Maternal Marijuana Exposure and Birth Weight: An Observational Study Surrounding Recreational Marijuana Legalization

Abstract

Objective This study aimed to study the relationship between prenatal marijuana and infant birth weight using natural cohorts established before, during and after the 20-month lapse between legalization and legal recreational sales in Washington State.

Study Design Over 5 years, 5,343 pregnant women with documented urine drug screen (UDS) results delivered at Tacoma General Hospital or Good Samaritan Hospital. Maternal medical data were extracted for three delivery cohorts established based on before (T1), during (T2), and after legalization (T3) of recreational marijuana and legalized availability. Univariate and multivariate models were created to study marijuana exposure on infants' birth weight.

Results Marijuana exposure increased the risk of low birth weight (LBW; odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.01–2.01). This was more pronounced in full-term babies (OR = 1.72, 95% CI: 1.10–2.69), and was independently associated with a higher risk for small for gestational age (SGA; OR = 1.51, 95% CI: 1.49–1.53). The associations between marijuana exposure and SGA were maintained in cohort-specific models (OR = 1.53, 95% CI: 1.01–2.32 for T2, and OR = 1.43, 95% CI: 1.01–2.02 for T3, respectively).

Conclusion Marijuana exposure verified by UDS was associated with LBW and SGA. However, recreational marijuana legalization and availability did not have direct impact on newborns' risk of LBW or SGA.

Keywords

maternal marijuana use - birth weight - small for gestational age - low birth weight - marijuana legalization

Note

This study was conducted at MultiCare Health System, Tacoma and Puyallup, Washington. This study was presented in part at the 37th Annual Society for Maternal Fetal Medicine meeting. January 23 to 28, 2017, Las Vegas, NV.

Publication History

Received: 12 June 2019

Accepted: 09 July 2019

Article published online:
20 August 2019

• References

• 1 Metz TD, Stickrath EH. Marijuana use in pregnancy and lactation: a review of the evidence. Am J Obstet Gynecol 2015; 213 (06) 761-778
• 2 Friedrich J, Khatib D, Parsa K, Santopietro A, Gallicano GI. The grass isn't always greener: the effects of cannabis on embryological development. BMC Pharmacol Toxicol 2016; 17 (01) 45
• 3 Benevenuto SG, Domenico MD, Martins MA. et al. Recreational use of marijuana during pregnancy and negative gestational and fetal outcomes: an experimental study in mice. Toxicology 2017; 376: 94-101
• 4 Gunn JKL, Rosales CB, Center KE. et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open 2016; 6 (04) e009986
• 5 Conner SN, Bedell V, Lipsey K, Macones GA, Cahill AG, Tuuli MG. Maternal marijuana use and adverse neonatal outcomes: a systematic review and meta-analysis. Obstet Gynecol 2016; 128 (04) 713-723
• 6 Warner TD, Roussos-Ross D, Behnke M. It's not your mother's marijuana: effects on maternal-fetal health and the developing child. Clin Perinatol 2014; 41 (04) 877-894
• 7 Chabarria KC, Racusin DA, Antony KM. et al. Marijuana use and its effects in pregnancy. Am J Obstet Gynecol 2016; 215 (04) 506.e1-506.e7
• 8 Metz TD, Allshouse AA, Hogue CJ. et al. Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. Am J Obstet Gynecol 2017; 217 (04) 478.e1-478.e8
• 9 Ko JY, Tong VT, Bombard JM, Hayes DK, Davy J, Perham-Hester KA. Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: a population-based study. Drug Alcohol Depend 2018; 187: 72-78
• 10 Leemaqz SY, Dekker GA, McCowan LM. et al; SCOPE Consortium. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications. Reprod Toxicol 2016; 62: 77-86
• 11 Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM. Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. J Pediatr 2018; 197: 90-96
• 12 Washington State Liquor and Cannabis Board. FAQs on Marijuana 2016. Accessed January 2, 2019 at: http://lcb.wa.gov/mj2015/faqs_i-502
• 13 Young-Wolff KC, Tucker LY, Alexeeff S. et al. Trends in self-reported and biochemically tested marijuana use among pregnant females in California from 2009–2016. JAMA 2017; 318 (24) 2490-2491
• 14 Straub H, Adams M, Silver RK. Can an electronic health record system be used for preconception health optimization?. Matern Child Health J 2014; 18 (09) 2134-2140
• 15 Kahveci B, Melekoglu R, Evruke IC, Cetin C. The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies. BMC Pregnancy Childbirth 2018; 18 (01) 343
• 16 Alexander GR, Kogan MD, Himes JH, Mor JM, Goldenberg R. Racial differences in birthweight for gestational age and infant mortality in extremely-low-risk US populations. Paediatr Perinat Epidemiol 1999; 13 (02) 205-217
• 17 Shah PS. Knowledge Synthesis Group on Determinants of LBW/PT births. Parity and low birth weight and preterm birth: a systematic review and meta-analyses. Acta Obstet Gynecol Scand 2010; 89 (07) 862-875
• 18 Goto E. Dose-response association between maternal body mass index and small for gestational age: a meta-analysis. J Matern Fetal Neonatal Med 2017; 30 (02) 213-218
• 19 Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab 2015; 66 (Suppl. 02) 14-20
• 20 Bailey BA, McCook JG, Hodge A, McGrady L. Infant birth outcomes among substance using women: why quitting smoking during pregnancy is just as important as quitting illicit drug use. Matern Child Health J 2012; 16 (02) 414-422
• 21 Slaughter-Acey JC, Holzman C, Calloway D, Tian Y. Movin' on up: socioeconomic mobility and the risk of delivering a small-for-gestational age infant. Matern Child Health J 2016; 20 (03) 613-622
• 22 Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84 (09) 1414-1420
• 23 American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 7th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012
• 24 Talge NM, Mudd LM, Sikorskii A, Basso O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics 2014; 133 (05) 844-853
• 25 de Moraes Barros MC, Guinsburg R, de Araújo Peres C, Mitsuhiro S, Chalem E, Laranjeira RR. Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period. J Pediatr 2006; 149 (06) 781-787
• 26 Lozano J, García-Algar O, Marchei E. et al. Prevalence of gestational exposure to cannabis in a Mediterranean city by meconium analysis. Acta Paediatr 2007; 96 (12) 1734-1737
• 27 Conner SN, Carter EB, Tuuli MG, Macones GA, Cahill AG. Maternal marijuana use and neonatal morbidity. Am J Obstet Gynecol 2015; 213 (03) 422.e1-422.e4
• 28 Mark K, Desai A, Terplan M. Marijuana use and pregnancy: prevalence, associated characteristics, and birth outcomes. Arch Women Ment Health 2016; 19 (01) 105-111
• 29 Hill M, Reed K. Pregnancy, breast-feeding, and marijuana: a review article. Obstet Gynecol Surv 2013; 68 (10) 710-718
• 30 Cary PL. The marijuana detection window: determining the length of time cannabinoids will remain detectable in urine following smoking: a critical review of relevant research and cannabinoid detection guidance for drug courts. Drug Court practitioner fact sheet. National Drug Court Institute. April 2006. Vol IV, No 2. Accessed December 14, 2018 at: https://www.ndci.org/sites/default/files/ndci/THC_Detection_Window_0.pdf
• 31 Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2016. NCHS Data Brief. September 2017. No. 287. Accessed June 25, 2019 at: https://www.cdc.gov/nchs/data/databriefs/db287.pdf
• 32 Center for Disease Control. Smoking and tobacco use. Fast facts and fact sheets. February 4, 2019. Accessed June 25, 2019 at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm
• 33 Osterman MJK, Martin JA. Timing and adequacy of prenatal care in the United States, 2015. National Vital Statistics Reports. May 30, 2018. Volume 67. No 3. Accessed June 25, 2019 at: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_03.pdf
• 34 LeWine H. Drinking a little alcohol early in pregnancy may be okay. Harvard Health Blog. Posted September 10, 2013. Accessed June 25, 2019 at: https://www.health.harvard.edu/blog/study-no-connection-between-drinking-alcohol-early-in-pregnancy-and-birth-problems-201309106667
• 35 Oster E. Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong—and What You Really Need to Know. New York: NY: Penguin Books; 2013
• 36 Food and Nutrition Service US Department of Agriculture. WIC funding and program data. Accessed June 25, 2019 at: https://www.fns.usda.gov/wic/wic-funding-and-program-data
• 37 Pearson G, Shiner M. Rethinking the generation gap: attitudes to illicit drugs among young people and adults. Criminol Crim Justice 2002; 2 (01) 71-86
• 38 Jarlenski M, Koma JW, Zank J, Bodnar LM, Bogen DL, Chang JC. Trends in perception of risk of regular marijuana use among US pregnant and nonpregnant reproductive-aged women. Am J Obstet Gynecol 2017; 217 (06) 705-707
• 39 Monte AA, Zane RD, Heard KJ. The implications of marijuana legalization in Colorado. JAMA 2015; 313 (03) 241-242
• 40 Couper FJ, Peterson BL. The prevalence of marijuana in suspected impaired driving cases in Washington state. J Anal Toxicol 2014; 38 (08) 569-574
• 41 Wright TE, Terplan M, Ondersma SJ. et al. The role of screening, brief intervention, and referral to treatment in the perinatal period. Am J Obstet Gynecol 2016; 215 (05) 539-547
• 42 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144 (07) 768-773