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Correlates of Continued Cannabis Use During Pregnancy
Abstract
Background
Cannabis use is increasingly common among pregnant women despite concern that it may be linked to adverse maternal and infant outcomes. Determining whether variables associated with cannabis use predict whether women continue or quit using during pregnancy may inform strategies to reduce prenatal use.
Methods
Pregnant women who regularly used cannabis before pregnancy (n = 296) were recruited via Facebook. After finding out they were pregnant, 41% reported quitting, 13% quit then relapsed, 32% reduced use, and 15% continued use at the same rate. Differences among these four cannabis use status groups (quit, relapsed, reduced, continued) in sociodemographics, cannabis use, cigarette use, perceived risk/benefit, delay discounting, and communications about cannabis with their doctor were assessed.
Results
Compared to those who quit, continuing use during pregnancy was associated with being unemployed (Relative Risk (RR) = .32, 95%CI[.13,.78]), using cigarettes pre-pregnancy (RR = 3.43, 95%CI[1.32,8.94]), being in an earlier trimester (RR = 4.38, 95%CI[1.18,16.23]), less perceived risk (RR = .79, 95%CI[.74,.85]), and more days per week of use pre-pregnancy (RR = .10, 95%CI [.01,.84]). Unintended pregnancy, shorter time to cannabis use after waking pre-pregnancy, using cannabis more times per day pre-pregnancy, and greater perceived benefits of use had significant bivariate associations with continued use during pregnancy, but did not retain significance in a multinomial model.
Conclusions
Identification of these correlates provides potential targets for prevention of or intervention for prenatal cannabis use. However, much more research is needed to understand prenatal cannabis use and its effects in order to better educate women and healthcare providers, and to design optimal public health strategies.
... identifying and understanding factors that may lead to discontinuation of cannabis use can be useful to promote strategies to reduce substance abuse. social and demographic factors, use of other illegal drugs, and a perceived low risk of fetal harming have been identified as factors associated with continuing using cannabis during pregnancy [8,10,11]. however, maternal and obstetric factors associated with cannabis discontinuation during pregnancy have not yet been established. a better understanding of these factors may improve cannabis screening during pregnancy and counseling for discontinuation, help to assess potential negative perinatal and long-term outcomes associated with cannabis use during pregnancy, and promote better discontinuation interventions. ...
... One of the aims of the present study was to find predictors of antenatal cannabis discontinuation. certain sociodemographic factors may put women at greater risk for continued cannabis use during pregnancy, such us unemployment, pre-pregnancy use of tobacco, perceived low risk of prenatal cannabis use, higher frequency of pre-pregnancy cannabis use [11], being unmarried and having less than 12 years of education [22]. Nevertheless, what are the obstetric factors that can increase the risk of cannabis continuation during pregnancy have been poorly studied. in the present study, parity was found a risk factor for antenatal cannabis continuation. ...
... Withdrawal syndrome 0 12 12.8 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) .009 mean ± standard deviation (iQr). ...
The aim of this study is to determine factors associated with cannabis discontinuation, to assess the impact of mental health and addiction interventions on cannabis discontinuation during pregnancy and to investigate the neonatal impact of cannabis discontinuation. This is a 10-year cohort study in a tertiary hospital in Barcelona, Spain, including women with self-reported cannabis use during pregnancy. Main outcome was cannabis discontinuation based on biological sample testing. Secondary outcomes were neonatal intensive care unit (NICU) admission, preterm birth, birth weight and bottle-feeding. When cannabis use was detected during pregnancy, 32 out of 81 (38.3%) discontinued cannabis during pregnancy vs. four out of 61 (6.6%) when detected at birth (p < .001). Multivariate binary logistic regression showed that null parity (OR: 6.95, p = .011), detection of cannabis use during pregnancy (OR: 5.35, p = .018) and early detection and referral to mental health care for counseling on cannabis cessation and interventions on the first trimester (OR: 25.46, p < .001) increased cannabis discontinuation. Risk for preterm birth <37 weeks (11.4% vs. 30.8%) and NICU admission (25.7% vs. 54.2%) were lower when discontinuation. Early detection of cannabis use during pregnancy, cessation counseling with mental health interventions, and null parity are predictors for cannabis discontinuation during pregnancy.
... Legalization of cannabis has created new challenges in providing perinatal care, as legalization has been associated with higher rates of cannabis use during and after pregnancy . In states where cannabis has been legalized, women report cannabis use during pregnancy due to its perceived benefit for nausea or anxiety (Barbosa-Leiker et al., 2020;Pike et al., 2021). Increases in psychosocial stress, isolation, and greater burdens of childcare during the COVID-19 pandemic may have contributed to more frequent use among some women (Young-Wolff et al., 2021). ...
... Disparities in perinatal cannabis use have been identified in California, where use during pregnancy is more common among younger women, women who live in neighborhoods with lower median household income, and Black non-Hispanic women, compared to White or Hispanic women (California Department of Public Health, 2016;Young-Wolff et al., 2019). In addition, prenatal cannabis use has been reported to be more common among women who also smoke tobacco prior to or during pregnancy (Haight et al., 2021;Pike et al., 2021), as well as women with concurrent alcohol or opioid use disorder (Page et al., 2022). ...
... However, whether current approaches to perinatal smoking cessation are adequate to address both tobacco and cannabis use is unknown (Substance Abuse and Mental Health Services Administration, SAMHSA, 2019). Recent surveys evaluating clinician counseling on perinatal cannabis use in the US showed that counseling was often not addressed or overly focused on legal implications of cannabis use (Panday et al., 2021;Pike et al., 2021). Using population-representative data from California, the present study compares reported tobacco and cannabis use during and after pregnancy among women in California, a state that recently legalized recreational cannabis use. ...
Objectives
As the social and legal acceptance of cannabis use grows, health professionals must understand and mitigate the impact of cannabis use in the perinatal period. Here we compare the prevalence of tobacco and cannabis use during and after pregnancy in California, a state that recently legalized cannabis use.Methods
Measures of tobacco and cannabis use during and after pregnancy were obtained from California’s Maternal and Infant Health Assessment, an annual population-based survey of California resident women with a live birth. To allow analysis of county-level variation, we pooled data from the 35 counties with the largest numbers of births from 2017 to 2019.ResultsCannabis use was more than twice as common as cigarette smoking among pregnant women (4.9% vs. 2.1%) in California. This difference was even more pronounced in some counties; for example, in Los Angeles, cannabis use was four times more prevalent than cigarette use. Either during or soon after birth, 7.3% of women in California reported cannabis use. Of those who smoked tobacco cigarettes prior to pregnancy, 73% quit before their third trimester of pregnancy, though 33.0% of these women reported a post-partum relapse in cigarette use.Conclusions
States that have legalized cannabis must attend to the increasing prevalence of perinatal cannabis use, as well as concurrent use with tobacco and other substances. Efforts to support cannabis cessation should draw from successful public health approaches in tobacco control.
... Given the recent legalization and decriminalization of Cannabis in many jurisdictions around the world, there is an urgent need to better understand its effects in a variety of populations, especially in pregnant women. Indeed, in the United States, 4-7% of pregnant women report using Cannabis (Ko et al., 2015;Volkow et al., 2019), and 16-38% of those self-report daily use (Ko et al., 2015;Pike et al., 2021;Metz et al., 2022;Satti et al., 2022). Cannabis use among pregnant and lactating women is largely motivated by its purported antiemetic properties, and for stress and anxiety relief (Westfall et al., 2006;Skelton et al., 2020;Satti et al., 2022). ...
... High-THC Cannabis smoke exposure produced acute changes in physiology of the pregnant dams without dramatic changes in fetal and neonatal parameters Our maternal Cannabis smoke exposure paradigm involved a single daily exposure from GD6 to GD20, which corresponds to the first and second trimesters of human pregnancy. Cannabis use is more prevalent during these stages of pregnancy than the third trimester as undesirable symptoms such as nausea are more prevalent (Volkow et al., 2019) and a significant portion of women quit using during pregnancy (Pike et al., 2021). In addition, we did not treat the dams during the earliest stages of pregnancy given the concerns regarding the effects of cannabinoid exposure on implantation and fetal reabsorption (Navarrete et al., 2020), although it is worth noting that some protocols initiate treatments during mating with effects on litter size (Weimar et al., 2020). ...
Because of the legalization of Cannabis in many jurisdictions and the trend of increasing Δ ⁹ -tetrahydrocannabinol (THC) content in Cannabis products, an urgent need exists to understand the impact of Cannabis use during pregnancy on fetal neurodevelopment and behavior. To this end, we exposed female Sprague Dawley rats to Cannabis smoke daily from gestational day 6 to 20 or room air. Maternal reproductive parameters, offspring behavior, and gene expression in the offspring amygdala were assessed. Body temperature was decreased in dams following smoke exposure and more fecal boli were observed in the chambers before and after smoke exposure in dams exposed to smoke. Maternal weight gain, food intake, gestational length, litter number, and litter weight were not altered by exposure to Cannabis smoke. A significant increase in the male-to-female ratio was noted in the Cannabis -exposed litters. In adulthood, male and female Cannabis smoke-exposed offspring explored the inner zone of an open field significantly less than control offspring. Gestational Cannabis smoke exposure did not affect behavior on the elevated plus maze test or social interaction test in the offspring. Cannabis offspring were better at visual pairwise discrimination and reversal learning tasks conducted in touchscreen-equipped operant conditioning chambers. Analysis of gene expression in the adult amygdala using RNA sequencing revealed subtle changes in genes related to development, cellular function, and nervous system disease in a subset of the male offspring. These results demonstrate that repeated exposure to high-THC Cannabis smoke during gestation alters maternal physiological parameters, sex ratio, and anxiety-like behaviors in the adulthood offspring.
... In our sample (2010-2012), 2.6% self-reported using cannabis while pregnant, which is Table 2 Descriptive statistics for the final sample and subgroups, and comparison tests between subgroups (N = 1489) similar to the rate of cannabis use during pregnancy in a study conducted in British Columbia (2.4% in 2010; Luke et al., 2019). In the present study, the majority of the women stopped using cannabis after the first trimester, as women usually stop their cannabis use when they find out they are pregnant (Pike et al., 2021). ...
Objectives
The objectives of this study are to describe cannabis use during pregnancy, identify associated factors, examine the associations between prenatal cannabis use and the cognitive, motor and language development of 2-year-old children, and determine whether these associations differ according to child sex.
Methods
Data from 1489 mother-infant dyads from the 3D prospective pregnancy and birth cohort Study (2010–2012) were used. Prenatal cannabis use was measured during interviews in each trimester of pregnancy. Cognitive and motor development were assessed by The Bayley Scales of Infant and Toddler Development (BSID-III) and language development by the MacArthur-Bates Communicative Development Inventories at 2 years of age. Multiple linear regressions and differential analyses by child sex were performed.
Results
2.6% of women reported using cannabis during pregnancy, the majority of whom stopped after the first trimester. Prenatal cannabis use was associated with lower socioeconomic status, prenatal use of alcohol and tobacco, and more distress symptoms during the first trimester of pregnancy. Results showed no significant associations between prenatal cannabis use (yes/no) and developmental indicators (Cognitive: B = 0.016, 95% CI [-0.268, 0.299]; Fine motor: B = 0.029, 95% CI [-0.271, 0.328]; Gross motor: B = 0.060, 95% CI [-0.143, 0.544]; Language: B = 0.200, 95% CI [-0.229, 0,465]). Contrary to our hypothesis, a positive association between cannabis use and language development was found in girls only.
Conclusion
The study, consisting of a large sample and developmental indicators independent of parental assessment, highlights the need for more studies on prenatal cannabis exposure documented by biomarkers.
... However, the prevalence of cannabis use could be liable to change if the cannabis is legalized, especially given the significant increase in usage in countries like the United States of America (USA) [26] and European countries, such as France [27,28] following recreational legalization. Studies conducted in the USA [29,30] have shown that in states where cannabis has been legalized, there is an increased social acceptance of cannabis use and a diminished risk perception [31]. There is a growing concern that this growing acceptability could extend globally, highlighting the need for further research on this topic. ...
Background
Despite multiple recommendations and strategies implemented at a national and international level, cigarette smoking, alcohol consumption, and cannabis use during pregnancy remains high in most countries. The objective of this study was to examine key stakeholders’ perception of the treatment interventions adopted in Spain, to identify political, organizational and personal factors associated with successful implementation, and to propose strategies for improvement.
Methods
A qualitative study with a phenomenological approach was conducted in 2022. The target groups were: (1) clinical decision makers in the field of addiction science, (2) health professionals who carry out treatment interventions, and (3) pregnant individuals who use tobacco, alcohol or cannabis. Two focus groups and eight in-depth interviews were conducted, recorded, and transcribed. Exploratory analysis and inductive open coding was performed, codes were merged into categories, and subcategories were identified.
Results
The analysis resulted in 10 subcategories which were further merged into three main categories: (1) Degree of adoption and utility of treatment interventions implemented; (2) Needs and demands with respect to the organization of treatment interventions; and, (3) Personal barriers to and facilitators for treatment. Respondents reported that despite multiple national and regional cessation initiatives, treatment interventions were rarely adopted in clinical practice. Health care administrators demanded reliable records to quantify substance use for better planning of activities. Health care professionals advocated for additional time and training and both echoed the importance of integrating cessation interventions into routine prenatal care and creating in-house specialized units. The difficulty in quitting, lack of awareness of risk for foetus and child and the controversial advice were identified as barriers by pregnant individuals.
Conclusions
Consistent with previous work, this study found that cessation strategies implemented by the health authorities are not effective if they are not accompanied by organizational and behavioral changes. The current study identifies a set of factors that could be pivotal in ensuring the success of treatment interventions targeting tobacco, alcohol and cannabis use among pregnant individuals.
... formed including those participants who continued to use cannabis during pregnancy.In addition, although several confounders were considered in the PSM analysis, potential confounders such as educational level or socioeconomic status, also related to cannabis use,32 were not considered due to lack of data.On the other hand, we want to highlight the main strengths of the present research. First, in this study, a biological test was used for confirming cannabis use, as compared to previous studies,5,7,8 where cannabis use was self-reported. ...
Introduction
Cannabis potency and its use during pregnancy have increased in the last decade. The aim of this study was to investigate the impact of antenatal cannabis use on fetal growth, preterm birth and other perinatal outcomes.
Material and methods
A propensity score‐matched analysis was performed in women with singleton pregnancies attending a tertiary care site in Barcelona. Women in the cannabis group were selected based on the results of a detection test. Primary outcomes were small for gestational age at birth (SGA), low birthweight and preterm birth. Secondary outcomes were other biometric parameters (neonatal length and head circumference), respiratory distress, admission to the neonatal intensive care unit and breastfeeding at discharge. A second propensity score‐matched analysis excluding other confounders (use of other recreational drugs and discontinuation of cannabis use during pregnancy) was performed.
Results
Antenatal cannabis was associated with a higher odds ratio of SGA (OR 3.60, 95% CI: 1.68–7.69), low birthweight (OR 3.94, 95% CI: 2.17–7.13), preterm birth at 37 weeks (OR 2.07, 95% CI: 1.12–3.84) and 32 weeks of gestation (OR 4.13, 95% CI: 1.06–16.11), admission to the neonatal intensive care unit (OR 1.95, 95% CI: 1.03–3.71), respiratory distress (OR 2.77, 95% CI: 1.26–6.34), and lower breastfeeding rates at discharge (OR 0.10, 95% CI: 0.05–0.18). When excluding other confounders, no significant association between antenatal cannabis use and SGA was found.
Conclusions
Antenatal cannabis use increases the risk of SGA, low birthweight, preterm birth and other adverse perinatal outcomes. However, when isolating the impact of cannabis use by excluding women who use other recreational drugs and those who discontinue cannabis during pregnancy, no significant association between antenatal cannabis use and SGA birth was found.
... The products, and trends. [30][31][32][33][34][35][36][37][38][39][40][41][42] Additionally, the authors and investigators of this study administer, recruit, and analyze the nation's largest and most frequently issued cannabis outcomes survey, which has been utilized for numerous academic, legislative, and regulatory commissioned studies. Statistical testing to determine 95% or higher confidence when relevant; and ...
Background:
In 2023, the Virginia House
Health, Welfare and Institutions Committee
requested that the Virginia Cannabis
Control Authority (Authority) conduct a
study on Virginia’s medical cannabis
program, focusing on patient access and
determining the necessity and feasibility of
adding new licenses to the existing
program. To complete this study, the
Authority contracted with Cannabis Public
Policy Consulting (CPPC) to complete a
population survey of past-year cannabis
consumers and patients, an assessment of
supply based on patient experiences (as
quantitative supply data was unavailable),
and a thorough policy analysis.
Results:
The study found that the Virginia
medical cannabis program is struggling to
capture patients amid evolving local policies
as well as adult-use policies in bordering
states, resulting in prices remaining high.
The price of medical cannabis in Virginia
is categorically higher compared to other
medical cannabis states, resulting in 90%
of patients purchasing cannabis from
sources other than the Virginia medical
market, with the largest proportion of
grams being obtained from an
unregulated, but not necessarily illicit,
market.
Approximately 57% of medical patients
obtained cannabis by growing at home
and 65.2% of patients received cannabis
from a friend or family suggesting that
recent home-grow and adult-use sharing legislation has negatively impacted the ability of Pharmaceutical Processors to obtain and retain demand.
Moreover, 12% of patients report traveling to obtain cannabis from other states or jurisdictions, most notably Washington, DC, and Maryland, where prices are much lower.
Virginia's estimated patient enrollment reflects 0.5% of the total state population despite low barriers to patient participation, further supporting the finding that individuals can meet their demand for medical cannabis elsewhere.
Of past-year consumers that are not patients, 22% reported they did not need to become medical patients because they already had access to cannabis, suggesting that interest in program participation is low among potential patients despite the recent reduction in barriers to patient participation.
Findings:
Virginia’s restrictive policy framework, including limited licensing and the Health Service Area (HSA) segmentation, coupled with the widespread availability of cannabis from out-of-state markets, home cultivation, and illicit channels, has created an
environment in which Pharmaceutical Processors are operating at their profit-maximizing supply quantity. In other words, licensees may have no expectation of increased profits if
they expand their supply and lower prices because substitute markets have recently taken root.
Importantly, the high prices of medical cannabis found in Virginia are likely necessary for Pharmaceutical Processors to remain solvent given the current market and policy
conditions and are unlikely to indicate an effort to intentionally overcharge medical patients.
Given the current absence of incentives for Pharmaceutical Processors to lower prices, medical patients will likely continue to seek cannabis from alternative sources, and
Pharmaceutical Processors will struggle to capture the full potential of patient demand.
Policy Pathways for Consideration:
For the Virginia General Assembly to meet the goal
of improving patient access to medical cannabis, the following five policy pathways may be considered. The shared objective of these pathways is to increase supply as a
mechanism to lower prices and shift patient demand to regulated Pharmaceutical Processors. These pathways are considerations and are not to be interpreted as formal
recommendations.
Pathway 1:
Make no policy changes to the medical cannabis program and issue the remaining Pharmaceutical Processor license in HSA I.
Pathway 2:
Add limited standalone medical cultivation, manufacturing, and dispensary licenses that can operate within any HSA, and allow Pharmaceutical Processors to expand beyond their six-store maximum within their HSA.
Pathway 3:
Issue additional Pharmaceutical Processor licenses in each HSA and maintain the HSA framework.
Pathway 4:
Issue additional Pharmaceutical Processor licenses, eliminate the HSA framework, and allow Pharmaceutical Processors to expand beyond their six-store maximum across the state.
Pathway 5:
Add limited standalone medical cultivation, manufacturing, and dispensary licenses, adopt permissive vertical integration for new and existing operators, allow Pharmaceutical Processors to expand in specialized supply chain functions, and
remove the HSA framework.
... Individuals report utilizing cannabis to relieve physical symptoms of pregnancy, such as nausea or poor sleep, as well as the psychological stressors associated with pregnancy ( Barbosa-Leiker et al. 2020). Among those who regularly use cannabis, the majority of individuals discontinue or decrease use during pregnancy, with individuals who continue to use more likely to believe that prenatal cannabis use is safe (Mark et al. 2017;Odom et al. 2020;Pike et al. 2021). ...
While past research has linked cannabis use in pregnancy with a history of depression, sparse literature exists on cannabis use during pregnancy and postpartum depression (PPD). In this study, we aimed to better understand the association between PPD and cannabis use during pregnancy in those with and without a history of depression. This was a retrospective cohort study of patients who received prenatal care at a single institution between January 2017 and December 2019. Patient demographics, obstetric history, depression history, substance use history, and Edinburgh Postnatal Depression Scale (EPDS) scores were extracted from patients’ medical records. Modified Poisson Regression with robust standard errors was used to estimate the relative risk (RR) of screening positive for PPD, adjusting for age at delivery, race/ethnicity, insurance type, marital status, and smoking history. Among the 799 subjects meeting inclusion criteria, 15.9% used cannabis during pregnancy. There was an increased risk of screening positive for PPD among prenatal cannabis users compared to non-users (aRR = 1.60, 95% CI: (1.05, 2.45)). Among individuals with a history of depression, the adjusted relative risk of screening positive for symptoms of PPD at the postpartum visit was 1.62 times greater in cannabis users compared to non-users (95% CI: (1.02, 2.58)). Prenatal cannabis use is associated with screening positive for PPD, particularly in those individuals with a history of depression. These results should discourage women with depression from self-medicating with cannabis in pregnancy and provide additional support to the existing recommendations to abstain from prenatal cannabis use.
... Conversely, some women discontinued use when the risk was uncertain or they could not find sufficient evidence of the safety. Some women weighed possible personal and infant health risks in choosing prescribed or over-the-counter medications with known risks against cannabis to manage conditions (e. g., pain, psychiatric symptoms) and generally considered cannabis safer than prescription medications (Jarlenski et al., 2016;Chang et al., 2019;Barbosa-Leiker et al., 2020;Ko et al., 2015;Young-Wolff et al., 2018;Pike et al., 2021). ...
Evidence suggests fetal risks are associated with cannabis use during pregnancy. Yet, insights into women’s decision-making and cannabis use during pregnancy are limited. This study explored these concepts with postpartum women who used cannabis during and after pregnancy. We conducted interviews with 15 women (4 self-identifying a race other than White and 4 self-identifying Hispanic ethnicity) who: 1) lived in the Puget Sound region of Washington State, 2) reported past-year cannabis use on a routine screen, and 3) had documented pregnancy and delivery March 2015-May 2017. Semi-structured interviews asked about decision-making and cannabis use during pregnancy and postpartum. We used template analysis for coding and analysis. The key findings included that women: 1) gathered information about cannabis use during pregnancy primarily through internet searches and discussions with peers; 2) were reluctant to talk with health care providers about cannabis; 3) used cannabis while pregnant to treat health issues, including morning sickness, pain, and mental health conditions; 4) were comfortable with their decision to use cannabis while pregnant, but had questions about long-term effects; and 5) tried to mitigate transmission through breastmilk. Women decided about cannabis during pregnancy based on their experience, health symptoms, and information gathered from the internet and peers, often without guidance from their health care provider. Results point to opportunities for providers to become informed about and engage in discussion with patients about cannabis use during preconception, pregnancy, and postpartum.
Introduction
There is an urgent need to improve the identification of psychosocial vulnerabilities in clinical practice (eg, stress, unstable living conditions) and examine their contribution to prenatal substance use, especially for legal substances such as alcohol, tobacco, and recently, cannabis.
Methods
We conducted a retrospective chart review of 1842 patients who completed the PROMOTE screening instrument during their first prenatal visit to outpatient clinics of a New York State health system in 6/2019–11/2020. The PROMOTE includes 18 core items to assess psychosocial vulnerabilities including the NIDA Quick Screen assessing past year substance use. Outcomes were tobacco, cannabis, and alcohol use during pregnancy based on electronic medical record abstraction including clinical notes, self-report, or urine toxicology.
Results
A total of 188 (10.2%) patients used at least 1 substance prenatally, including 132 (7.2%) tobacco, 50 (2.7%) cannabis, and 45 (2.4%) alcohol. Two of the NIDA Quick Screen items (past year tobacco use and past year illegal drug use) were associated in the bivariate analysis with greater use risk of all 3 substances. Additional risk factors uniquely associated with specific prenatal substance use variables include low education predicting tobacco use (adjusted odds ratio [AOR] = 2.74, 95% confidence interval [CI] = 1.43–5.23), being unpartnered predicting cannabis use (AOR = 3.37, 95% CI = 1.21–9.39), and major life events predicting alcohol use (AOR = 3.25, 95% CI = 1.439–7.38).
Conclusions
Utilizing brief psychosocial self-screening instruments such as the PROMOTE can help identify and refer at-risk patients to appropriate care. Particular attention should be paid to life context including partner support, emotional health, stress, and past year substance use.
Clinical studies demonstrate that the risk of developing neurological disorders is increased by overconsumption of the commonly used drugs, alcohol, nicotine and cannabis. These drug-induced neurological disorders, which include substance use disorder (SUD) and its co-occurring emotional conditions such as anxiety and depression, are observed not only in adults but also with drug use during adolescence and after prenatal exposure to these drugs, and they are accompanied by long-lasting disturbances in brain development. This report provides overviews of clinical and preclinical studies, which confirm these adverse effects in adolescents and the offspring prenatally exposed to the drugs and include a more in-depth description of specific neuronal systems, their neurocircuitry and molecular mechanisms, affected by drug exposure and of specific techniques used to determine if these effects in the brain are causally related to the behavioral disturbances. With analysis of further studies, this review then addresses four specific questions that are important for fully understanding the impact that drug use in young individuals can have on future pregnancies and their offspring. Evidence demonstrates that the adverse effects on their brain and behavior can occur: (1) at low doses with short periods of drug exposure during pregnancy; (2) after pre-conception drug use by both females and males; (3) in subsequent generations following the initial drug exposure; and (4) in a sex-dependent manner, with drug use producing a greater risk in females than males of developing SUDs with emotional conditions and female offspring after prenatal drug exposure responding more adversely than male offspring. With the recent rise in drug use by adolescents and pregnant women that has occurred in association with the legalization of cannabis and increased availability of vaping tools, these conclusions from the clinical and preclinical literature are particularly alarming and underscore the urgent need to educate young women and men about the possible harmful effects of early drug use and to seek novel therapeutic strategies that might help to limit drug use in young individuals.
Objectives
This study aimed to explore competing priorities when cannabis is used during pregnancy from the perspective of providers and Black and Latina people. Maternal cannabis use is increasingly common, but patients and providers alike struggle to navigate it.
Methods
This pilot used qualitative, constructivist ground theory methods to conduct semi-structured, remote interviews between 16 November 2021, and 7 February 2022 with 7 Black and Latina people who used cannabis during pregnancy, and 10 providers between 15 March 2022, and 6 April 2022, all of who were in Southern California, U.S.
Results
We identified three main findings: (1) Providers reported barriers to caregiving and relationship building with patients due to maternal cannabis use stigma, (2) Providers prioritized the fetus despite patients’ current health system challenges that drove cannabis use, and (3) Both patients and providers engaged in personal research beyond the healthcare system to better understand maternal cannabis use.
Discussion
Our findings indicate that challenges exist between people who use cannabis during pregnancy and providers. Both groups need accurate, sociocultural sensitive information about maternal cannabis use via a harm reduction lens.
Due to the recent legalization of Cannabis in many jurisdictions and the consistent trend of increasing THC content in Cannabis products, there is an urgent need to understand the impact of Cannabis use during pregnancy on fetal neurodevelopment and behavior. To this end, we repeatedly exposed female Sprague-Dawley rats to Cannabis smoke from gestational days 6 to 20 (n=12; Aphria Mohawk; 19.51% THC, <0.07% cannabidiol) or room-air as a control (n=10) using a commercially available system. Maternal reproductive parameters, behavior of the adult offspring, and gene expression in the offspring amygdala were assessed. Body temperature was decreased in dams following smoke exposure and more fecal boli were observed in the chambers before and after smoke exposure in those dams exposed to smoke. Maternal weight gain, food intake, gestational length, litter number, and litter weight were not altered by exposure to Cannabis smoke. A significant increase in the male-to-female ratio was noted in the Cannabis -exposed litters. In adulthood, both male and female Cannabis smoke-exposed offspring explored the inner zone of an open field significantly less than control offspring. Gestational Cannabis smoke exposure did not affect behavior on the elevated plus maze test or social interaction test in the offspring. Cannabis offspring were better at visual pairwise discrimination and reversal learning tasks conducted in touchscreen-equipped operant conditioning chambers. Analysis of gene expression in the adult amygdala using RNAseq revealed subtle changes in genes related to development, cellular function, and nervous system disease in a subset of the male offspring. These results demonstrate that repeated exposure to high-THC Cannabis smoke during gestation alters maternal physiological parameters, sex ratio, and anxiety-like behaviors in the adulthood offspring.
Significance statement
Cannabis use by pregnant women has increased alongside increased THC content in recent years. As smoking Cannabis is the most common method of use, we used a validated model of Cannabis smoke exposure to repeatedly expose pregnant rats to combusted high-THC Cannabis smoke. Our results show alterations in litter sex ratio, anxiety-like behavior, and decision making in the offspring which may relate to subtle changes in expression of amygdala genes related to development, cellular function, and nervous system disease. Thus, we believe this gestational Cannabis exposure model may be useful in delineating long-term effects on the offspring.
Background:
Cannabis use has increased in Canada since its legalization in 2018, including among pregnant women who may be motivated to use cannabis to reduce symptoms of nausea and vomiting. However, a growing body of research suggests that cannabis use during pregnancy may harm the developing fetus. As a result, patients increasingly seek medical advice from online sources, but these platforms may also spread anecdotal descriptions or misinformation. Given the possible disconnect between online messaging and evidence-based research about the effects of cannabis use during pregnancy, there is a potential for advice taken from social media to affect the health of mothers and their babies.
Objective:
This study aims to quantify the volume and tone of English language posts related to cannabis use in pregnancy from January 2012 to December 2021.
Methods:
Modeling published frameworks for scoping reviews, we will collect publicly available posts from Twitter that mention cannabis use during pregnancy and use the Twitter Application Programming Interface for Academic Research to extract data from tweets, including public metrics such as the number of likes, retweets, and quotes, as well as health effect mentions, sentiment, location, and users' interests. These data will be used to quantify how cannabis use during pregnancy is discussed on Twitter and to build a qualitative profile of supportive and opposing posters.
Results:
The CHEO Research Ethics Board reviewed our project and granted an exemption in May 2021. As of December 2021, we have gained approval to use the Twitter Application Programming Interface for Academic Research and have developed a preliminary search strategy that returns over 3 million unique tweets posted between 2012 and 2021.
Conclusions:
Understanding how Twitter is being used to discuss cannabis use during pregnancy will help public health agencies and health care providers assess the messaging patients may be receiving and develop communication strategies to counter misinformation, especially in geographical regions where legalization is recent or imminent. Most importantly, we foresee that our findings will assist expecting families in making informed choices about where they choose to access advice about using cannabis during pregnancy.
Trial registration:
Open Science Framework 10.17605/OSF.IO/BW8DA; www.osf.io/6fb2e.
International registered report identifier (irrid):
PRR1-10.2196/34421.
Background: Despite limited data demonstrating pronounced negative effects of prenatal cannabis exposure, popular opinion and public policies still reflect the belief that cannabis is fetotoxic. Methods: This article provides a critical review of results from longitudinal studies examining the impact of prenatal cannabis exposure on multiple domains of cognitive functioning in individuals aged 0 to 22 years. A literature search was conducted through PsycINFO, PubMed, and Google Scholar. Articles were included if they examined the cognitive performance of offspring exposed to cannabis in utero. Results: An examination of the total number of statistical comparisons (n = 1,001) between groups of participants that were exposed to cannabis prenatally and non-exposed controls revealed that those exposed performed differently on a minority of cognitive outcomes (worse on <3.5 percent and better in <1 percent). The clinical significance of these findings appears to be limited because cognitive performance scores of cannabis-exposed groups overwhelmingly fell within the normal range when compared against normative data adjusted for age and education. Conclusions: The current evidence does not suggest that prenatal cannabis exposure alone is associated with clinically significant cognitive functioning impairments.
Aims:
We aimed to determine the association between stressful life events (SLEs) in the year prior to childbirth with (1) pre-pregnancy cannabis use, (2) cessation of cannabis use during pregnancy, and (3) postpartum relapse to cannabis use.
Design:
We used data from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2016, a cross-sectional, population-based surveillance system.
Setting:
Mailed and telephone surveys conducted in five states - Alaska, Colorado, Maine, Michigan and Washington - in the United States.
Participants:
Women (n=6061) who delivered a live infant within the last 6 months and had data on cannabis use.
Measurements:
Self-reported data included SLEs (yes/no response for 14 individual events in the 12 months prior to childbirth) and cannabis use (yes/no prior to pregnancy, during pregnancy, and at the time of the survey [approximately 2-6 months postpartum]). The associations between SLEs and cannabis use (primary outcomes) were examined in logistic regression models adjusted for maternal demographics (e.g., age, race, education), geography (i.e., state of residence) and cigarette smoking.
Findings:
Pre-pregnancy, 16.4% (997/6061) of respondents endorsed using cannabis, with 36.4% (363/997) continuing cannabis use during pregnancy. Among the 63.6% (634/997) who did not report use during pregnancy, 23.2% (147/634) relapsed to cannabis use during the postpartum. Nine of the 14 possible SLEs were associated with increased odds of pre-pregnancy cannabis use (e.g., husband/partner or mother went to jail aOR: 2.16, 95% CI:1.30-3.62) and four were associated with increased odds of continued cannabis use during pregnancy (e.g., husband/partner lost job aOR: 2.19, 95% CI: 1.21-3.96). The odds of postpartum relapse to cannabis were significantly associated with 2 SLEs (husband/partner said they didn't want pregnancy aOR: 2.86 CI: 1.10-7.72; husband/partner or mother went to jail aOR: 0.37, 95% CI: 0.13-1.00).
Conclusions:
Stressful life events during the year prior to childbirth appear to be linked to greater odds of women's cannabis use during the perinatal period, especially during pre-pregnancy.
Background:
Cannabis use is common among individuals of reproductive age. We examined publicly posted questions about perinatal cannabis use and licensed United States health care provider responses.
Materials and Methods:
Data were medical questions on perinatal cannabis use posted online from March 2011 to January 2017 on an anonymous digital health platform. Posters were able to "thank" health care providers for their responses and providers could "agree" with other provider responses. We characterized 364 user questions and 596 responses from 277 unique providers and examined endorsement of responses through provider "agrees" and user "thanks."
Results:
The most frequent questions concerned prenatal cannabis use detection (24.7%), effects on fertility (22.6%), harms of prenatal use to the fetus (21.3%), and risks of baby exposure to cannabis through breast milk (14.4%). Provider sentiment in responses regarding the safety of perinatal cannabis use were coded as 55.6% harmful, 8.8% safe, 8.8% mixed/unsure, and 26.8% safety unaddressed. Half of providers (49.6%) discouraged perinatal cannabis use, 0.5% encouraged use, and 49.9% neither encouraged nor discouraged use. Provider responses received 1,004 provider "agrees" and 583 user "thanks." Provider responses indicating that perinatal cannabis use is unsafe received more provider "agrees" than responses indicating that use is safe (B = 0.42, 95% CI 0.02-0.82, p = 0.04). User "thanks" did not differ by provider responses regarding safety or dis/encouragement.
Conclusion:
The data indicate public interest in cannabis use effects before, during, and after pregnancy. While most health care providers indicated cannabis use during pregnancy and breastfeeding is not safe, many did not address safety or discourage use, suggesting a missed educational opportunity.
Driving under the influence of cannabis (DUIC) is a public health concern, and data are needed to develop screening and prevention tools. Measuring the level of intoxication that cannabis users perceive as safe for driving could help stratify DUIC risk. This study tested whether intoxication levels perceived as safe for driving predicted past-month DUIC frequency. Online survey data were collected in 2017 from a national sample of n = 3010 past-month cannabis users with lifetime DUIC (age 18+). Respondents indicated past-month DUIC frequency, typical cannabis intoxication level (1-10 scale), and cannabis intoxication level perceived as safe for driving (0-10 scale). Approximately 24%, 38%, 13%, and 24% of respondents engaged in DUIC on 0, 1-9, 10-19, and 20-30 days respectively in the past month. Among these four DUIC frequency groups, median typical intoxication varied little (5-6), but median intoxication perceived as safe for driving varied widely (3-8). Higher intoxication levels perceived as safe for driving corresponded to frequent DUIC (Spearman's rho: 0.46). For each unit increase in intoxication level perceived as safe for driving, the odds of past-month DUIC increased 18% to 68% (multinomial logistic regression odds ratio - MOR1-9 days: 1.18, 95% CI: 1.13-1.23; MOR10-19 days: 1.40, 95% CI: 1.30-1.50; MOR20-30 days: 1.68, 95% CI: 1.57-1.80). In this targeted sample of past-month cannabis users, DUIC frequency varied widely, but daily/near-daily DUIC was common (24%). Measuring intoxication levels perceived as safe for driving permits delineation of past-month DUIC frequency. This metric has potential as a component of public health prevention tools.
Cannabis use increased among pregnant women in the United States from 2002 to 2014.¹ However, changes in cannabis use and frequency by trimester over time and national prevalence of medical cannabis use during pregnancy are unknown. Data from the National Survey on Drug Use and Health (NSDUH) were examined to address these knowledge gaps.
Background
Current theories in neuroscience emphasize the crucial role of individual differences in the brain contributing to the development of risk taking during adolescence. Yet, little is known about developmental pathways through which family risk factors are related to neural processing of risk during decision making, ultimately contributing to health risk behaviors. Using a longitudinal design, we tested whether neural risk processing, as affected by family multi‐risk index, predicted delay discounting and substance use.
Method
One hundred and fifty‐seven adolescents (aged 13–14 years at Time 1, 52% male) were assessed annually three times. Family multi‐risk index was measured by socioeconomic adversity, household chaos, and family risk‐taking behaviors. Delay discounting was assessed by a computerized task, substance use by questionnaire data, and risk‐related neural processing by blood‐oxygen‐level‐dependent (BOLD) responses in the amygdala during a lottery choice task.
Results
Family multi‐risk index at Time 1 was related to adolescent substance use at Time 3 (after controlling for baseline substance use) indirectly through heightened amygdala sensitivity to risks and greater delay discounting.
Conclusions
Our results elucidate the crucial role of neural risk processing in the processes linking family multi‐risk index and the development of substance use. Furthermore, risk‐related amygdala activation and delay discounting are important targets in the prevention and treatment of substance use among adolescents growing up in high‐risk family environments.
Delay discounting, or the process by which reinforcers lose value with delay to their receipt, has been identified as a trans-disease process underlying addiction, other disorders, and maladaptive health behaviors. Delay discounting has been identified as an endophenotype for multiple psychiatric disorders including substance use disorder, ADHD, and major depressive disorder, with this endophenotype being linked to deficits in dopaminergic and serotonergic neurotransmission. In addition, neuroanatomical and neurophysiological deficits in areas of the executive and impulsive systems have been associated with both steeper discounting and substance use disorders. Delay discounting constitutes a novel target for interventions to change health behaviors. A new theory, termed reinforcer pathology, has been developed uniting these findings and setting the stage for future research.
Confusion and controversy related to the potential for cannabis use to cause harm, or alternatively to provide benefit, continues globally. This issue has grown in intensity and importance with the increased recognition of the public health implications related to the escalation of the legalization of cannabis and cannabinoid products. This selective overview and commentary attempt to succinctly convey what is known about one potential consequence of cannabis use, the development of cannabis use disorder (CUD). Such knowledge may help guide a reasonable and objective public health perspective on the potential impact of cannabis use and CUD. Current scientific data and clinical observation strongly support the contention that cannabis use, like the use of other substances such as alcohol, opioids, stimulants, and tobacco, can develop into a use disorder (addiction) with important clinical consequences. Epidemiological data indicate that the majority of those who use cannabis do not have problems related to their use, but a substantial subset (10–30%) do report experiencing symptoms and consequences consistent with a CUD. Treatment seeking for CUD comprises a substantial proportion of all substance use treatment admissions, yet treatment response rates show much room for improvement. Changing cannabis policies related to its therapeutic and recreational use are likely to impact the development of CUD and its course; however, definitive data on such effects are not yet available. Clearly, the development of more effective prevention and treatment strategies is needed for those vulnerable to developing a CUD and for those with a CUD.
Objectives:
In Hungary, 37% of women living in poverty were smokers in 2012. There are no valid data of pregnant women's spontaneous smoking cessation.
Methods:
Our retrospective cohort study (2009-2012) targeted the most underdeveloped regions with an estimated 6-8.5% of Roma population. The sample (N = 12,552) represented 76% of the target population i.e. women in four counties in a year delivering live born babies. Chi-square probe and multivariable logistic regression model (p < 0.05) were used to assess relationship between socio-demographic characteristics and spontaneous cessation.
Results:
Prior to pregnancy, the overall smoking rate was 36.8%. That of women in deep poverty and Roma was 49.7% and 51.1%, respectively. 70.3% of smokers continued smoking during the pregnancy. Among them 80.6% lived in deep poverty. Spontaneous quitting rate was 23.0%. Factors correlated with continued smoking included being Roma (OR = 1.95), undereducated (OR = 2.66), living in homes lacking amenities (OR = 1.48), and having regularly smoking partner (OR = 2.07). Cessation was promoted by younger age (≤ 18 years) (OR = 0.18), being married (OR = 0.50), and the first pregnancy.
Conclusions:
Tailored cessation programmes are needed for Roma, older, low-income, and multiparous women who are less likely to quit on their own. Engaging husbands/partners is essential to reduce smoking among pregnant women and second-hand smoke exposure.
The rapid and wide-reaching expansion of internet access and digital technologies offers epidemiologists numerous opportunities to study health behaviors. One particularly promising new data collection strategy is the use of Facebook's advertising platform in conjunction with Web-based surveys. Our research team at the Center for Technology and Behavioral Health has used this quick and cost-efficient method to recruit large samples and address unique scientific questions related to cannabis use. In conducting this research, we have gleaned several insights for using this sampling method effectively and have begun to document the characteristics of the resulting data. We believe this information could be useful to other researchers attempting to study cannabis use or, potentially, other health behaviors. The first aim of this paper is to describe case examples of procedures for using Facebook as a survey sampling method for studying cannabis use. We then present several distinctive features of the data produced using this method. Finally, we discuss the utility of this sampling method for addressing specific types of epidemiological research questions. Overall, we believe that sampling with Facebook advertisements and Web surveys is best conceptualized as a targeted, nonprobability-based method for oversampling cannabis users across the United States.
Construal Level Theory states that psychologically proximal outcomes are construed concretely while psychologically distal outcomes are construed abstractly. Previous research suggests that the principles of Construal Level Theory can be applied to enhance self-control, as measured by delay discounting. The present studies replicate and expand on this work by examining whether theory-informed priming manipulations lead to delay discounting reductions in a repeated-measures design. Study 1 conceptually replicated previous work, with reduced delay discounting observed as a function of thinking abstractly. Studies 2 and 3 expanded on this work by reinterpreting (a) preference for immediate outcomes as preference for outcomes that are construed concretely, and (b) dispreference for delayed outcomes as dispreference for outcomes that are construed abstractly. Study 2 provided support for the first interpretation, as reduced delay discounting was observed as a function of thinking concretely about the future. Study 3 provided support for the second interpretation, as reduced delay discounting was observed as a function of thinking abstractly about the present. In studies 1 and 3, significant condition × order interactions were observed. In all three studies, the same impact of order of exposure to priming manipulation was observed, indicating specific carryover effects.
Objectives:
The objective of this study was to investigate pregnant women's current use of cannabis and their intended patterns of use with relation to their views on the legalization of cannabis and their knowledge of potential harms.
Methods:
A voluntary, anonymous survey regarding patterns of use of cannabis and views on legalization was distributed to a convenience sample of pregnant women presenting for prenatal care at an outpatient university clinic. Chi-square and Fischer's exact tests were used for analysis using STATA.
Results:
Of 306 surveys returned, 35% of women reported currently using cannabis at the time of diagnosis of pregnancy and 34% of those women continued to use. Seventy percent of respondents endorsed the belief that cannabis could be harmful to a pregnancy. Fifty-nine percent of respondents believed that cannabis should be legalized in some form and 10% reported that they would use cannabis more during pregnancy if it were legalized. Those who continued to use cannabis during pregnancy were less likely than those who quit to believe that cannabis use could be harmful during pregnancy (26% vs 75%, P < 0.001). The most common motivation for quitting cannabis use in pregnancy was to avoid being a bad example (74%); in comparison, only 27% of respondents listed a doctor's recommendation as a motivation to quit.
Conclusions:
Cannabis use during pregnancy is relatively common and persistent, despite knowledge of the potential risks of harm. Views toward legalization vary among pregnant women and may impact cannabis use during pregnancy. In a changing legal climate, there is a need for clear messaging on the effects of cannabis use during pregnancy.
Introduction: Rates of cannabis use disorder (CUD) among vulnerable populations have increased in recent years, highlighting a need to equip providers with an efficient screening tool.
Materials and Methods: A short form of the Cannabis Use Disorder Identification Test-Revised (CUDIT-R) was developed by using item response theory and traditional statistical methods, with data from two community samples of cannabis users representing two countries. Four item selection methods (Rasch regression, test characteristic curve, logistic regression, discriminant function analysis) were employed to identify the optimal three-item shortened version. The diagnostic ability of the short form was evaluated by using receiver operating characteristic curves.
Results: Using a cut score of 2, the 3-item CUDIT-Short Form (CUDIT-SF; reliability alpha = 0.66, Sample 1; 0.80, Sample 2) identified 78.26% of participants in Sample 1 and 78.31% of participants in Sample 2 who met DSM-5 criteria for CUD, with 98% agreement in Sample 1 and 93% agreement in Sample 2 with the full CUDIT-R on CUD classifications using a cut score of 13. Specificity was 76.70 and 78.00 in Samples 1 and 2, respectively.
Conclusions: The CUDIT-SF may be useful in busy clinical settings for a stepwise screening. Further validation of this shortened version with larger samples and in different settings is warranted.
This report describes a systematic literature review of voucher and related monetary-based contingency management (CM) interventions for substance use disorders (SUDs) over 5.2 years (November 2009 through December 2014). Reports were identified using the search engine PubMed, expert consultations, and published bibliographies. For inclusion, reports had to (a) involve monetary-based CM; (b) appear in a peer-reviewed journal; (c) include an experimental comparison condition; (d) describe an original study; (e) assess efficacy using inferential statistics; (f) use a research design allowing treatment effects to be attributed to CM. Sixty-nine reports met inclusion criteria and were categorized into 7 research trends: (1) extending CM to special populations, (2) parametric studies, (3) extending CM to community clinics, (4) combining CM with pharmacotherapies, (5) incorporating technology into CM, (6) investigating longer-term outcomes, (7) using CM as a research tool. The vast majority (59/69, 86%) of studies reported significant (p < 0.05) during-treatment effects. Twenty-eight (28/59, 47%) of those studies included at least one follow-up visit after CM was discontinued, with eight (8/28, 29%) reporting significant (p < 0.05) effects. Average effect size (Cohen's d) during treatment was 0.62 (95% CI: 0.54, 0.70) and post-treatment it was 0.26 (95% CI: 0.11, 0.41). Overall, the literature on voucher-based CM over the past 5 years documents sustained growth, high treatment efficacy, moderate to large effect sizes during treatment that weaken but remain evident following treatment termination, and breadth across a diverse set of SUDs, populations, and settings consistent with and extending results from prior reviews.
Objective To assess the effects of use of cannabis during pregnancy on maternal and fetal outcomes.
Data sources 7 electronic databases were searched from inception to 1 April 2014. Studies that investigated the effects of use of cannabis during pregnancy on maternal and fetal outcomes were included.
Study selection Case–control studies, cross-sectional and cohort studies were included.
Data extraction and synthesis Data synthesis was undertaken via systematic review and meta-analysis of available evidence. All review stages were conducted independently by 2 reviewers.
Main outcomes and measures Maternal, fetal and neonatal outcomes up to 6 weeks postpartum after exposure to cannabis. Meta-analyses were conducted on variables that had 3 or more studies that measured an outcome in a consistent manner. Outcomes for which meta-analyses were conducted included: anaemia, birth weight, low birth weight, neonatal length, placement in the neonatal intensive care unit, gestational age, head circumference and preterm birth.
Results 24 studies were included in the review. Results of the meta-analysis demonstrated that women who used cannabis during pregnancy had an increase in the odds of anaemia (pooled OR (pOR)=1.36: 95% CI 1.10 to 1.69) compared with women who did not use cannabis during pregnancy. Infants exposed to cannabis in utero had a decrease in birth weight (low birth weight pOR=1.77: 95% CI 1.04 to 3.01; pooled mean difference (pMD) for birth weight=109.42 g: 38.72 to 180.12) compared with infants whose mothers did not use cannabis during pregnancy. Infants exposed to cannabis in utero were also more likely to need placement in the neonatal intensive care unit compared with infants whose mothers did not use cannabis during pregnancy (pOR=2.02: 1.27 to 3.21).
Conclusions and relevance Use of cannabis during pregnancy may increase adverse outcomes for women and their neonates. As use of cannabis gains social acceptance, pregnant women and their medical providers could benefit from health education on potential adverse effects of use of cannabis during pregnancy.
Objectives:
To compare pregnant women who are current smokers at their first prenatal visit with those who recently quit smoking in the 90 days prior to their first prenatal visit (i.e., spontaneous quitters) to identify differences between them and factors that predict their intake smoking status.
Methods:
One hundred and thirty participants were enrolled in this cross-sectional research study. The sample was drawn from a population of pregnant women attending their first prenatal visit at a low-income obstetrics clinic in Baltimore, Maryland; the large majority of which have characteristics that previous research has identified as putting them at high-risk of continued smoking during pregnancy. Participants were recruited through referrals from clinical staff. Intake data collection occurred between March and December, 2013.
Results:
Of the 130 pregnant women enrolled in the study, 126 had complete intake data. The sample included 86 current smokers and 40 recent quitters. The large majority of participants were African American with an average age of 26. Current smokers were significantly more likely than recent quitters to have: more depression symptoms; self-perceived stress; internalizing and externalizing disorder symptoms; substance use disorders; and tobacco dependence. The most significant predictors of smoking status at first prenatal visit were depressive symptoms, readiness to quit, and number of children.
Conclusions:
for Practice Differences were identified at intake among this sample of pregnant women already considered to be at high-risk for continued smoking throughout their pregnancy. This study identified relevant factors associated with whether or not a woman had recently quit smoking in early pregnancy or was continuing to smoke at her first prenatal visit. Knowledge of these factors may benefit physicians in understanding and promoting smoking cessation throughout the perinatal period and specifically intervening to decrease depressive symptoms and increasing readiness to quit may improve outcomes.
Psychiatric problems have been commonly reported in patients with migraine. This study investigated the reliability and validity of the Generalized Anxiety Disorder-7 (GAD-7) and Generalized Anxiety Disorder-2 (GAD-2) in patients with migraine.
Subjects were recruited from a headache clinic and a neuropsychologist examined their GAD using the Mini International Neuropsychiatric Interview-Plus Version 5.0.0 (MINI). Subjects completed several instruments, including the GAD-7, the Beck Anxiety Inventory (BAI), the Migraine Disability Assessment Scale (MIDAS), the Headache Impact Test-6 (HIT-6), and the Migraine-Specific Quality of Life (MSQoL).
Among 146 participants, 32 patients (21.9 %) had GAD as determined by the MINI. Cronbach’s α for the GAD-7 and GAD-2 were 0.915 and 0.820, respectively. At a cutoff score of 5, the GAD-7 had a sensitivity of 78.1 %, a specificity of 74.6 %, a positive predictive value (PPV) of 46.3 %, and a negative predictive value (NPV) of 92.4 %. At a cutoff score of 1, the GAD-2 had a sensitivity of 84.4 %, a specificity of 72.8 %, a PPV of 46.6 %, and a NPV of 94.3 %. The scores of the GAD-7 and GAD-2 well correlated with the BAI score, the MIDAS score, the HIT-6 score, and the MSQoL score.
The GAD-7 and GAD-2 are both reliable and valid screening instruments for GAD in patients with migraine.
Rationale
Despite consistent evidence of the familiality of substance misuse, the mechanisms by which family history (FH) increases the risk of addiction are not well understood. One behavioral trait that may mediate the risk for substance use and addiction is delay discounting (DD), which characterizes an individual’s preferences for smaller immediate rewards compared to larger future rewards.
Objectives
The aim of this study is to examine the interrelationships among FH, DD, and diverse aspects of personal substance use, and to test DD as a mediator of the relationship between FH and personal substance use.
Methods
The study used crowdsourcing to recruit a community sample of adults (N = 732). Family history was assessed using a brief assessment of perceived parental substance use problems, personal substance use was assessed using the Alcohol Use Disorders Identification Test and a measure of frequency of use, and delay discounting was assessed using a latent index of discounting preferences across six reward magnitudes.
Results
Steeper discounting was significantly associated with personal alcohol, tobacco, and marijuana use, and level of substance experimentation. Steeper DD was also associated with a denser parental FH of alcohol, tobacco, and overall substance misuse. Parental FH density was significantly associated with several aspects of personal substance use, and these relationships were partially mediated by DD.
Conclusions
The current study suggests that impulsivity, as measured by DD, is one proximal mechanism by which parental FH increases substance use later in life. The causal role of DD in this relationship will need to be established in future longitudinal studies.
Delay discounting is associated with problematic substance use and poorer treatment outcomes in adolescents and adults with substance use disorders. Although some research has addressed delay discounting among individuals with cannabis use disorders (CUDs), results have been equivocal, and no study has examined whether discounting rates differ between adolescent and adult cannabis users. The aim of this study was to compare discounting rates between adolescents and adults in treatment for CUD to determine whether discounting at intake or changes in discounting across treatment differed between age groups. Participants were 165 adolescents and 104 adults enrolled in treatment for CUD. Participants completed a delay discounting task at intake and end of treatment for 2 commodities (money and cannabis) at 2 different magnitudes (1,000). Repeated measures mixed models examined differences in discounting rates by commodity and magnitude across age groups at intake and changes in discounting across treatment. At intake, adolescents discounted money more than adults whereas adults showed greater discounting at 1,000. In addition, adults had greater decreases in discounting of cannabis over the course of treatment. Overall, adolescents appeared less sensitive to changes in magnitude of rewards, discounted money at higher rates, and showed less improvement in discounting over the course of treatment compared to adults. Comparing delay discounting in adolescents and adults with CUD can contribute to a better understanding of how development influences the effect of discounting on substance use to better inform treatment for substance use disorders. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
We investigated three potential predictors (educational attainment, prepregnancy smoking rate, and delay discounting [DD]) of spontaneous quitting among pregnant smokers. These predictors were examined alone and in combination with other potential predictors using study-intake assessments from controlled clinical trials examining the efficacy of financial incentives for smoking cessation and relapse prevention. Data from 349 pregnant women (231 continuing smokers and 118 spontaneous quitters) recruited from the greater Burlington, VT, area contributed to this secondary analysis, including psychiatric/sociodemographic characteristics, smoking characteristics, and performance on a computerized DD task. Educational attainment, smoking rate, and DD values were each significant predictors of spontaneous quitting in univariate analyses. A model examining those three predictors together retained educational attainment as a main effect and revealed a significant interaction of DD and smoking rate (i.e., DD was a significant predictor at lower but not higher smoking rates). A final model considering all potential predictors, included education, the interaction of DD and smoking rate, and five additional predictors (i.e., stress ratings, the belief that smoking during pregnancy will "greatly harm my baby," age of smoking initiation, marital status, and prior quit attempts during pregnancy). The study presented here contributes new knowledge on predictors of spontaneous quitting among pregnant smokers with substantive practical implications for reducing smoking during pregnancy. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Individuals who discount delayed rewards at a high rate are more likely to engage in substance abuse, overeating, or problem gambling. Such findings suggest the value of methods to obtain an accurate and fast measurement of discount rate that can be easily deployed in variety of settings. In the present study, we developed and evaluated the 5-trial adjusting delay task, a novel method of obtaining a discount rate in less than 1 min. We hypothesized that discount rates from the 5-trial adjusting delay task would be similar and would correlate with discount rates from a lengthier task we have used previously, and that 4 known effects relating to delay discounting would be replicable with this novel task. To test these hypotheses, the 5-trial adjusting delay task was administered to 111 college students 6 times to obtain discount rates for 6 different commodities, along with a lengthier adjusting amount discounting task. We found that discount rates were similar and correlated between the 5-trial adjusting delay task and the adjusting amount task. Each of the 4 known effects relating to delay discounting was replicated with the 5-trial adjusting delay task to varying degrees. First, discount rates were inversely correlated with amount. Second, discount rates between past and future outcomes were correlated. Third, discount rates were greater for consumable rewards than with money, although we did not control for amount in this comparison. Fourth, discount rates were lower when $0 amounts opposing the chosen time point were explicitly described. Results indicate that the 5-trial adjusting delay task is a viable, rapid method to assess discount rate. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Background-depression greatly burdens sub-Saharan Africa, especially populations living with HIV/AIDS, for whom few validated depression
scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dual-purpose instrument yielding DSM-IV diagnoses and severity,
and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings.
ObjectiveTo assess the validity/reliability of PHQ-9 and PHQ-2.
DesignObservational, two occasions 7 days apart.
ParticipantsA total of 347 patients attending psychosocial support groups.
MeasurementsDemographics, PHQ-9, PHQ-2, general health perception rating and CD4 count.
ResultsRates for PHQ-9 DSM-IV major depressive disorder (MDD), other depressive disorder (ODD) and any depressive disorder were 13%,
21% and 34%. Depression was associated with female gender, but not CD4. Construct validity was supported by: (1) a strong
association between PHQ-9 and general health rating, (2) a single major factor with loadings exceeding 0.50, (3) item-total
correlations exceeding 0.37 and (4) a pattern of item means similar to US validation studies. Four focus groups indicated
culturally relevant content validity and minor modifications to the PHQ-9 instructions. Coefficient alpha was 0.78. Test-retest
reliability was acceptable: (1) intraclass correlation 0.59 for PHQ-9 total score, (2) kappas 0.24, 0.25 and 0.38 for PHQ-9
MDD, ODD and any depressive disorder and (3) weighted kappa 0.53 for PHQ-9 depression severity categories. PHQ-2 ≥3 demonstrated
high sensitivity (85%) and specificity (95%) for diagnosing any PHQ-9 depressive disorder (AUC, 0.97), and 91% and 77%, respectively,
for diagnosing PHQ-9 MDD (AUC, 0.91). Psychometrics were also good within four gender/age (18–35, 36–61) subgroups.
ConclusionsPHQ-9 and PHQ-2 appear valid/reliable for assessing DSM-IV depressive disorders and depression severity among adults living
with HIV/AIDS in western Kenya.
This study aimed to examine the association between cannabis use before and during pregnancy and birth outcomes.
Overall, 26.3% of women reported previous use of cannabis and 2.6% reported current use. Multivariate analysis, controlling for potential confounders, including tobacco smoking, alcohol consumption, and use of other illicit drugs, showed that cannabis use in pregnancy was associated with low birth weight (odds ratio (OR) = 1.7; 95% confidence interval (CI): 1.3-2.2), preterm labor (OR = 1.5; 95% CI: 1.1-1.9), small for gestational age (OR = 2.2; 95% CI: 1.8-2.7), and admission to the neonatal intensive care unit (OR = 2.0; 95% CI: 1.7-2.4).
The results of this study show that the use of cannabis in pregnancy is associated with increased risk of adverse birth outcomes. Prevention programs that address cannabis use during pregnancy are needed.
Data were from women birthing at the Mater Mothers' Hospital in Brisbane, Australia, over a 7-y period (2000-2006). Women were interviewed in the initial antenatal visit about their use of cannabis and other substances. Records for 24,874 women who provided information about cannabis use, and for whom birth outcomes data were available, were included in the analysis.
Delay discounting is the decline in the present value of a reward with delay to its receipt. Across a variety of species, populations, and reward types, value declines hyperbolically with delay. Value declines steeply with shorter delays, but more shallowly with longer delays. Quantitative modeling provides precise measures to characterize the form of the discount function. These measures may be regarded as higher-order dependent variables, intervening variables, or hypothetical constructs. I suggest the degree of delay discounting may be a personality trait. In the end, the ontological status of measures of delay discounting is irrelevant. Whatever delay discounting may be, its study has provided the field of behavior analysis and other areas measures with robust generality and predictive validity for a variety of significant human problems. Research on moderating the degree of delay discounting has the potential to produce substantial societal benefits.
The purpose of this research was to assess factors associated with quit attempts and successful smoking cessation among a sample of socioeconomically disadvantaged pregnant women living in Eastern Hungary.
In-person interviews were conducted among 201 women residing in Eastern Hungary who self-identified as occasional or regular smokers at the time they learned they were pregnant.
54% of the women were smokers at the time they learned they were pregnant. Just over half tried to quit, but only 20% were successful. Factors associated with reduced likelihood of quit attempts included being a regular (vs. occasional) smoker (OR = 0.36, 95% CI 0.13-1.00) and being Roma (vs. non-Roma) (OR = 0.32, 95% CI 0.14-0.72). Women who completed high school were 7% times more likely to quit (OR = 7.5, 95% CI 1.68-33.2) and those who were employed were 7% times more likely to quit (OR = 7.6, 95% CI 1.88-30.35). Regular smokers were 88% less likely to quit than occasional smokers.
Smoking cessation interventions targeting pregnant women are needed in Eastern Hungary. Efforts to integrate smoking cessation into the current excellent pre-natal care and health visitor program will reach most women who are pregnant or who have given birth within the preceding 3 years.
This article reviews the empirical literature on spontaneous quitting of cigarette smoking among pregnant women. We define
spontaneous quitting and discuss its prevalence and the characteristics that differentiate spontaneous quitters from women
who continue to smoke during pregnancy. We examine the success of these women in abstaining throughout their pregnancy, and
their pattern of relapse back to smoking during the postpartum period. We review studies that have tested strategies to maintain
abstinence among spontaneous quitters, and we conclude the article with gaps identified in the literature that warrant further
study.
Objectives
Recreational cannabis use has been legal in Canada since October 2018. This study sought to determine current prevalence and trends of cannabis use among pregnant women in the greater Hamilton area.
Methods
An anonymous survey was distributed in May–October 2019 to pregnant patients attending family practice, midwifery, low- and high-risk obstetrical clinics. It was carried out via electronic tablet, and included lifetime and in-pregnancy cannabis use, intent for postpartum cannabis use, and characteristics of use. Demographic data included age, relationship status, partner cannabis use, educational attainment, and household income. Descriptive statistics were calculated, and logistic regression analyses were performed to explore relationships between cannabis use and demographics.
Results
Among 478 respondents, 11.3% had used cannabis at any point in pregnancy, 4.2% were currently using and 4.8% intended to use while breastfeeding. Of current users, 65.0% reported using at least weekly and 95.0% reported nausea, sleep, or anxiety as reasons for use. Women who used cannabis in pregnancy and intended to use while breastfeeding were more likely to report partner cannabis use and lower educational attainment. Women reporting partner cannabis use were 3.3-fold more likely to use cannabis in pregnancy (p<0.001; 95% CI 1.77–6.17) and women without post-secondary education were 8.6-fold more likely to use cannabis than university-educated women (P<0.0001; 95% CI 3.78–19.52).
Conclusions
Partner cannabis use and lower educational attainment predict likelihood of in-pregnancy cannabis use and intent for postpartum use. Education about safer alternatives for coping with nausea, sleep difficulties and anxiety may help reduce the prevalence of cannabis use in pregnancy.
Importance
Recent evidence suggests that cannabis use during pregnancy is increasing, although population-based data about perinatal outcomes following in utero exposure remain limited.
Objective
To assess whether there are associations between self-reported prenatal cannabis use and adverse maternal and perinatal outcomes.
Design, Setting, and Participants
Population-based retrospective cohort study covering live births and stillbirths among women aged 15 years and older in Ontario, Canada, between April 2012 and December 2017.
Exposures
Self-reported cannabis exposure in pregnancy was ascertained through routine perinatal care.
Main Outcomes and Measures
The primary outcome was preterm birth before 37 weeks’ gestation. Indicators were defined for birth occurring at 34 to 36 6/7 weeks’ gestation (late preterm), 32 to 33 6/7 weeks’ gestation, 28 to 31 6/7 weeks’ gestation, and less than 28 weeks’ gestation (very preterm birth). Ten secondary outcomes were examined including small for gestational age, placental abruption, transfer to neonatal intensive care, and 5-minute Apgar score. Coarsened exact matching techniques and Poisson regression models were used to estimate the risk difference (RD) and relative risk (RR) of outcomes associated with cannabis exposure and control for confounding.
Results
In a cohort of 661 617 women, the mean gestational age was 39.3 weeks and 51% of infants were male. Mothers had a mean age of 30.4 years and 9427 (1.4%) reported cannabis use during pregnancy. Imbalance in measured maternal obstetrical and sociodemographic characteristics between reported cannabis users and nonusers was attenuated using matching, yielding a sample of 5639 reported users and 92 873 nonusers. The crude rate of preterm birth less than 37 weeks’ gestation was 6.1% among women who did not report cannabis use and 12.0% among those reporting use in the unmatched cohort (RD, 5.88% [95% CI, 5.22%-6.54%]). In the matched cohort, reported cannabis exposure was significantly associated with an RD of 2.98% (95% CI, 2.63%-3.34%) and an RR of 1.41 (95% CI, 1.36-1.47) for preterm birth. Compared with no reported use, cannabis exposure was significantly associated with greater frequency of small for gestational age (third percentile, 6.1% vs 4.0%; RR, 1.53 [95% CI, 1.45-1.61]), placental abruption (1.6% vs 0.9%; RR, 1.72 [95% CI, 1.54-1.92]), transfer to neonatal intensive care (19.3% vs 13.8%; RR, 1.40 [95% CI, 1.36-1.44]), and 5-minute Apgar score less than 4 (1.1% vs 0.9%; RR, 1.28 [95% CI, 1.13-1.45]).
Conclusions and Relevance
Among pregnant women in Ontario, Canada, reported cannabis use was significantly associated with an increased risk of preterm birth. Findings may be limited by residual confounding.
Tobacco smoking among those seeking treatment for cannabis use disorder (CUD) is common and is a negative predictor of cannabis outcomes. Quitting tobacco may be beneficial for those seeking to quit cannabis use. This initial proof of concept, controlled trial was designed to compare a simultaneous versus sequential tobacco intervention among those seeking treatment for CUD. Sixty-seven adults received either a simultaneous (SIM) or sequential (SEQ) approach to tobacco cessation in the context of outpatient treatment for CUD. A tobacco intervention (TI) that combined web-based counseling with nicotine replacement therapy (NRT) was provided during weeks 1–12 for SIM and was delayed until weeks 13–24 for SEQ. During weeks 1–12, no between-condition significant differences were observed on treatment participation or cannabis use outcomes. The majority of SIM participants initiated TI counseling (62%), 50% made at least one quit attempt and 41% initiated NRT. Interestingly, 39% in SEQ made tobacco quit attempts and 18% initiated NRT on their own before the TI was offered to them. However, only 30% of those in SEQ continued treatment during weeks 13–24, which compromised between-condition comparisons following the TI, but illustrated a potential clinical concern with delaying the TI. Tobacco cessation outcomes generally were poor and did not differ between conditions. This initial controlled trial suggests that addressing tobacco use during CUD treatment is acceptable and generates action towards tobacco cessation. Additional trials testing more intensive TI models may be necessary to identify more efficacious interventions for co-use of cannabis and tobacco.
The objective of the current narrative literature review is to provide an epidemiological, developmental and clinical overview on cannabis use during pregnancy. Cannabis use in pregnancy poses major health concerns for pregnant mothers and their developing children. Although studies on the short- and long-term consequences of prenatal cannabis exposure are increasing, findings have been inconsistent or difficult to interpret due to methodological issues. Thus, consolidating these findings into clinical recommendations based on the mixed studies in the literature remains a challenge. Synthesizing the available observational studies is also difficult, because some of the published studies have substantial methodological weaknesses. Improving observational studies will be an important step toward understanding the extent to which prenatal exposure to cannabis influences neurodevelopment in the offspring. Therefore, further research on prenatal cannabis exposure and the long-term consequences to offspring health in representative samples are needed to guide and improve clinical care for pregnant women and their children. Future research should also investigate the role of policies on prenatal cannabis use.
: media-1vid110.1542/5799877373001PEDS-VA_2018-1076Video Abstract BACKGROUND AND OBJECTIVE: Marijuana is the most commonly used recreational drug among breastfeeding women. With legalization of marijuana in several US states and a 1990 study in which authors documented psychomotor deficits in infants breastfed by mothers using marijuana, there is a need for information on potential exposure to the breastfed infant. Our objective with this study was to quantify cannabinoids in human milk after maternal marijuana use.
Methods:
Between 2014 and 2017, 50 breastfeeding women who reported marijuana use provided 54 breast milk samples to a research repository, Mommy's Milk. Concentrations of Δ-9-tetrahydrocannabinol (∆9-THC), 11-hydroxy-Δ-9-tetrahydrocannabinol, cannabidiol, and cannabinol were measured by using liquid chromatography mass spectrometry electrospray ionization.
Results:
∆9-THC was detectable in 34 (63%) of the 54 samples up to ∼6 days after last reported use; the median concentration of ∆9-THC was 9.47 ng/mL (range: 1.01-323.00). Five samples had detectable levels of 11-hydroxy-Δ-9-tetrahydrocannabinol (range: 1.33-12.80 ng/mL) or cannabidiol (range: 1.32-8.56 ng/mL). The sample with the highest concentration of cannabidiol (8.56 ng/mL) did not have measurable ∆9-THC. Cannabinol was not detected in any samples. The number of hours since last use was a significant predictor of log ∆9-THC concentrations (-0.03; 95% confidence interval [CI] -0.04 to -0.01; P = .005). Adjusted for time since last use, the number of daily uses and time from sample collection to analysis were also significant predictors of log ∆9-THC concentrations (0.51; 95% CI 0.03 to 0.99; P = .039; 0.08; 95% CI 0.00 to 0.15; P = .038, respectively).
Conclusions:
∆9-THC was measurable in a majority of breast milk samples up to ∼6 days after maternal marijuana use.
Objective:
Marijuana use may pose risks for reproductive and perinatal health.(1,2) Marijuana use among pregnant and reproductive-aged women increased 62% in the last decade.(3) Our objective was to investigate time trends in perception of risk of regular marijuana use among U.S. pregnant and non-pregnant reproductive-age women.
Study design:
We analyzed National Survey on Drug Use and Health (NSDUH) data from 2005-2015, a nationally representative survey on substance use in the civilian, non-institutionalized U.S.
Population:
(4) Data were collected using computer-assisted self-interviewing techniques to maximize privacy and confidentiality. We included female respondents ages 18-44 who were pregnant (unweighted N=8,713) or not pregnant (unweighted N=161,902). Respondents were asked: "How much do people risk harming themselves physically and in other ways when they smoke marijuana once or twice a week?" Possible responses included "No risk", "Slight risk," "Moderate risk," "Great risk", or "Don't Know." We calculated time trends in respondents answering "No risk." We used logistic regression to examine annual changes in the perception of no risk of regular marijuana use, adjusted for age, race/ethnicity, education, pregnancy status, and marijuana use within the prior 30 days. Average predicted probabilities of perceiving no risk of regular marijuana use were derived from regression models to show adjusted changes in risk perception over time among pregnant and non-pregnant women, by marijuana use status. Analyses were weighted to account for the complex survey design. The NSDUH are deidentified, publicly available data, and this study did not require IRB approval.
Results:
The average predicted probability of reporting no risk of regular marijuana use among all women increased from 4.6% in 2005 (95% CI: 4.2,5.0) to 19.0% in 2015 (95% CI: 18.3,19.7). Among women who did not report marijuana use in the prior 30 days, the average predicted probability of reporting no risk of regular marijuana use increased from 3.5% (95% CI: 3.0,3.9) to 16.5% (95% CI: 14.9,18.1) among pregnant women and from 3.1% (95% CI: 2.8,3.4) to 14.8% (95% CI: 14.0,15.5) among non-pregnant women (Figure). Among women who reported marijuana use in the prior 30 days, the average predicted probability of reporting no risk of regular marijuana use increased from 25.8% (95% CI: 23.0,28.7) to 65.4% (95% CI: 62.5,68.4) among pregnant women and from 23.7% (95% CI: 21.8,25.6) to 62.6% (95% CI: 61.0,64.3) among non-pregnant women. The probability of women reporting no risk of daily cigarette smoking also increased over time (1.1% in 2005 vs. 3.4% in 2015; data not shown), although this increase was far smaller than that observed for marijuana use.
Conclusion:
Perception that regular marijuana use has no risk has increased threefold from 2005-2015 among U.S. reproductive-age women. Pregnant and non-pregnant women who used marijuana in the prior 30 days more commonly perceived that regular use had no risk, relative to women who had no such marijuana use. However, perception that regular marijuana use has no risk increased even among women without marijuana use in the prior 30 days. We relied on self-reported marijuana use, which might underestimate the true prevalence. Women were asked about perception of risk of marijuana use generally, and not specifically about perinatal marijuana use. As 30 states have laws permitting medical or recreational marijuana, it is important to understand patterns in women's perceptions of the risks of regular marijuana use. Findings support the importance of investigating the effects of marijuana use on reproductive health.
Introduction:
The purpose of this study was to examine the association between pregnant women's socio-demographic characteristics, smoking-related variables and psychological symptoms (anxiety and depression) and both tobacco consumption and spontaneous quitting at the first trimester of pregnancy. In particular, we wished to examine the contribution of depressive symptoms to tobacco consumption and spontaneous quitting, while controlling for anxiety symptoms, socio-demographic and smoking-related variables.
Methods:
The sample was comprised of 901 Spanish pregnant women. Assessment included an ad hoc questionnaire with socio-demographic and tobacco consumption information, the Edinburg Postnatal Depression Scale (EPDS), and The State-Anxiety Inventory (STAI-S). Two multiple logistic regression analyses were performed, respectively to predict tobacco consumption and to predict spontaneous quitting.
Results:
Having a partner who smokes (OR=5.578), not having a college education (OR=2.803), higher scores on the EPDS (OR=1.073) and higher scores on the STAI-S (OR=1.027) increase the probability of continuing smoking. Being primiparous (OR=2.463), having a college education (OR=2.141), smoking fewer cigarettes before pregnancy (OR=1.175), and lower scores on the STAI-S (OR=1.045) increase the probability of spontaneously quitting smoking at the first trimester of pregnancy.
Conclusions:
Depressive symptoms were a predictor of tobacco consumption but not of spontaneous quitting; spontaneous quitting was better predicted by anxiety symptoms. These findings support recommendations that women with depressive symptoms are at risk for smoking during pregnancy and highlight that anxious symptoms should be targeted in interventions for smoking cessation during pregnancy.
Objective:
To describe obstetric provider attitudes, beliefs, approaches, concerns, and needs about addressing perinatal marijuana use with their pregnant patients.
Methods:
We conducted individual semi-structured interviews with obstetric providers and asked them to describe their thoughts and experiences about addressing perinatal marijuana use. Interviews were transcribed verbatim, coded and reviewed to identify themes.
Results:
Fifty-one providers participated in semi-structured interviews. Providers admitted they were not familiar with identified risks of marijuana use during pregnancy, they perceived marijuana was not as dangerous as other illicit drugs, and they believed patients did not view marijuana as a drug. Most provider counseling strategies focused on marijuana's status as an illegal drug and the risk of child protective services being contacted if patients tested positive at time of delivery.
Conclusions:
When counseling about perinatal marijuana use, obstetric providers focus more on legal issues than on health risks. They describe needing more information regarding medical consequences of marijuana use during pregnancy.
Practice implications:
Provider training should include information about potential consequences of perinatal marijuana use and address ways to improve obstetric providers' counseling. Future studies should assess changes in providers' attitudes as more states consider the legalization of marijuana.
Epidemiologic studies have reported an association between depression and continuing smoking during pregnancy. However, differences in study design and methodology challenge study comparability. The purpose of this study was to examine the relationship between maternal depression and continuing smoking among pregnant European women while adjusting for maternal characteristics. This multinational, web-based study evaluated pregnant women in 15 European countries recruited from October 2011 to February 2012. Data on depression status, smoking habits, maternal socio-demographic characteristics, and life-style factors were collected via an anonymous online questionnaire. Associations were estimated with logistic regression. Of 4,295 women included, 1,481 (34.5 %) reported smoking before pregnancy, and 391 (26.4 %) continued smoking during pregnancy whereof 127 (32.5 %) were depressed. The association between depression and continuing smoking during pregnancy were uniform across the European countries (OR 2.02, 95 % CI 1.50-2.71), with about twice the prevalence of continuing smoking among the depressed. There was a strong relationship between continuing smoking in pregnancy and low education level (OR 4.46, 95 % CI 2.72-7.32), which coincided with risky pregnancy behavior such as failure to attend pregnancy/birth preparation courses (OR 1.80, 95 % CI 1.19-2.72) and follow recommended use of folic acid (OR 1.81, 95 % CI 1.23-2.65). Women who perceived the risk for the fetus of continued smoking during pregnancy as higher were the least likely to continue smoking during pregnancy (OR 0.72, 95 % CI 0.68-0.77). This underlines the clustering of risk in some pregnant women, and the results should guide antenatal care of depressed women struggling to quit smoking during pregnancy.
A growing literature has documented the substantial prevalence of and putative mechanisms underlying co-occurring (i.e. concurrent or simultaneous) cannabis and tobacco use. Greater understanding of the clinical correlates of co-occurring cannabis and tobacco use may suggest how intervention strategies may be refined to improve cessation outcomes and decrease the public health burden associated with cannabis and tobacco use.
A systematic review of the literature on clinical diagnoses, psychosocial problems and outcomes associated with co-occurring cannabis and tobacco use. Twenty-eight studies compared clinical correlates in co-occurring cannabis and tobacco users versus cannabis- or tobacco-only users. These included studies of treatment-seekers in clinical trials and non-treatment-seekers in cross-sectional or longitudinal epidemiological or non-population-based surveys.
Sixteen studies examined clinical diagnoses, four studies examined psychosocial problems and 11 studies examined cessation outcomes in co-occurring cannabis and tobacco users (several studies examined multiple clinical correlates). Relative to cannabis use only, co-occurring cannabis and tobacco use was associated with a greater likelihood of cannabis use disorders, more psychosocial problems and poorer cannabis cessation outcomes. Relative to tobacco use only, co-occurring use did not appear to be associated consistently with a greater likelihood of tobacco use disorders, more psychosocial problems or poorer tobacco cessation outcomes.
Cannabis users who also smoke tobacco are more dependent on cannabis, have more psychosocial problems and have poorer cessation outcomes than those who use cannabis but not tobacco. The converse does not appear to be the case.
Second-hand smoke presents a health risk for a large group of entirely helpless nonsmokers: unborn children. Reliable data on women continuing to smoke during pregnancy are essential for effective preventive and interventional programs. The aim of this review is therefore to identify this risk group compared with spontaneous quitters of smoking.
This systematic literature review is based solely on empirical original papers derived from samples of pregnant women smoking at the beginning of pregnancy. In accordance with the QUOROM Statement all population or clinic-based samples were included. Collectives from intervention studies were not included. All studies were from developed nations and published between January 1997 and March 2008.
A total of 19 studies were identified. The rate of quitters was between 4.0% and 69.7% for population-based studies, and 26.5% and 47.0% for clinic-based studies. A smoking partner, a large number of children, a high rate of tobacco consumption, as well as deficiencies in prenatal care were predictors of smoking during pregnancy.
This study identifies risk factors and correlates and indicates common obstacles for women to quit smoking during pregnancy.
The risk groups that can be defined based on our results are a key target population for preventive measures.
This study examined the influence of education on smoking status in a cohort (n=316) of pregnant women who were smokers at the time they learned of the current pregnancy. Subjects were participants in clinical trials examining the efficacy of monetary-based incentives for smoking-cessation and relapse prevention. In multivariate analyses, educational achievement was a robust predictor of smoking status upon entering prenatal care, of achieving abstinence antepartum among those still smoking at entry into prenatal care, and of smoking status at 6-month postpartum in the entire cohort and the subsample who received smoking-cessation treatment. In addition to educational attainment, other predictors of smoking status included smoking-related characteristics (e.g., number of cigarettes/day smoked pre-pregnancy), treatment, maternal age, and stress ratings. We suggest that strategies to increase educational attainment be included with more conventional tobacco-control policies in efforts to reduce smoking among girls and young women.
Prenatal marijuana exposure is associated with adverse perinatal effects. Very little is known about the effect of postnatal marijuana exposure on infant development. Postnatal exposure can result from maternal use of marijuana during lactation. Delta-9-tetrahydrocannabinol (THC) transfers and concentrates in the mother's milk and is absorbed and metabolized by the nursing infant. The present study investigated the relationship between infant exposure to marijuana via the mother's milk and infant motor and mental development at one year of age. One hundred and thirty-six breast-fed infants were assessed at one year of age for motor and mental development. Sixty-eight infants were exposed to marijuana via the mother's milk. An additional 68 infants were matched to the marijuana-exposed infants on pre- and postpartum maternal alcohol and tobacco use. Marijuana exposure via the mother's milk during the first month postpartum appeared to be associated with a decrease in infant motor development at one year of age.
EDITORIAL COMMENT: The takeaway message from this sophisticated audit of smoking behaviour of pregncny Seems to be that during pregnancy. seems to be that spontaneous quitters who lapse back to the habit should be identifed, since they comprise about 35% of smokers who a n likely to quit after counselling during pregnancy. This paper gives important insight into the logistics of planning a policy of prevention of smoking during prenancy. We await, with interest, the authors' findings in their randomized controlled trial of a smoking cessation intervention
Summary: Spontaneous quitters are prepregnancy smokers who quit by the time of their first antenatal visit. We recruited 192 self‐declared spontaneous quitters and 407 smokers at their first visit to the antenatal clinic at the Royal Women's Hospital during April, 1994‐May, 1995. Spontaneous quitters made up 23% of prepregnancy smokers. Information about self‐declared quitters and smokers was collected by self‐completed questionnaires. Urine samples collected at the first visit and in late pregnancy were assayed for cotinine to validate smoking status. A cut‐off urinary concentration of >653 nmol/L cotinine was used to determine active smoking. At the first visit, 20% of the self‐declared spontaneous quitters were smoking and by late pregnancy, regardless of their initial biochemically verified status, 27% were smoking. Spontaneous quitters were different from women who said they were still smoking at their first antenatal visit, in a range of demographic variables and measures of addictive behaviour.
This paper both reviews the current literature and explores anecdotal information as reported by Nursing Mothers' Breastfeeding Counsellors relating to breastfeeding and the use of alcohol, caffeine, nicotine and marijuana. All of these drugs do enter breastmilk to some extent and can have a detrimental effect on the production, volume, composition and ejection of breastmilk, as well as a direct adverse effect on the infant. Breastfeeding mothers should be encouraged to restrict their intake of these so-called recreational drugs. It is acknowledged that this is a particularly stressful period in a mother's life and that she may need additional support and practical suggestions to limit the exposure of these drugs to the infant.
This is a prospective study of the effects of prenatal marijuana exposure on child behavior problems at age 10. The sample consisted of low-income women attending a prenatal clinic. Half of the women were African-American and half were Caucasian. The majority of the women decreased their use of marijuana during pregnancy. The assessments of child behavior problems included the Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and the Swanson, Noland, and Pelham (SNAP) checklist. Multiple and logistic regressions were employed to analyze the relations between marijuana use and behavior problems of the children, while controlling for the effects of other extraneous variables. Prenatal marijuana use was significantly related to increased hyperactivity, impulsivity, and inattention symptoms as measured by the SNAP, increased delinquency as measured by the CBCL, and increased delinquency and externalizing problems as measured by the TRF. The pathway between prenatal marijuana exposure and delinquency was mediated by the effects of marijuana exposure on inattention symptoms. These findings indicate that prenatal marijuana exposure has an effect on child behavior problems at age 10.
This study explored pregnant women's assessment of the health risks associated with maternal smoking. The aim was to determine if stage of change relating to smoking is associated with risk assessment. A cross-sectional survey (employing a self-completion questionnaire) was conducted of all women who attended antenatal clinics at Leicester Royal Infirmary, National Health Service Trust, UK over a 2 week period. Questionnaires were completed by 254 respondents. Twenty seven percent of non-smokers agreed with more than 75% of a series of statements about the dangers of maternal smoking compared to 5% of smokers and 44% of women in social class I (highest social class) agreed with more than 75% of the statements compared with only 10% of women in social classes IV and V (lower social class groups). Married women were twice as likely to concur with more than 75% of the health risks compared to single or cohabiting women and 29% of women intending to breastfeed agreed with more than 75% of the statements compared with only 8.7% of women not intending to breastfeed. There was no significant effect of age, whether the pregnancy was planned, previous obstetric complications or whether the woman had a child with asthma or respiratory infections. A multiple regression analysis indicated that smokers were much less likely to agree with the health risks than their non-smoking counterparts (p = 0.034). Stage of change was related to both the number of health risks agreed with and the level of conviction. A woman's stage of change could be assessed at the start of antenatal care so that appropriate smoking cessation advice can be offered.
Facets of attention were examined in 152 13- to 16-year-old adolescents for whom prenatal exposure to marihuana and cigarettes had been ascertained. The subjects, participants in an ongoing longitudinal study, were from a low-risk, predominantly middle-class sample. The assessment battery included 11 variables derived from a Continuous Performance Test, the Wisconsin Card Sorting Test, the Stroop Test, a number of memory tasks and four subtests of the Wechsler Intelligence Scale for Children. A principal components analysis yielded a five-factor model that was highly concordant with a recent model of attention proposed by Mirsky. Prenatal cigarette exposure was associated with an encode/retain (working memory) component of attention and, at the younger age, with the impulsivity element. Prenatal marihuana was associated with the factor describing stability of attention over time. The differential drug findings were consistent with and extend observations noted when this sample was assessed at earlier ages.
Recent research suggests that in utero exposure to maternal smoking is a risk factor for conduct disorder and delinquency. We review evidence of causality, a controversial but important public health question.
We analyzed studies of maternal prenatal smoking and offspring antisocial behavior within a causal framework.
The association is (1) independent of confounders, (2) present across diverse contexts, and (3) consistent with basic science. Methodological limitations of existing studies preclude causal conclusions.
Existing evidence provides consistent support for, but not proof of, an etiologic role for prenatal smoking in the onset of antisocial behavior. The possibility of identifying a preventable prenatal risk factor for a serious mental disorder makes further research on this topic important for public health.
Despite the strong evidence of harmful effects, tobacco and alcohol use during pregnancy continue to be major public health challenges. Some women, however, do stop spontaneously when they learn of their pregnancy. No study has investigated spontaneous cessation of both behaviors in a low-income predominantly unmarried U.S. population.
To describe the prevalence of spontaneous cessation of cigarette and alcohol use alone and in combination and associated factors among low-income pregnant women.
Subjects (N=601) were currently smoking or smoking when they became pregnant and participating in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs in the greater Boston, Massachusetts, area. Baseline interviews assessed the factors being studied and the spontaneous cessation of cigarette and alcohol use with pregnancy. Saliva cotinine verified self-reported smoking status.
Spontaneous cessation of smoking and alcohol use was reported by 28% and 80% of the women, respectively; 25% spontaneously quit both, and 15% stopped neither. Multivariable analyses indicated that smoking cessation was less likely in women who had previous births, had a husband or partner who smoked, were born in the United States, were black (non-Hispanic, non-Portuguese), had less than a high school education, were highly addicted, reported lower perceived risk to the fetus, and reported "too many other problems in life to stop." Hispanic ethnicity, younger age, and more social support to quit smoking were related to spontaneous alcohol abstinence.
Targeted multiple strategies, including those aimed at increasing participation of partners, are needed for low-income pregnant smokers.
A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2.
The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day"). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score > or =3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics-gynecology samples.
The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.
Committee opinion no. 722: marijuana use during pregnancy and lactation
- American College of Obstetricians and Gynecologists
Effects of prenatal marijuana exposure on child behavior problems at age 10
- Goldschmidt