Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

References

    1. American Medical Association’s Board of Trustees, 1990. Legal interventions during pregnancy. Court-ordered medical treatments and legal penalties for potentially harmful behavior by pregnant women. JAMA 264, 2663–2670. - PubMed
    1. Andrade SE, Bérard A, Nordeng HME, Wood ME, van Gelder MMHJ, Toh S, 2017. Administrative Claims Data Versus Augmented Pregnancy Data for the Study of Pharmaceutical Treatments in Pregnancy. Curr. Epidemiol. reports 4, 106–116. 10.1007/s40471-017-0104-1 - DOI - PMC - PubMed
    1. Angelotta C, Appelbaum PS, 2017. Criminal Charges for Child Harm from Substance Use in Pregnancy. J. Am. Acad. Psychiatry Law 45, 193–203. - PubMed
    1. Bondarenko AI, 2019. Cannabinoids and Cardiovascular System, in: Bukiya AN (Ed.), Recent Advances in Cannabinoid Physiology and Pathology. Springer International Publishing, Cham, pp. 63–87. 10.1007/978-3-030-21737-2_5 - DOI
    1. Chabarria KC, Racusin DA, Antony KM, Kahr M, Suter MA, Mastrobattista JM, Aagaard KM, 2016. Marijuana use and its effects in pregnancy. Am. J. Obstet. Gynecol 215, 506.e1–506.e7. 10.1016/j.ajog.2016.05.044 - DOI - PubMed

Publication types