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      Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis

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          Abstract

          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.

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          Most cited references35

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          Dose-response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)-a systematic review and meta-analyses.

          S. Malini, Vincent Jaddoe, H Irving … (2011)
          Descriptions of the effects of moderate alcohol consumption during pregnancy on adverse pregnancy outcomes have been inconsistent. To review systematically and perform meta-analyses on the effect of maternal alcohol exposure on the risk of low birthweight, preterm birth and small for gestational age (SGA). Using Medical Subject Headings, a literature search of MEDLINE, EMBASE, CINAHL, CABS, WHOlist, SIGLE, ETOH, and Web of Science between 1 January 1980 and 1 August 2009 was performed followed by manual searches. Case-control or cohort studies were assessed for quality (STROBE), 36 available studies were included. Two reviewers independently extracted the information on low birthweight, preterm birth and SGA using a standardised protocol. Meta-analyses on dose-response relationships were performed using linear as well as first-order and second-order fractional polynomial regressions to estimate best fitting curves to the data. Compared with abstainers, the overall dose-response relationships for low birthweight and SGA showed no effect up to 10 g pure alcohol/day (an average of about 1 drink/day) and preterm birth showed no effect up to 18 g pure alcohol/day (an average of 1.5 drinks/day); thereafter, the relationship showed a monotonically increasing risk for increasing maternal alcohol consumption. Moderate consumption during pre-pregnancy was associated with reduced risks for all outcomes. Dose-response relationship indicates that heavy alcohol consumption during pregnancy increases the risks of all three outcomes whereas light to moderate alcohol consumption shows no effect. Preventive measures during antenatal consultations should be initiated. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.
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            Outcomes in young adulthood for very-low-birth-weight infants.

            Elaine Borawski, Lydia Cartar, Mark Schluchter … (2002)
            Very-low-birth-weight infants (those weighing less than 1500 g) born during the initial years of neonatal intensive care have now reached young adulthood. We compared a cohort of 242 survivors among very-low-birth-weight infants born between 1977 and 1979 (mean birth weight, 1179 g; mean gestational age at birth, 29.7 weeks) with 233 controls from the same population in Cleveland who had normal birth weights. We assessed the level of education, cognitive and academic achievement, and rates of chronic illness and risk-taking behavior at 20 years of age. Outcomes were adjusted for sex and sociodemographic status. Fewer very-low-birth-weight young adults than normal-birth-weight young adults had graduated from high school (74 percent vs. 83 percent, P=0.04). Very-low-birth-weight men, but not women, were significantly less likely than normal-birth-weight controls to be enrolled in postsecondary study (30 percent vs. 53 percent, P=0.002). Very-low-birth-weight participants had a lower mean IQ (87 vs. 92) and lower academic achievement scores (P<0.001 for both comparisons). They had higher rates of neurosensory impairments (10 percent vs. <1 percent, P<0.001) and subnormal height (10 percent vs. 5 percent, P=0.04). The very-low-birth-weight group reported less alcohol and drug use and had lower rates of pregnancy than normal-birth-weight controls; these differences persisted when comparisons were restricted to the participants without neurosensory impairment. Educational disadvantage associated with very low birth weight persists into early adulthood.
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              Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study.

              F Verhulst, Henning Tiemeier, Anja C. Huizink … (2009)
              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.
              Article 0 comments Cited 82 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2016
                Publication date (Electronic): 1 April 2016
                Volume: 6
                Issue: 4
                Electronic Location Identifier: e009986
                Affiliations
                [1 ]Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
                [2 ]Mel and Enid Zuckerman College of Public Health, University of Arizona, Phoenix, Arizona, USA
                [3 ]Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
                [4 ]Arizona Health Sciences Library, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
                [5 ]Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
                [6 ]Arizona Department of Health Services, Phoenix, Arizona, USA
                Author notes
                [Correspondence to ] Professor John Ehiri; jehiri@ 123456email.arizona.edu
                Article
                Publisher ID: bmjopen-2015-009986
                DOI: 10.1136/bmjopen-2015-009986
                PMC ID: 4823436
                PubMed ID: 27048634
                SO-VID: 50977965-2d8c-4b4b-b53f-f7745a6fcb1b
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 14 September 2015
                Date revision received : 4 January 2016
                Date accepted : 9 February 2016
                Funding
                Funded by: Arizona Department of Health Services, http://dx.doi.org/10.13039/100007306;
                Categories
                Subject: Public Health
                Subject: Research
                Subject: 1506
                Subject: 1612
                Subject: 1724
                Subject: 1681
                Subject: 1703
                Subject: 1845
                Subject: 1724
                Custom metadata
                special-feature press-release

                ScienceOpen disciplines: Medicine
                Keywords: public health,preventive medicine
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: public health, preventive medicine

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