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. 2021 Aug 1:225:108757.
doi: 10.1016/j.drugalcdep.2021.108757. Epub 2021 May 21.

Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes

Gretchen Bandoli  1 , Laura Jelliffe-Pawlowski  2 , Benjamin Schumacher  3 , Rebecca J Baer  4 , Jennifer N Felder  5 , Jonathan D Fuchs  6 , Scott P Oltman  2 , Martina A Steurer  7 , Carla Marienfeld  8
Affiliations

Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes

Gretchen Bandoli et al. Drug Alcohol Depend. .

Abstract

Background: Cannabis use and cannabis use disorders are increasing in prevalence, including among pregnant women. The objective was to evaluate the association of a cannabis-related diagnosis (CRD) in pregnancy and adverse maternal and infant outcomes.

Methods: We queried an administrative birth cohort of singleton deliveries in California between 2011-2017 linked to maternal and infant hospital discharge records. We classified pregnancies with CRD from International Classification of Disease codes. We identified nicotine and other substance-related diagnoses (SRD) in the same manner. Outcomes of interest included maternal (hypertensive disorders) and infant (prematurity, small for gestational age, NICU admission, major structural malformations) adverse outcomes.

Results: From 3,067,069 pregnancies resulting in live births, 29,112 (1.0 %) had a CRD. CRD was associated with an increased risk of all outcomes studied; the strongest risks observed were for very preterm birth (aRR 1.4, 95 % CI 1.3, 1.6) and small for gestational age (aRR 1.4, 95 % CI 1.3, 1.4). When analyzed with or without co-exposure diagnoses, CRD alone conferred increased risk for all outcomes compared to no use. The strongest effects were seen for CRD with other SRD (preterm birth aRR 2.3, 95 % CI 2.2, 2.5; very preterm birth aRR 2.6, 95 % CI 2.3, 3.0; gastrointestinal malformations aRR 2.0, 95 % CI 1.6, 2.6). The findings were generally robust to unmeasured confounding and misclassification analyses.

Conclusions: CRD in pregnancy was associated with increased risk of adverse maternal and infant outcomes. Providing education and effective treatment for women with a CRD during prenatal care may improve maternal and infant health.

Keywords: Adverse birth outcomes; Adverse maternal outcomes; Cannabis related diagnosis; Epidemiology.

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Conflict of interest statement

Conflict of interest

The authors report no conflicts to declare.

Figures

Figure 1.
Figure 1.
Prevalence of cannabis-related diagnosis, with or without concomitant exposures from 2011–2017. Black line denotes the prevalence of cannabis-related diagnoses per 100,000 deliveries.
Figure 2.
Figure 2.
Multivariable risk ratio estimates and 95% confidence intervals. All models adjusted for pre-pregnancy BMI, race and ethnicity, payer source, anxiety, depression, bipolar disorder, preexisting hypertension, preexisting diabetes, maternal age and education and alcohol use. Models of any cannabis-related diagnoses (in black) further adjusted for nicotine use and other substance-related diagnoses.
Figure 3.
Figure 3.
Multivariable risk ratio estimates and 95% confidence intervals. All models adjusted for pre-pregnancy BMI, race and ethnicity, payer source, anxiety, depression, bipolar disorder, preexisting hypertension, preexisting diabetes, maternal age and education and alcohol use. Models of any cannabis-related diagnoses (in black) further adjusted for nicotine use and other substance-related diagnoses. Eye malformations are not graphed due to scaling differences, but are displayed in Supplemental Table 3.
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