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      Maternal, Fetal and Neonatal Outcomes Related to Recreational Cannabis Use during Pregnancy: Analysis of a Real-World Clinical Data Warehouse between 2010 and 2019

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          Abstract

          Background: Cannabis is the main illicit psychoactive substance used in French childbearing women and very few data are available about adverse events (AEs) related to its use during pregnancy. The aim of this study was to evaluate the association between recreational cannabis use during pregnancy and adverse outcomes from a real-world clinical data warehouse. Methods: Data from the Poitiers University Hospital warehouse were analyzed between 1 January 2010 and 31 December 2019. Logistic regression models were used to evaluate associations between outcomes in three prenatal user groups: cannabis alone ± tobacco (C ± T) (n = 123), tobacco alone (T) (n = 191) and controls (CTRL) (n = 355). Results: Pregnant women in the C ± T group were younger (mean age: 25.5 ± 5.7 years), had lower pre-pregnancy body mass index (22.8 ± 5.5 kg/m2), more psychiatric history (17.5%) and were more likely to benefit from universal free health-care coverage (18.2%) than those in the T and CTRL groups. Cannabis use increases the occurrence of voluntary interruption of pregnancy, at least one AE during pregnancy, at least one neonatal AE, the composite adverse pregnancy outcome over 28, prematurity and small for gestational age. Conclusion: Given the trivialization of recreational cannabis use during pregnancy, there is an urgent need to communicate on AEs of cannabis use during pregnancy.

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          Pregnant women and substance use: fear, stigma, and barriers to care

          Background Substance use during pregnancy and motherhood is both a public health and criminal justice concern. Negative health consequences associated with substance use impact both the mother and the developing fetus, and there are ongoing attempts to criminalize substance use during pregnancy that put pregnant substance-using women at risk of detection, arrest, and punishment. This study explored the experiences of substance-using mothers as they navigated health and criminal justice consequences and accessed needed resources in the community. Methods In-depth life history interviews were conducted with 30 recently-pregnant women who had used alcohol or other drugs during their pregnancies. The three-part interview schedule included questions about past and current substance use, life history, and experiences with criminal justice authorities, child protective services, and health professionals. Results Women’s stories highlighted their strategies for managing their risk of detection by health or criminal justice authorities, including isolating themselves from others, skipping treatment appointments, or avoiding treatment altogether. Women described multiple barriers to treatment and healthcare, including a lack of suitable treatment options and difficulty finding and enrolling in treatment. Conclusion The findings suggest that policies that substance-using women find threatening discourage them from seeking comprehensive medical treatment during their pregnancies. The implications of the findings are discussed, particularly the need for further expansion of treatment programs and social services to meet the needs of substance-using women.
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            Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study.

            Cannabis is the most commonly consumed illicit drug among pregnant women. Intrauterine exposure to cannabis may result in risks for the developing fetus. The importance of intrauterine growth on subsequent psychological and behavioral child development has been demonstrated. This study examined the relation between maternal cannabis use and fetal growth until birth in a population-based sample. Approximately 7,452 mothers enrolled during pregnancy and provided information on substance use and fetal growth. Fetal growth was determined using ultrasound measures in early, mid-, and late pregnancy. Additionally, birth weight was assessed. Maternal cannabis use during pregnancy was associated with growth restriction in mid-and late pregnancy and with lower birth weight. This growth reduction was most pronounced for fetuses exposed to continued maternal cannabis use during pregnancy. Fetal weight in cannabis-exposed fetuses showed a growth reduction of -14.44 g/week (95% confidence interval -22.94 to -5.94, p = .001) and head circumference (-0.21 mm/week, 95% confidence interval -0.42 to 0.02, p = .07), compared with nonexposed fetuses. Maternal cannabis use during pregnancy resulted in more pronounced growth restriction than maternal tobacco use. Paternal cannabis use was not associated with fetal growth restriction. Maternal cannabis use, even for a short period, may be associated with several adverse fetal growth trajectories.
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              Trends and correlates of cannabis use in pregnancy: a population-based study in Ontario, Canada from 2012 to 2017

              Objective Forthcoming legislative changes will legalize and make cannabis widely available in Canada. We conducted an analysis of Ontario’s birth registry to determine recent trends and correlates of cannabis use in pregnancy. Methods We conducted a population-based retrospective cohort study assembled from the Better Outcomes Registry & Network (BORN) Ontario database, covering live births and stillbirths in Ontario between April 2012 and December 2017. Trends in self-reported cannabis use in pregnancy were analyzed according to maternal age and area-level socio-economic status (SES) using log binomial regression analysis. Results A total of 10,731 women reported cannabis use in pregnancy. Prevalence increased from 1.2% in 2012 to 1.8% in 2017 (p-trend, < 0.001), equivalent to a relative increase of 61% (relative risk [RR] 1.61, 95% confidence interval [CI] 1.51 to 1.72). The crude prevalence of cannabis use in pregnancy among women aged 15 to 24 years and in the lowest two area-level income quintiles was 6.7%, compared to 0.3% among women aged 35 years and over in the highest three income quintiles (RR 24.59, 95% CI 21.98 to 27.52). A majority (52.0%) of cannabis users were aged 15–24 years and 54.7% of users were in the lowest two income quintiles. Conclusion Cannabis use in pregnancy has increased since 2012 in Ontario and was reported in about 2% of pregnancies in 2017. Increases were predominately among women of younger ages and those of lower SES, and these groups account for half of users. Promoting cannabis cessation in pregnancy could lead to improved perinatal and later childhood outcomes and reduce health inequalities. Electronic supplementary material The online version of this article (10.17269/s41997-018-0148-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
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                Journal
                IJERGQ
                International Journal of Environmental Research and Public Health
                IJERPH
                MDPI AG
                1660-4601
                September 2023
                August 30 2023
                : 20
                : 17
                : 6686
                Article
                10.3390/ijerph20176686
                c771fbc5-4f2e-42c1-9e51-406937c362b8
                © 2023

                https://creativecommons.org/licenses/by/4.0/

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