Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes, Gretchen Bandoli et al., 2021

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

Gretchen Bandoli, Laura Jelliffe-Pawlowski, Benjamin Schumacher, Rebecca J. Baer, Jennifer N. Felder, Jonathan D. Fuchs, Scott P. Oltman, Martina A. Steurer, Carla Marienfeld

Drug and Alcohol Dependence, 2021, 225, 108757.

doi : 10.1016/j.drugalcdep.2021.108757



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 mis-classification 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.