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    1 Comment for this article
    EXPAND ALL
    Unrolling and Unravelling Far-Reaching Implications of Cannabis Use in Pregnancy Study
    Albert Stuart Reece, MBBS, FRCS(Ed.), MD | University of Western Australia and Edith Cowan University
    The recent paper by Young-Wolff and colleagues reports several major findings relating to cannabis use in pregnancy 1. The data are particularly noteworthy as they were compiled in the northern counties of California which is known to be one of the highest areas of cannabis use in the nation, and has also been identified as a hotspot of both autism and gastroschisis 2. Amongst the authors’ major findings are a marked rise in high intensity use of daily use both before and during pregnancy; the striking differentials in cannabis use by age group, race and income which are seven-fold, twenty-fold and four-fold respectively; and the rate of self-admitted cannabis use in pregnancy reaching almost 4% in 2017, a finding particularly notable in terms of these authors’ prior report that 80% of patients falsely under-report cannabis use 3.

    Together these data indicate that cannabis is used differentially and disproportionately by the young, the poor and racial minorities – the same epidemiological profile as gastroschisis, an anomaly which has been uniformly linked with cannabis use in all seven studies on this issue 4. Indeed a recent CDC paper documented a threefold increase in gastroschisis in minority teenage mothers a disparity which quickly collapsed with increasing age 5, just as the pregnancy-cannabis use data of Young-Wolff does.

    Such data leave open the possibility that small groups of high intensity cannabis users might be contributing disproportionately to adverse neurodevelopmental neonatal and other pediatric outcomes; and suggest that integral-cumulative exposure and intensity of exposure may be paramount. Indeed cannabis was recently linked with autism rates across US states and shown to be significantly higher under cannabis-liberal regimes 6,7.

    Nor is it just neurodevelopmental outcomes which are at risk. Cardiovascular defects have also been implicated 8 with atrial septal defect rising substantially in Colorado, Hawaii, Kentucky, Canada and Queensland in association with cannabis 4,9 which further implies that our list of cannabis-related sequalae remains incomplete.

    Interestingly several national surveys show that the historically low rate of cannabis use amongst African-Americans has risen in recent years.

    Cannabis acts epigenomically and heritably by altering DNA methylation, histone modification and reduction in total histones 10.

    Most importantly as agreed by both authors 1,11 the situation is readily amenable to education both of our patients and the public in general, and, since cannabis use in pregnancy closely parallels that in the general community, carry wider implications for cannabis legalization worldwide.


    References


    1. Young-Wolff KC, Sarovar V, Tucker L-Y, et al. JAMA Network Open. 2019;2(7):e196471-e196471.
    2. Reece A.S., Hulse G.K.. JAMA Surgery 2019; 154 (4) 366-367.
    3. Young-Wolff KC, Tucker L, Alexeeff S, et al. JAMA. 2017;318(24):2490-2491.
    4. Reece A. S., Hulse G.K. Clinical Pediatrics: Open Access. 2019;4(1):1000146.
    5. Short TD, Stallings EB, Isenburg J, et al. MMWR Morb Mortal Wkly Rep. 2019;68(2):31-36.
    6. Reece A. S., Hulse G.K. (A) Clinical Pediatrics: Open Access. 2019;4(2):In Press.
    7. Reece A. S., Hulse G.K. (B) Clinical Pediatrics: Open Access. 2019;4(2):In Press.
    8. Jenkins KJ, Correa A, Feinstein JA, et al. Circulation. 2007;115(23):2995-3014.
    9. Reece A. S., Hulse G.K. Clinical Pediatrics. 2019;In Press.
    10. Reece AS, Hulse GK. Epigenetics. 2019:1-16.
    11. Metz TD, Stickrath EH. JAMA Network Open. 2019;2(7):e196464-e196464.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Original Investigation
    Substance Use and Addiction
    July 19, 2019

    Self-reported Daily, Weekly, and Monthly Cannabis Use Among Women Before and During Pregnancy

    Author Affiliations
    • 1Division of Research, Kaiser Permanente Northern California, Oakland
    • 2Department of Psychiatry, University of California, San Francisco
    • 3Early Start Program, Kaiser Permanente Northern California, Oakland
    • 4Regional Offices, Kaiser Permanente Northern California, Oakland
    JAMA Netw Open. 2019;2(7):e196471. doi:10.1001/jamanetworkopen.2019.6471
    Key Points español 中文 (chinese)

    Question  Has the frequency of cannabis use among pregnant women in the year before and during pregnancy increased in recent years?

    Findings  In this serial cross-sectional study of 367 403 pregnancies among women in Kaiser Permanente Northern California who were universally screened for self-reported cannabis use as part of standard prenatal care, annual relative rates of daily, weekly, and monthly cannabis use in the year before pregnancy and during pregnancy increased from 2009 to 2017. Relative rates of self-reported daily cannabis use in the year before and during pregnancy increased fastest.

    Meaning  Results of this study demonstrate that frequency of cannabis use in the year before pregnancy and during pregnancy has increased among women in Northern California in recent years, with relative rates of daily cannabis use increasing most rapidly.

    Abstract

    Importance  As the overall prevalence of prenatal cannabis use rises, it is vital to also monitor trends in the frequency of cannabis use in the period leading up to and during pregnancy because more frequent use may confer greater health risks for mothers and their children.

    Objective  To examine trends in the frequency of self-reported cannabis use among pregnant women in the year before and during pregnancy.

    Design, Setting, and Participants  Cross-sectional study using data from 367 403 pregnancies among 276 991 women 11 years or older who completed a self-administered questionnaire on cannabis use during standard prenatal care in Kaiser Permanente Northern California from January 1, 2009, to December 31, 2017. The annual prevalence of self-reported daily, weekly, and monthly cannabis use among women before and during pregnancy was estimated using Poisson regression with a log link function, adjusting for sociodemographics. Data analyses were conducted from February to May 2019.

    Exposures  Calendar year.

    Main Outcomes and Measures  Self-reported frequency of cannabis use in the year before pregnancy and during pregnancy assessed as part of standard prenatal care (at approximately 8 weeks’ gestation).

    Results  Among the overall sample of 367 403 pregnancies among 276 991 women, 35.9% of the women self-reported white race/ethnicity; 28.0%, Hispanic; 16.6%, Asian; 6.0%, African American; and 13.5%, other. In the sample, 1.2% of the women were aged 11 to 17 years; 15.3%, 18 to 24 years; 61.4%, 25 to 34 years; and 22.0%, older than 34 years. Median (interquartile range) neighborhood household income was $70 472 ($51 583-$92 643). From 2009 to 2017, the adjusted prevalence of cannabis use in the year before pregnancy increased from 6.80% (95% CI, 6.42%-7.18%) to 12.50% (95% CI, 12.01%-12.99%), and the adjusted prevalence of cannabis use during pregnancy increased from 1.95% (95% CI, 1.78%-2.13%) to 3.38% (95% CI, 3.15%-3.60%). Annual relative rates of change in self-reported daily cannabis use (1.115; 95% CI, 1.103-1.128), weekly cannabis use (1.083; 95% CI, 1.071-1.095), and monthly or less cannabis use (1.050; 95% CI, 1.043-1.057) in the year before pregnancy increased significantly, with daily use increasing most rapidly (from 1.17% to 3.05%). Similarly, annual relative rates of change in self-reported daily cannabis use (1.110; 95% CI, 1.089-1.132), weekly cannabis use (1.075; 95% CI, 1.059-1.092) and monthly or less cannabis use (1.044; 95% CI, 1.032-1.057) during pregnancy increased significantly from 2009 to 2017, with daily use increasing most rapidly (from 0.28% to 0.69%).

    Conclusions and Relevance  Results of this study demonstrate that frequency of cannabis use in the year before pregnancy and during pregnancy has increased in recent years among pregnant women in Northern California, potentially associated with increasing acceptance of cannabis use and decreasing perceptions of cannabis-associated harms.

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