Cannabis Use During the Perinatal Period in a State With Legalized Recreational and Medical Marijuana: The Association Between Maternal Characteristics, Breastfeeding Patterns, and Neonatal Outcomes

摘要

Cannabis is the most commonly used psychoactive substance in the United States, and recent estimates of the prevalence of cannabis use among pregnant women in the United States range between 3% and 16%. Population-based surveillance data from the National Survey on Drug Use and Health suggests that cannabis use among pregnant women in the United States has increased as much as 62% between 2002 and 2014. Coupledwith a vocal procannabis advocacy movement, this substance may be perceived as " safe" to use during pregnancy. Growing evidence suggests prenatal cannabis exposure has a detrimental impact on offspring neurocognitive function starting in the toddler years. Several large epidemiologic studies have detected an increased risk with preterm birth and low birth weight and other studies reported null findings. However, much of the research on the effects of prenatal cannabis on neonatal outcomes was based on cannabis exposures in the 1980s and 1990s, and may not be reflective of contemporary potency of cannabis products or use patterns. The researchers conducted a cross-sectional study investigating the prevalence of maternal cannabis use during pregnancy and the early postnatal period using 2 years of data from the Colorado Pregnancy Risk Assessment Monitoring System (PRAMS). Trimester-specific prenatal cannabis use patterns were examined according to maternal demographic characteristics, selected maternal risk factors, breastfeeding initiation and duration, and pregnancy intendedness. The Colorado Department of Public Health and Environment collected population-based data regarding cannabis use during and after pregnancy from a stratified randomsample of women who delivered a live-born infant between January 1, 2014, and December 31, 2015 (n = 3285). Exclusion criteria included nonresidentmothers, out-of-state births to Colorado residents, mothers choosing adoption for their infants, multiple births of 4 or more children, and maternal age younger than 15 years. PRAMS questionnaires were administered in English and Spanish to women at approximately 2 to 4 months postpartum. PRAMS data were linked to the Colorado birth certificate data to obtain additional maternal demographic, health information, and neonatal outcomes. The state-approved questions included questions about marijuana/ hashish use during various periods during their pregnancy, breastfeeding initiation, and maternal pregnancy intendedness, with neonatal outcomes of interested abstracted from the birth certificate. Maternal demographic factors, including age, level of education, race/ ethnicity, Medicaid status, Special Supplemental Nutrition Program for Women, Infants, and Children recipient status, total household income, and marital status, were evaluated. Additional selected maternal risk factors, such as tobacco use in the last 3 months of pregnancy, physical abuse, diabetes status, and others, were considered. Colorado PRAMS questionnaires were obtained from 3285 women who gave birth to live infants between January 1, 2014, and December 31, 2015. The response rate was 59% in 2014 and 63% in 2015. The final analytic cohort included PRAMS questionnaires from 3207 women with a weighted response reflecting 129,784 mothers. The study found that the self-reported prevalence of cannabis use at any time during pregnancy was 5.7% +/- 0.5% and the prevalence of early postnatal cannabis use among women who breastfed was 5.0% (95% confidence interval [ CI], 4.1%-6.2%).