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Sieger ML, Nichols C, Chen S, Sienna M, Sanders M. Novel Implementation of State Reporting Policy for Substance-Exposed Infants. Hosp Pediatr 2022; 12:841-848. [PMID: 36093638 DOI: 10.1542/hpeds.2022-006562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Child Abuse Prevention and Treatment Act's provisions concerning hospitalist and child protective services response to infants with prenatal substance exposure (IPSE) were revised in 2016 to address the impact of the opioid epidemic. In 2019, Connecticut unveiled a statewide hospital reporting infrastructure to divert IPSE without safety concerns from CPS using a deidentified notification to CPS and a plan of safe care (POSC). Connecticut is the first state to implement a separate, deidentified notification system. METHODS We used notification and birth data to determine rates per 1000 births. We employed multinomial logistic regression to understand factors associated with 3 mutually exclusive outcomes: (1) diversion with POSC, (2) report with POSC, or (3) report without POSC. RESULTS During the first 28 months of policy implementation, hospitalists submitted over 4700 notifications (8% of total Connecticut births). Over three-quarters (79%) of notifications included marijuana exposure, and 21% included opioid exposure. Fewer than 3% included alcohol exposure. Black mothers were disproportionally overrepresented among notifications compared with the state population, and all other race groups underrepresented. Over half of identified IPSE were diverted. Type of substance exposure was the strongest predictor of outcome, controlling for maternal age and race group. CONCLUSIONS Connecticut Child Abuse Prevention and Treatment Act diverted IPSE without provider safety concerns away from child protective services. Substance exposure type was associated with the dyad's outcome at hospital discharge. Nonuniversal screening practices may contribute to racial disproportionality in implementation.
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Affiliation(s)
| | - Cynthia Nichols
- University of Connecticut, School of Social Work, Hartford, Connecticut
| | - Shiyi Chen
- University of Connecticut, School of Social Work, Hartford, Connecticut
| | - Melissa Sienna
- UCONN Health, School of Medicine, Department of Public Health Sciences, Farmington, Connecticut
| | - Marilyn Sanders
- UCONN School of Medicine, Department of Pediatrics, Farmington, Connecticut Connecticut Children's Medical Center, Hartford, Connecticut
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2
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The Liberalization of Cannabis Possession Laws and Birth Outcomes: A State-Level Fixed Effects Analysis, 2003–2019. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-022-09714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Koto P, Allen VM, Fahey J, Kuhle S. Maternal cannabis use during pregnancy and maternal and neonatal outcomes: A retrospective cohort study. BJOG 2022; 129:1687-1694. [PMID: 35118787 DOI: 10.1111/1471-0528.17114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 01/13/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the relationship between reported prenatal cannabis use and neonatal and maternal outcomes and whether the legalisation of cannabis in Canada affected the rates of reported use or the association with maternal and neonatal outcomes. DESIGN Population-based retrospective cohort study. SETTING Routinely collected data in a real-world setting. POPULATION All women in the Canadian province of Nova Scotia with singleton births between 1 January 2004 and 30 June 2021. METHODS The association between cannabis use and maternal and neonatal outcomes was examined using generalised linear models with inverse probability weighting. MAIN OUTCOME MEASURES Maternal and neonatal outcomes in the peripartum and postpartum period. RESULTS Rates of reported cannabis use in pregnancy increased from 1.3% to 7.5% over the study period with no appreciable change in slope after legalisation in 2018. Infants of mothers reporting cannabis use in pregnancy were more likely to have major anomalies and a 5-minute Apgar score ≤7, require neonatal intensive care unit admission, and had lower birthweight, head circumference and birth length than infants of mothers not reporting cannabis use. These associations did not differ before and after legalisation. CONCLUSIONS Reported cannabis use during pregnancy is associated with early postnatal complications and reduced fetal growth, even after taking into account a range of confounding factors. Rates of reported cannabis use during pregnancy increased over the past 5 years in Nova Scotia with no apparent additional effect of legalisation.
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Affiliation(s)
- Prosper Koto
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Fahey
- Reproductive Care Programme of Nova Scotia, Halifax, Nova Scotia, Canada
| | - Stefan Kuhle
- Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynaecology and Paediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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4
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Shi Y, Zhu B, Liang D. The associations between prenatal cannabis use disorder and neonatal outcomes. Addiction 2021; 116:3069-3079. [PMID: 33887075 PMCID: PMC8492477 DOI: 10.1111/add.15467] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 02/24/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Cannabis use disorder (CUD) during pregnancy has increased dramatically in the United States (US). This study examined the associations between prenatal CUD and adverse neonatal outcomes and heterogeneities in the associations by mothers' tobacco use status and race/ethnicity. DESIGN Population-based, retrospective cohort study. SETTING California, USA. PARTICIPANTS A total of 4.83 million mothers who delivered a live singleton birth during 2001 to 2012 and their paired infants. Data were obtained from mother-infant linked hospital discharge records and birth and death certificates. Identified by ICD-9 codes recorded at delivery, 20 237 mothers had prenatal CUD. MEASUREMENTS Neonatal outcomes included length of gestation, preterm birth, birth weight, admission into neonatal intensive care unit, hospitalization within 1 year of birth, and death within 1 year of birth. Propensity score matching was used to balance maternal, paternal, and infant characteristics in the comparisons between infants exposed and unexposed to prenatal CUD. FINDINGS CUD increased from 2.8 to 6.9 per 1000 deliveries during 2001 to 2012. Multivariable regressions in matched samples estimated that prenatal CUD was associated with greater odds of being small for gestational age (OR = 1.13, 95% CI = 1.08, 1.18), preterm birth (OR = 1.06, 95% CI = 1.01, 1.12), low birth weight (OR = 1.13, 95% CI = 1.07, 1.20), and death within 1 year of birth (OR = 1.35, 95% CI = 1.12, 1.62). Compared with infants whose mothers were tobacco non-users, infants whose mothers were tobacco users had greater odds of preterm birth, low birth weight, hospitalization, and death in association with prenatal CUD. Compared with infants whose mothers were non-Hispanic White, infants whose mothers were Hispanic had greater odds of hospitalization and death and infants whose mothers were non-Hispanic Black had greater odds of being small for gestational age in association with prenatal CUD. CONCLUSION Prenatal cannabis use disorder appears to be associated with escalated odds of major adverse neonatal outcomes, with heterogeneities in the associations by mothers' tobacco use status and race/ethnicity.
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Affiliation(s)
- Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Bin Zhu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Di Liang
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
- School of Public Health, Fudan University, Shanghai, China
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5
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Prenatal THC exposure raises kynurenic acid levels in the prefrontal cortex of adult rats. Prog Neuropsychopharmacol Biol Psychiatry 2020; 100:109883. [PMID: 32032697 PMCID: PMC7260707 DOI: 10.1016/j.pnpbp.2020.109883] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 02/08/2023]
Abstract
Cannabis remains one of the most widely used illicit drugs during pregnancy. The main psychoactive component of marijuana (Δ9-tetrahydrocannabinol, THC) is correlated with untoward physiological effects in the offspring. Neurobehavioral and cognitive impairments have been reported in longitudinal studies on children and adolescents prenatally exposed to marijuana, and a link to psychiatric disorders has been proposed. Interestingly, the deleterious effects of prenatal cannabis use are similar to those observed in adult rats prenatally exposed to (L)-kynurenine, the direct bioprecursor of the neuroactive metabolite kynurenic acid (KYNA). We therefore investigated whether alterations in KYNA levels in the rat brain might play a role in the long-term consequences of prenatal cannabinoid exposure. Pregnant Wistar rats were treated daily with THC [5 mg/kg, p.o.] from gestational day (GD)5 through GD20. Using in vivo microdialysis in the medial prefrontal cortex, adult animals were then used to determine the extracellular levels of KYNA and glutamate. Compared to controls, extracellular basal KYNA levels were higher, and basal glutamate levels were lower, in prenatally THC-exposed rats. These rats also showed abnormal short-term memory. Following an additional acute challenge with a low dose of kynurenine (5 mg/kg i.p.) in adulthood, the increase in extracellular KYNA levels in the mPFC was more pronounced in in prenatally THC-exposed rats. These effects could be causally related to the cognitive dysfunction seen in prenatally THC-exposed rats. In the translational realm, these experiments raise the prospect of prevention of KYNA neosynthesis as a promising novel approach to combat some of the detrimental long-term effects of prenatal cannabis use.
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6
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Lee E, Pluym ID, Wong D, Kwan L, Varma V, Rao R. The impact of state legalization on rates of marijuana use in pregnancy in a universal drug screening population. J Matern Fetal Neonatal Med 2020; 35:1660-1667. [PMID: 32419547 DOI: 10.1080/14767058.2020.1765157] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: To evaluate the effect of state legalization of rate on marijuana use in pregnancy in a population with universal drug screening.Methods: This is a retrospective cohort study from July 2016 to December 2018 of pregnant women who had universal drug screening of marijuana use before and after legalization of recreational marijuana in California on 1 January 2018. Maternal medical conditions and neonatal outcomes associated with usage were also evaluated. Student's t-test, Wilcoxon rank-sum test, and multiple linear regression were used for statistical analyses.Results: Of 466 women, initial marijuana usage in pregnancy confirmed by urine drug test increased after legalization from 6 to 11% (p = .05). Factors associated with marijuana usage included younger age, white or black race, single marital status, psychiatric disorders, intimate partner violence and concomitant tobacco and alcohol use. 73% of users in this study had cessation of marijuana use with subsequent negative UDT. There was no statistical difference in rates of preterm birth, small for gestational age, NICU admission, or Apgar scores, when adjusted for other risk factors. Conclusion: Rates of marijuana usage in pregnant women who underwent universal drug screening increased after legalization. There were no differences in neonatal outcomes between users and non-users.
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Affiliation(s)
- Emily Lee
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ilina D Pluym
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Deanna Wong
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vanita Varma
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rashmi Rao
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
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7
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Goodwin RD, Zhu J, Heisler Z, Metz TD, Wyka K, Wu M, Das Eiden R. Cannabis use during pregnancy in the United States: The role of depression. Drug Alcohol Depend 2020; 210:107881. [PMID: 32143978 DOI: 10.1016/j.drugalcdep.2020.107881] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/11/2019] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cannabis use is increasing in the United States. Prior work suggests tobacco use in pregnancy is much more common among those with depression. It is not known whether cannabis use is also more common among this especially vulnerable group. Identifying those at highest risk for cannabis use is required to direct prevention and intervention efforts. METHODS Data were drawn from the 2005-2018 National Survey on Drug Use and Health (NSDUH), an annual, cross-sectional sample of persons ages 12 and older representative of the US. The prevalence of past-30-day cannabis use by depression status (past-12-month) and by sociodemographic factors and perception of risk associated with cannabis use was estimated among pregnant women. RESULTS Cannabis use was significantly more common among pregnant women with, compared to without, depression (12.7 % vs. 3.7 %; odds ratio (OR) = 3.8 (95 % confidence interval 2.8, 5.0)). This was the case across all sociodemographic subgroups. The relationship between depression and cannabis use was significantly stronger among those who perceived moderate-great risk (OR = 6.9 (3.7, 13.0)) compared with no risk (OR = 1.6 (1.1, 2.4); Pint = 0.0003) associated with regular use. CONCLUSIONS Women with depression are more than three times more likely to use cannabis during pregnancy. Disparities in cannabis use among pregnant women by depression status appear to be echoing trends in tobacco use. Education about risks associated with cannabis use in pregnancy and prevention, akin to those for prenatal tobacco use, may be needed among pregnant women who are depressed to stem this increase and potentially growing disparity.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
| | - Zoe Heisler
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
| | - Torri D Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT 84132, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
| | - Melody Wu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Rina Das Eiden
- Department of Psychology, College of Liberal Arts, Pennsylvania State University, University Park, PA 16802, USA
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8
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Birth and early developmental screening outcomes associated with cannabis exposure during pregnancy. J Perinatol 2020; 40:473-480. [PMID: 31911642 PMCID: PMC7047636 DOI: 10.1038/s41372-019-0576-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare birth and early developmental screening outcomes for infants with and without in utero cannabis exposures. STUDY DESIGN Observational cohort of women receiving prenatal care within a large health system, live birth between October 1, 2015 and December 1, 2017, and at least one infant visit. Cannabis exposure was through routine urine toxicology screen. Preterm birth, small for gestational age (SGA) birth, birth defects, and early developmental screening outcomes were assessed from birth and electronic health record data. RESULTS Of 3435 women, 283 (8.2%) had a positive urine toxicology screen. In utero cannabis exposure was associated with SGA birth, adjusted rate ratio (aRR) 1.69 (95% confidence interval [CI]: 1.22-2.34). Abnormal 12-month developmental screens occurred in 9.1% of infants with in utero cannabis exposure vs. 3.6% of those with negative maternal screens, aRR 1.90 (95% CI: 0.92-3.91). Additional birth outcomes were not associated with in utero cannabis exposure. CONCLUSIONS Exposure to cannabis during pregnancy may adversely impact fetal growth.
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9
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Klawans MR, Northrup TF, Villarreal YR, Berens PD, Blackwell S, Bunag T, Stotts AL. A comparison of common practices for identifying substance use during pregnancy in obstetric clinics. Birth 2019; 46:663-669. [PMID: 30916432 DOI: 10.1111/birt.12426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Substance use during pregnancy has been linked to adverse birth and other outcomes. Screening and intervention in the prenatal clinic are recommended, and reliance on patient reports or selective urine drug screening is inadequate. The aim of this prospective project was to determine substance use identification rates associated with common screening practices, compared to universal screening, among pregnant women seeking care at an urban, academic obstetric clinic. METHODS Women attending their first prenatal visit (N = 275) completed a self-report questionnaire on lifetime and current substance use. A urine drug screening was also conducted, the results of which were not reported to providers. Participants' charts were reviewed to obtain the results of provider-ordered screens. RESULTS The sample was primarily African-American and Latino, with Medicaid insurance. Ten women (4.6%) reported current marijuana use, while more than double that number (n = 27; 11.6%) screened positive for marijuana via universal screening. The majority of women who screened positive via universal screening did not have a provider-ordered urine drug screening, and less than one-third (29.3%) of clinician-ordered screens were positive for at least one substance. Finally, 90% of women who reported they were using marijuana were not selected by providers for a screen. DISCUSSION Data demonstrate the high proportion of women using marijuana and the limitations of patient self-report and selective, nonroutine screening to identify substance use during pregnancy. Effective, standardized, clinic-wide strategies are needed to support providers in identifying pregnant women who use substances in order to increase the frequency of education and intervention.
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Affiliation(s)
- Michelle R Klawans
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, Texas
| | - Thomas F Northrup
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, Texas
| | - Yolanda R Villarreal
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, Texas
| | - Pamela D Berens
- Department of Obstetrics, Gynecology, and Reproductive Services, UTHealth McGovern Medical School, Houston, Texas
| | - Sean Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Services, UTHealth McGovern Medical School, Houston, Texas
| | - Tiffany Bunag
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, Texas
| | - Angela L Stotts
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth) McGovern Medical School, Houston, Texas.,Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, Houston, Texas
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James Huntsman R, Tang-Wai R, Acton B, Alcorn J, William Lyon A, David Mousseau D, Seifert B, Laprairie R, Prosser-Loose E, Ondrej Hanuš L. Cannabis for the treatment of paediatric epilepsy? An update for Canadian paediatricians. Paediatr Child Health 2018; 23:368-373. [PMID: 30455572 DOI: 10.1093/pch/pxy036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The plant Cannabis sativa produces over 140 known cannabinoids. These chemicals generate considerable interest in the medical research community for their possible application to several intractable disease conditions. Recent reports have prompted parents to strongly consider Cannabis products to treat their children with drug resistant epilepsy. Physicians, though, are reluctant to prescribe Cannabis products due to confusion about their regulatory status and limited clinical data supporting their use. We provide the general paediatrician with a brief review of cannabinoid biology, the literature regarding their use in children with drug resistant epilepsy, the current Health Canada and Canadian Paediatric Society recommendations and also the regulations from the physician regulatory bodies for each province and territory. Given the complexities of conducting research on Cannabis products for children with epilepsy, we also discuss outstanding research objectives that must be addressed to support Cannabis products as an accepted treatment option for children with refractory epilepsy.
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Affiliation(s)
- Richard James Huntsman
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan.,Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Richard Tang-Wai
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan.,Division of Pediatric Neurology, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Bryan Acton
- Saskatchewan Health Authority, Saskatoon Area and Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Jane Alcorn
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Andrew William Lyon
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan.,Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan
| | - Darrell David Mousseau
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan.,Cell Signalling Laboratory, Departments of Psychiatry and Physiology, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Blair Seifert
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan.,Department of Pharmaceutical Services, Saskatchewan Health Authority, Saskatoon, Saskatchewan
| | - Robert Laprairie
- Cannabinoid Research Initiative of Saskatchewan (CRIS), University of Saskatchewan, Saskatoon, Saskatchewan.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Erin Prosser-Loose
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Lumir Ondrej Hanuš
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University, Ein Kerem Campus, Jerusalem
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11
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Sharapova SR, Phillips E, Sirocco K, Kaminski JW, Leeb RT, Rolle I. Effects of prenatal marijuana exposure on neuropsychological outcomes in children aged 1-11 years: A systematic review. Paediatr Perinat Epidemiol 2018; 32:512-532. [PMID: 30335203 PMCID: PMC6261687 DOI: 10.1111/ppe.12505] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/01/2018] [Accepted: 08/17/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Normalisation of medicinal and recreational marijuana use has increased the importance of fully understanding effects of marijuana use on individual-and population-level health, including prenatal exposure effects on child development. We undertook a systematic review of the literature to examine the long-term effects of prenatal marijuana exposure on neuropsychological function in children aged 1-11 years. METHODS Primary research publications were searched from Medline, Embase, PsychInfo, CINAHL EbscoHost, Cochrane Library, Global Health and ERIC (1980-2018). Eligible articles documented neuropsychological outcomes in children 1-11 years who had been prenatally exposed to marijuana. Studies of exposure to multiple prenatal drugs were included if results for marijuana exposure were reported separately from other substances. Data abstraction was independently performed by two reviewers using a standardised protocol. RESULTS The eligible articles (n = 21) on data from seven independent longitudinal studies had high quality based on the Newcastle-Ottawa Scale. Some analyses found associations (P < 0.05) between prenatal marijuana exposure and decreased performance on memory, impulse control, problem-solving, quantitative reasoning, verbal development and visual analysis tests; as well as increased performance on attention and global motion perception tests. Limitations included concurrent use of other substances among study participants, potential under-reporting and publication biases, non-generalisable samples and limited published results preventing direct comparison of analyses. CONCLUSIONS The specific effects of prenatal marijuana exposure remain unclear and warrant further research. The larger number of neuropsychological domains that exhibit decreased versus increased psychological and behavioural functions suggests that exposure to marijuana may be harmful for brain development and function.
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Affiliation(s)
- Saida R. Sharapova
- Office on Smoking and Health, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, GA
| | - Elyse Phillips
- Office on Smoking and Health, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, GA
| | - Karen Sirocco
- Prevention Research Branch, Division of Epidemiology,
Services and Prevention, National Institute on Drug Abuse, National Institutes of
Health, Bethesda, MD
| | - Jennifer W. Kaminski
- Division of Human Development and Disability, National
Center on Birth Defects and Developmental Disabilities, Centers for Disease Control
and Prevention, Atlanta, GA
| | - Rebecca T. Leeb
- Division of Human Development and Disability, National
Center on Birth Defects and Developmental Disabilities, Centers for Disease Control
and Prevention, Atlanta, GA
| | - Italia Rolle
- Office on Smoking and Health, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, GA
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12
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Prindle JJ, Hammond I, Putnam-Hornstein E. Prenatal substance exposure diagnosed at birth and infant involvement with child protective services. CHILD ABUSE & NEGLECT 2018; 76:75-83. [PMID: 29078100 DOI: 10.1016/j.chiabu.2017.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 05/13/2023]
Abstract
Infants have the highest rates of maltreatment reporting and entries to foster care. Prenatal substance exposure is thought to contribute to early involvement with child protective services (CPS), yet there have been limited data with which to examine this relationship or variations by substance type. Using linked birth, hospital discharge, and CPS records from California, we estimated the population prevalence of medically diagnosed substance exposure and neonatal withdrawal disorders at birth. We then explored the corresponding rates of CPS involvement during the first year of life by substance type after adjusting for sociodemographic and health factors. Among 551,232 infants born alive in 2006, 1.45% (n=7994) were diagnosed with prenatal substance exposure at birth; 61.2% of those diagnosed were reported to CPS before age 1 and nearly one third (29.9%) were placed in foster care. Medically diagnosed prenatal substance exposure was strongly associated with an infant's likelihood of being reported to CPS, yet significant variation in the likelihood and level of CPS involvement was observed by substance type. Although these data undoubtedly understate the prevalence of prenatal illicit drug and alcohol use, this study provides a population-based characterization of a common pathway to CPS involvement during infancy. Future research is needed to explicate the longer-term trajectories of infants diagnosed with prenatal substance exposure, including the role of CPS.
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Affiliation(s)
- John J Prindle
- Children's Data Network, Suzanne Dworak-Peck School of Social Work, University of Southern California, United States.
| | - Ivy Hammond
- Children's Data Network, Suzanne Dworak-Peck School of Social Work, University of Southern California, United States
| | - Emily Putnam-Hornstein
- Children's Data Network, Suzanne Dworak-Peck School of Social Work, University of Southern California, United States
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13
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Vadivelu N, Kai AM, Kodumudi G, Sramcik J, Kaye AD. Medical Marijuana: Current Concepts, Pharmacological Actions of Cannabinoid Receptor Mediated Activation, and Societal Implications. Curr Pain Headache Rep 2018; 22:3. [PMID: 29349551 DOI: 10.1007/s11916-018-0656-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The purpose of the following review is to summarize the history and current policies related to marijuana use and prevalence, basic and clinical science pharmacological literature regarding efficacy, subpopulations of concern, and varying policies regarding its use at present. RECENT FINDINGS With the increasingly widespread utilization of marijuana, there is also a growing complexity of public health policy, regulation, and necessity to further assess the medical indications and adverse long-term effects of marijuana use. Health care providers as well as the general public must be prepared to become familiar and up-to-date with medical literature, legislation, and educational material regarding medical marijuana.
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Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University, TMP3 333, Cedar Street, New Haven, CT, 06520, USA.
| | - Alice M Kai
- Department of Internal Medicine, NYU Winthrop Hospital, 259 First Street, Mineola, NY, 11501, USA
| | - Gopal Kodumudi
- California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA, 95757, USA
| | - Julie Sramcik
- Department of Anesthesiology, Yale University, TMP3 333, Cedar Street, New Haven, CT, 06520, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Suite 656, New Orleans, LA, 70112, USA
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Washio Y, E. Martin C, Goldstein ND, Terplan M. Characteristics of pregnant women who reported alcohol use at admission to substance use treatment. J Subst Abuse Treat 2017; 82:82-86. [DOI: 10.1016/j.jsat.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/29/2022]
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15
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Torres CA, Hart CL. Marijuana and pregnancy: objective education is good, but biased education is not. Am J Obstet Gynecol 2017; 217:227. [PMID: 28400309 DOI: 10.1016/j.ajog.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/03/2017] [Indexed: 11/26/2022]
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16
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Fantasia HC. Pharmacologic Implications of Marijuana Use During Pregnancy. Nurs Womens Health 2017; 21:217-223. [PMID: 28599743 DOI: 10.1016/j.nwh.2017.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/01/2017] [Indexed: 06/07/2023]
Abstract
Marijuana is the most commonly used recreational drug in the United States, including among women of childbearing age and women who are pregnant. Changing legal statutes that allow for the use of medical marijuana and the decriminalization of marijuana for personal use reflect more permissive societal views on the use of this drug. Active compounds in marijuana cross the placenta rapidly and are excreted in breast milk. Results of studies of the effects of marijuana on a developing fetus and neonate are conflicting, but researchers have identified chronic marijuana exposure as a risk factor for preterm birth and small-for-gestational-age infants. This article reviews the pharmacology of marijuana and discusses implications for nurses who work with women of childbearing age.
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