1
|
Pan K, Jukic AM, Mishra GD, Mumford SL, Wise LA, Schisterman EF, Ley SH, Charlton BM, Chavarro JE, Hart JE, Sidney S, Xiong X, Barbosa-Leiker C, Schliep K, Shaffer JG, Bazzano LA, Harville EW. The association between preconception cannabis use and gestational diabetes mellitus: The Preconception Period Analysis of Risks and Exposures Influencing health and Development (PrePARED) consortium. Paediatr Perinat Epidemiol 2024; 38:69-85. [PMID: 37751914 PMCID: PMC11000150 DOI: 10.1111/ppe.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The metabolic changes that ultimately lead to gestational diabetes mellitus (GDM) likely begin before pregnancy. Cannabis use might increase the risk of GDM by increasing appetite or promoting fat deposition and adipogenesis. OBJECTIVES We aimed to assess the association between preconception cannabis use and GDM incidence. METHODS We analysed individual-level data from eight prospective cohort studies. We identified the first, or index, pregnancy (lasting ≥20 weeks of gestation with GDM status) after cannabis use. In analyses of pooled individual-level data, we used logistic regression to estimate study-type-specific odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential confounders using random effect meta-analysis to combine study-type-specific ORs and 95% CIs. Stratified analyses assessed potential effect modification by preconception tobacco use and pre-pregnancy body mass index (BMI). RESULTS Of 17,880 participants with an index pregnancy, 1198 (6.7%) were diagnosed with GDM. Before the index pregnancy, 12.5% of participants used cannabis in the past year. Overall, there was no association between preconception cannabis use in the past year and GDM (OR 0.97, 95% CI 0.79, 1.18). Among participants who never used tobacco, however, those who used cannabis more than weekly had a higher risk of developing GDM than those who did not use cannabis in the past year (OR 2.65, 95% CI 1.15, 6.09). This association was not present among former or current tobacco users. Results were similar across all preconception BMI groups. CONCLUSIONS In this pooled analysis of preconception cohort studies, preconception cannabis use was associated with a higher risk of developing GDM among individuals who never used tobacco but not among individuals who formerly or currently used tobacco. Future studies with more detailed measurements are needed to investigate the influence of preconception cannabis use on pregnancy complications.
Collapse
Affiliation(s)
- Ke Pan
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Anne Marie Jukic
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Gita D. Mishra
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Sunni L. Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Enrique F. Schisterman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sylvia H. Ley
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Brittany M. Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jorge E. Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Xu Xiong
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Karen Schliep
- Division of Public Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey G. Shaffer
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Emily W. Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| |
Collapse
|
2
|
Bouquet E, Blouin P, Pérault-Pochat MC, Carlier-Guérin C, Millot F, Ricco JB, De Keizer J, Pain S, Guétarni F. Maternal, Fetal and Neonatal Outcomes Related to Recreational Cannabis Use during Pregnancy: Analysis of a Real-World Clinical Data Warehouse between 2010 and 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6686. [PMID: 37681826 PMCID: PMC10487904 DOI: 10.3390/ijerph20176686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Cannabis is the main illicit psychoactive substance used in French childbearing women and very few data are available about adverse events (AEs) related to its use during pregnancy. The aim of this study was to evaluate the association between recreational cannabis use during pregnancy and adverse outcomes from a real-world clinical data warehouse. METHODS Data from the Poitiers University Hospital warehouse were analyzed between 1 January 2010 and 31 December 2019. Logistic regression models were used to evaluate associations between outcomes in three prenatal user groups: cannabis alone ± tobacco (C ± T) (n = 123), tobacco alone (T) (n = 191) and controls (CTRL) (n = 355). RESULTS Pregnant women in the C ± T group were younger (mean age: 25.5 ± 5.7 years), had lower pre-pregnancy body mass index (22.8 ± 5.5 kg/m2), more psychiatric history (17.5%) and were more likely to benefit from universal free health-care coverage (18.2%) than those in the T and CTRL groups. Cannabis use increases the occurrence of voluntary interruption of pregnancy, at least one AE during pregnancy, at least one neonatal AE, the composite adverse pregnancy outcome over 28, prematurity and small for gestational age. CONCLUSION Given the trivialization of recreational cannabis use during pregnancy, there is an urgent need to communicate on AEs of cannabis use during pregnancy.
Collapse
Affiliation(s)
- Emilie Bouquet
- Addictovigilance Center, Department of Clinical Pharmacology, Poitiers University Hospital, 86000 Poitiers, France
- French National Institute of Health and Medical Research (INSERM) U1084, Experimental and Clinical Neurosciences Laboratory, University of Poitiers, CEDEX 9, 86073 Poitiers, France
- Clinical Investigation Center CIC1402, INSERM, Poitiers University Hospital, University of Poitiers, 86000 Poitiers, France
| | - Pascal Blouin
- Department of Clinical Research and Innovation, Poitiers University Hospital, 86000 Poitiers, France
| | - Marie-Christine Pérault-Pochat
- Addictovigilance Center, Department of Clinical Pharmacology, Poitiers University Hospital, 86000 Poitiers, France
- French National Institute of Health and Medical Research (INSERM) U1084, Experimental and Clinical Neurosciences Laboratory, University of Poitiers, CEDEX 9, 86073 Poitiers, France
- Clinical Investigation Center CIC1402, INSERM, Poitiers University Hospital, University of Poitiers, 86000 Poitiers, France
| | - Caroline Carlier-Guérin
- Department of Obstetrics and Gynecology, Poitiers University Hospital, 86000 Poitiers, France
| | - Frédéric Millot
- Department of Pediatrics, Poitiers University Hospital, 86000 Poitiers, France
| | - Jean-Baptiste Ricco
- Department of Clinical Research and Innovation, Poitiers University Hospital, 86000 Poitiers, France
| | - Joe De Keizer
- Clinical Investigation Center CIC1402, INSERM, Poitiers University Hospital, University of Poitiers, 86000 Poitiers, France
| | - Stéphanie Pain
- Addictovigilance Center, Department of Clinical Pharmacology, Poitiers University Hospital, 86000 Poitiers, France
- French National Institute of Health and Medical Research (INSERM) U1084, Experimental and Clinical Neurosciences Laboratory, University of Poitiers, CEDEX 9, 86073 Poitiers, France
| | - Farid Guétarni
- Department of Clinical Research and Innovation, Poitiers University Hospital, 86000 Poitiers, France
| |
Collapse
|
3
|
Towobola A, Towobola B, Nair B, Makwana A. The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review. BJPsych Bull 2023; 47:28-37. [PMID: 34749839 PMCID: PMC10028554 DOI: 10.1192/bjb.2021.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS AND METHOD As drug policies pertaining to cannabis use become more liberalised, the prevalence of cannabis use in pregnancy could increase. However, there is limited guidance available for clinicians. This paper presents a narrative review of literature published in the past 16 years (2006-2021) to (a) address the impact of legalisation and decriminalisation on the risks, ethics and support of women who use cannabis during pregnancy and (b) develop guidance for clinicians. RESULTS Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. CLINICAL IMPLICATIONS This review confirmed that the recommendation of cannabinoid-based products for pregnant and breast-feeding women is currently premature. More research is needed to address safety concerns. We discussed navigating ethical concerns and suggest targeted management strategies for clinicians treating pregnant women who choose to use cannabis.
Collapse
Affiliation(s)
| | | | - Bosky Nair
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| | - Arti Makwana
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| |
Collapse
|
4
|
Tchuente V, Sheehy O, Zhao JP, Gorgui J, Gomez YH, Berard A. Is in-utero exposure to cannabis associated with the risk of attention deficit with or without hyperactivity disorder? A cohort study within the Quebec Pregnancy Cohort. BMJ Open 2022; 12:e052220. [PMID: 35940828 PMCID: PMC9364390 DOI: 10.1136/bmjopen-2021-052220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE AND OBJECTIVE Prenatal cannabis effect on attention deficit with or without hyperactivity disorder (ADHD) remains to be determined. Our aim is to quantify the impact of in-utero exposure to cannabis on the risk of ADHD. DESIGN Cohort study. SETTING Questionnaires were mailed to women sampled from the Quebec Pregnancy Cohort (QPC). Data from questionnaires were then linked with their QPC (built with administrative health databases, hospital patient charts and birth certificate databases). PARTICIPANTS Respondents who gave birth to a singleton live born between January 1998 and December 2003 and were continuously enrolled in the Régie de l'assurance maladie du Québec (RAMQ) medication insurance plan for at least 12 months before the first day of gestation and during pregnancy. EXPOSURE In-utero cannabis exposure was based on mothers' answers to the question on cannabis use during pregnancy (yes/no) and categorised as occasionally, regularly exposed and unexposed if they chose one of these categories. OUTCOMES ADHD was defined by a diagnosis of ADHD through the RAMQ medical services or MedEcho databases or a prescription filled for ADHD medication through RAMQ pharmaceutical services between birth and the end of the follow-up period. Follow-up started at the birth and ended at the index date (first diagnosis or prescription filled for ADHD), child death (censoring), end of public coverage for medications (censoring) or the end of study period, which was December 2015 (censoring), whichever event came first. RESULTS A total of 2408 children met the inclusion criteria. Of these children, 86 (3.6%) were exposed to cannabis in-utero and 241 (10.0%) had an ADHD diagnosis or medication filled. After adjustments for potential confounders, no significant association was found between in-utero cannabis exposure (occasional (1.22 (95% CI 0.63 to 2.19)) or regular (1.22 (95% CI 0.42 to 2.79))) and the risk of ADHD in children. CONCLUSIONS In-utero exposure to cannabis seemed to not be associated with the risk ADHD in children.
Collapse
Affiliation(s)
- Vanina Tchuente
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Odile Sheehy
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Jin-Ping Zhao
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Jessica Gorgui
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | | | - Anick Berard
- Research Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Rosenbaum M. Passive Prenatal Exposure to Cannabinoids Promotes Weight Gain and Dysglycemia in Childhood. J Clin Endocrinol Metab 2022; 107:e3530-e3531. [PMID: 35435965 PMCID: PMC9282262 DOI: 10.1210/clinem/dgac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Michael Rosenbaum
- Correspondence: Michael Rosenbaum, MD, Departments of Pediatrics and Medicine, Columbia University Irving Medical Center, 1150 St. Nicholas Ave, New York, NY 10032, USA.
| |
Collapse
|
6
|
Cajachagua-Torres KN, El Marroun H, Reiss IKM, Jaddoe VWV. Maternal preconception and pregnancy tobacco and cannabis use in relation to placental developmental markers: A population-based study. Reprod Toxicol 2022; 110:70-77. [PMID: 35378220 DOI: 10.1016/j.reprotox.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Maternal tobacco and cannabis use during pregnancy are associated with adverse perinatal outcomes. We hypothesized that maternal tobacco and cannabis use are associated with placental adaptations, which subsequently lead to adverse perinatal outcomes. In a population-based prospective cohort study of 8008 pregnant women, we assessed maternal tobacco and cannabis use by questionnaires. Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured in the first and second trimester and at delivery from blood samples. Placental weight and pregnancy complications were obtained from medical records. We observed that tobacco use before and during first-trimester only was not associated with any angiogenic factors. As compared to no tobacco use, continued use during pregnancy was associated with higher PlGF, lower sFlt-1 concentrations, and lower sFlt-1/PlGF ratio in second trimester (all p-values <0.05). Also, compared to no cannabis use, use before and during pregnancy was associated with higher PlGF concentrations and lower sFlt-1/PlGF ratio in first and second trimester (all p-values <0.05). First trimester only cannabis use was associated with higher sFlt-1 concentrations and higher sFlt-1/PlGF ratio at delivery (all p-values <0.05). Compared to non-use, tobacco use before pregnancy was associated with a higher placental weight, whereas continued tobacco use during pregnancy was associated with a lower placental weight. Continued tobacco or cannabis use was related to higher placental weight to birth weight ratio and higher risk of pregnancy complications (all p-values <0.05). These results suggest that maternal tobacco and cannabis use lead to placental vascular maladaptation predisposing to adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Kim N Cajachagua-Torres
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Hanan El Marroun
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; The Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, 3000 CB, Rotterdam, The Netherlands; The Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, 3062 PA, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| |
Collapse
|
7
|
BANERJEE SOHINI, DEACON ALYSSA, SUTER MELISSAA, AAGAARD KJERSTIM. Understanding the Placental Biology of Tobacco Smoke, Nicotine, and Marijuana (THC) Exposures During Pregnancy. Clin Obstet Gynecol 2022; 65:347-359. [PMID: 35125390 PMCID: PMC9042338 DOI: 10.1097/grf.0000000000000691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Widespread public health campaigns have reduces the prevalence of tobacco and nicotine exposures during pregnancy in the United States. However, tobacco and nicotine exposures during pregnancy persist as a common modifiable perinatal risk exposure. Furthermore, declines in tobacco use have been accompanied by parallel rises in both the prevalence and incidence of marijuana use in pregnancy. This is worrisome, as the macromolecules which comprise tobacco and marijuana smoke affect placental function. In this chapter we summarize the decades of evidence contributing to our understanding of the placental molecular pathophysiology accompanying these chemical exposures, thereby rendering risk of adverse perinatal outcomes.
Collapse
Affiliation(s)
- SOHINI BANERJEE
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - MELISSA A. SUTER
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - KJERSTI M. AAGAARD
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|