynecol. 2016; 128: 713-723
- Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis.BMJ Open. 2016; 6e009986
- Maternal periconceptional illicit drug use and the risk of congenital malformations.Epidemiology. 2009; 20: 60-66
- Association between marijuana use and adverse obstetrical and neonatal outcomes.J Perinatol. 2015; 35: 991-995
- Maternal lifestyle factors and risk for ventricular septal defects.Birth Defects Res A Clin Mol Teratol. 2004; 70: 59-64
- The Ottawa Prenatal Prospective Study (OPPS): methodological issues and findings–it's easy to throw the baby out with the bath water.Life Sci. 1995; 56: 2159-2168
- Comparative methods for handling missing data in large databases.J Vasc Surg. 2013; 58 (1353–59e6)
Article info
Publication history
Published online: November 14, 2018
Accepted:
August 23,
2018
Received:
July 23,
2018
Footnotes
Conflict of interest: The authors confirm that they have no conflicts of interest. Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
