(93) Impact of Prenatal Cannabis Use on Maternal and Neonatal Outcomes

Introduction:   As cannabis has become more accessible and the prevalence of use has significantly increased in the US [1], cannabis is now the number one used federally illicit drug in pregnancy. [2] The U.S. Surgeon General and the American College of Obstetricians and Gynecologists have advised pregnant and lactating patients to abstain from cannabis, but most continue to use [3], in part because current safety data is limited and the available literature is insufficient to establish a casual association between cannabis use and outcomes. [4,5] This study aims to assess the maternal and neonatal outcomes associated with cannabis use in pregnancy.

Methods:  We conducted a retrospective cohort study using California linked hospital discharge-vital statistics data (2007-2011) to evaluate the association of cannabis use and perinatal outcomes. We included singleton, non-anomalous births with 23-42 weeks gestational age. Chi-squared and multivariable logistic regression (adjusted for maternal race, age education, body mass index, insurance, prenatal care, tobacco use, alcohol use, and substance use, including cocaine, methamphetamine, and opioid use) were utilized for statistical analyses. Because of multiple comparisons, statistical significance was set at 0.01. All analyses were conducted using STATA version 17.

Results:  Of the 2,380,446 patients included, 9,144 (0.38%) were identified as using cannabis during pregnancy. Maternal cannabis use was found to be associated with adverse perinatal outcomes. There was an increased risk for maternal outcomes, including gestational hypertension (aOR 1.19, 95% CI 1.05-1.34; p = 0.004), pre-eclampsia (aOR 1.15, 95% CI 1.04-1.28; p=0.006), preterm delivery (aOR 1.44, 95% CI 1.34-1.55; p< 0.001), and severe maternal morbidity (aOR 1.22, 95% 1.01-1.47; p=0.033). Prenatal cannabis use was also associated with an increased risk of neonatal outcomes including respiratory distress syndrome (aOR 1.29, 95% 1.19-1.4; p< 0.001), hypoglycemia (aOR 1.37, 95% CI 1.12-1.66; p=0.001), small for gestational age (aOR 1.47, 95% CI 1.38-1.57; p< 0.001), neonatal intensive care unit admission (aOR 1.35, 95% CI 1.27-1.44; p< 0.001), neonatal demise within 28 days of life (aOR 2.0, 95% CI 1.39-2.94; p< 0.001), and infant death within one year (aOR 1.13, 95% 1.65-2.76; p< 0.001). We did not identify a statistically significant increase in cesarean delivery (aOR 1.03, 95% CI 0.96-1.09; p=0.33) or stillbirth (aOR 1.17, 95% CI 0.84-1.64; p=0.32).

Conclusion:  The results of our study suggest that cannabis use was associated with increased maternal and neonatal morbidity and mortality. Future studies are needed to assess barriers to patient and obstetrical provider perceived harm in pregnancy. As cannabis use in pregnancy is becoming more commonplace, our findings can help guide preconception and prenatal counseling as well as neonatal care.

References: [1] Cerdá M, Mauro C, Hamilton A, Levy NS, Santaella-Tenorio J, Hasin D, Wall MM, Keyes KM, Martins SS. Association Between Recreational Marijuana Legalization in the United States and Changes in Marijuana Use and Cannabis Use Disorder From 2008 to 2016. JAMA Psychiatry. 2020;77(2), 165–171. https://doi.org/10.1001/jamapsychiatry.2019.3254

[2] El Marroun H, Tiemeier H, Jaddoe VWV, Hofman A, Verhulst FC, van den Brink W, Huizink AC. Agreement between maternal cannabis use during pregnancy according to self-report and urinalysis in a population-based cohort: The Generation R Study. European Addiction Research. 2011;17(1):37–43. https://doi.org/10.1159/000320550

[3] Bayrampour H, Zahradnik M, Lisonkova S, Janssen P. Women’s perspectives about cannabis use during pregnancy and the postpartum period: An integrative review. Preventive Medicine. 2019’;119:17–23. https://doi.org/10.1016/j.ypmed.2018.12.002

[4] Metz TD, Allshouse AA., Hogue CJ, Goldenberg RL, Dudley DJ, Varner MW, Conway DL, Saade GR, Silver RM. Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. American Journal of Obstetrics and Gynecology. 2017;217(4):478.e1-478.e8. https://doi.org/10.1016/j.ajog.2017.05.050

[5] Rodriguez C, Sheeder J, Allshouse A, Scott S, Wymore E, Hopfer C, Hermesch A, Metz T. Marijuana use in young mothers and adverse pregnancy outcomes: A retrospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2019;126(12):1491–1497. https://doi.org/10.1111/1471-0528.15885