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Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes

Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal... Obstetric Anesthesia Digest Volume 40, Number 2, June 2020 Epidemiologic Reports Surveys Glance and colleagues used data from over 800,000 This retrospective cohort analysis included women of at deliveries in California from 2011 to 2012 to construct a least 15 years of age who delivered a live singleton infant between composite measurement for risk-adjusted maternal and April 1, 2012, and December 31, 2017 at an Ontario hospital. neonatal morbidity and mortality. Hierarchical logistic regres- Maternal cannabis exposure during pregnancy was recorded sion models were created to predict severe maternal and new- during prenatal visits, as well as in clinical histories obtained at born morbidity based on maternal characteristics using 2011 patients’ hospital admission for delivery. The primary outcome data, and then 2012 data were used to validate the models. was preterm birth before 37 weeks’ gestation. Secondary peri- These models, adjusting for maternal characteristics, allow natal outcomes included incidence of stillbirth, SGA at birth, hospitals who care for sicker populations to be better compared placental abruption, neonatal intensive care admission, and with hospitals who serve generally healthier populations. Apgar score at 5 minutes. Maternal outcomes included incidence Caring for women during pregnancy is unique because of preeclampsia, gestational diabetes, and delivery modality. outcomes for 2 individuals must be considered and requires Standardized mean differences were used to compare women weighing risks for one against benefits for the other. Rates of who self-reported use of cannabis during pregnancy with those severe neonatal morbidity, on average, are higher than severe who did not report use across all baseline characteristics. maternal morbidity (3.67% vs. 1.53%). To equally weigh Matching methods were used to reduce imbalance and account maternal and neonatal morbidity, Glance and colleagues for potential confounding across obstetrical, maternal, and soci- selected the geometric mean, instead of the simple average, to odemographic characteristics between reported cannabis users calculate risk. In addition, 3 outcomes were recommended to be and nonusers considered concurrently when evaluating hospital performance: There were 759,281 pregnancy records resulting in a severe neonatal morbidity, severe maternal morbidity, and the singleton birth, but after exclusions for missing information on composite outcome integrating the 2. Calculating these meas- cannabis exposure and covariates, the final sample size was ures are complicated by the limitations of administrative data. 661,617. Between reported cannabis users and nonusers, significant imbalance was identified across covariates. Meaningful quality measures are lacking in the field of obstetric anesthesiology. One useful measure would be an Standardized mean differences > 10% (which together indicate “experience of anesthetic care” question, in addition to an association between cannabis use and the covariates) existed capturing overall patient experience. Optimization of anes- for psychiatric disorders (0.97), maternal age (1.03), parity thetic care and anesthesiologists’ involvement in peripartum (0.34), income level (0.58), prepregnancy body mass index medical management is vital to improving overall obstetric (0.32), maternal smoking (1.31), alcohol use (0.58), opioid use and perinatal care. Though there is room for improvement (0.43), antenatal care (0.45), and year of birth (0.14). in this new composite measure—linking administrative data Preterm birth before 37 weeks’ gestation was 12.0% sources, updating coding algorithms—this is a potentially among reported cannabis users and 6.1% among women who useful quality measure to achieve favorable outcomes. did not use cannabis [risk difference = 5.88%; 95% confidence interval (CI), 5.22%-6.54%]. Also, the risk of preterm birth was greater among reported cannabis users across all gestational age categories. Reported cannabis use was also associated with statistically significant increases in SGA [6.1% vs. 4.0%; relative Association Between Self-reported risk (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), neonatal intensive care Prenatal Cannabis Use and Maternal, admission (19.3% vs. 13.8%; RR= 1.40; 95% CI, 1.36-1.44), and Apgar score of <4 at 5 minutes (1.1% vs. 0.9%; RR= 1.28; 95% Perinatal, and Neonatal Outcomes CI, 1.13-1.45). However, cannabis use was associated with a Corsi D., Walsh L., Weiss D., Hsu H., El-Chaar D., 0.5% reduction in the incidence of preeclampsia (RR = 0.90; 95% CI, 0.86-0.95) and gestational diabetes (RR= 0.91; 95% Hawken S., Fell D., and Walker M. CI, 0.86-0.96). It should be noted that these effects may be associated with the ingestion of combustible carbon monoxide. (JAMA. 2019;322:145–152) In summary, pregnant women in Ontario, Canada who reported cannabis use were at significantly increased Ottawa Hospital Research Institute, Ottawa, ON, Canada risk of preterm birth. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/01.aoa.0000661352.00928.f0 Topics: Drug Abuse in Pregnancy, Maternal Morbidity and Mor- tality, Neonatal Morbidity and Mortality Guidelines for Postoperative Care in Cesarean Delivery: Enhanced he rate of cannabis use among pregnant women in Canada Recovery After Surgery (ERAS) Society T was 2% in 2017. With recent legalization, it is anticipated that cannabis use among pregnant women will continue to rise. Recommendations (Part 3) Cannabinoids can cross the placenta and enter the fetal blood supply. Previous studies have demonstrated a relationship Macones G.A., Caughey A.B., Wood S.L., between pregnant mothers who use cannabinoids and increased Wrench I.J., Huang J., Norman M., Pettersson K., incidence of low birth weight, small for gestational age (SGA), Fawcett W.J., Shalabi M.M., Metcalfe A., stillbirth, and admission to neonatal intensive care. The aim of Gramlich L., Nelson G., and Wilson R.D. this study was to evaluate associations between reported pre- natal cannabis use and maternal, perinatal, and neonatal outcomes. (Am J Obstet Gynecol. 2019;221:247.e1–247.e9) Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. www.obstetricanesthesia.com | 69 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Obstetric Anesthesia Digest Wolters Kluwer Health

Association Between Self-reported Prenatal Cannabis Use and Maternal, Perinatal, and Neonatal Outcomes

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
0275-665X
eISSN
1536-5395
DOI
10.1097/01.aoa.0000661352.00928.f0
Publisher site
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Abstract

Obstetric Anesthesia Digest Volume 40, Number 2, June 2020 Epidemiologic Reports Surveys Glance and colleagues used data from over 800,000 This retrospective cohort analysis included women of at deliveries in California from 2011 to 2012 to construct a least 15 years of age who delivered a live singleton infant between composite measurement for risk-adjusted maternal and April 1, 2012, and December 31, 2017 at an Ontario hospital. neonatal morbidity and mortality. Hierarchical logistic regres- Maternal cannabis exposure during pregnancy was recorded sion models were created to predict severe maternal and new- during prenatal visits, as well as in clinical histories obtained at born morbidity based on maternal characteristics using 2011 patients’ hospital admission for delivery. The primary outcome data, and then 2012 data were used to validate the models. was preterm birth before 37 weeks’ gestation. Secondary peri- These models, adjusting for maternal characteristics, allow natal outcomes included incidence of stillbirth, SGA at birth, hospitals who care for sicker populations to be better compared placental abruption, neonatal intensive care admission, and with hospitals who serve generally healthier populations. Apgar score at 5 minutes. Maternal outcomes included incidence Caring for women during pregnancy is unique because of preeclampsia, gestational diabetes, and delivery modality. outcomes for 2 individuals must be considered and requires Standardized mean differences were used to compare women weighing risks for one against benefits for the other. Rates of who self-reported use of cannabis during pregnancy with those severe neonatal morbidity, on average, are higher than severe who did not report use across all baseline characteristics. maternal morbidity (3.67% vs. 1.53%). To equally weigh Matching methods were used to reduce imbalance and account maternal and neonatal morbidity, Glance and colleagues for potential confounding across obstetrical, maternal, and soci- selected the geometric mean, instead of the simple average, to odemographic characteristics between reported cannabis users calculate risk. In addition, 3 outcomes were recommended to be and nonusers considered concurrently when evaluating hospital performance: There were 759,281 pregnancy records resulting in a severe neonatal morbidity, severe maternal morbidity, and the singleton birth, but after exclusions for missing information on composite outcome integrating the 2. Calculating these meas- cannabis exposure and covariates, the final sample size was ures are complicated by the limitations of administrative data. 661,617. Between reported cannabis users and nonusers, significant imbalance was identified across covariates. Meaningful quality measures are lacking in the field of obstetric anesthesiology. One useful measure would be an Standardized mean differences > 10% (which together indicate “experience of anesthetic care” question, in addition to an association between cannabis use and the covariates) existed capturing overall patient experience. Optimization of anes- for psychiatric disorders (0.97), maternal age (1.03), parity thetic care and anesthesiologists’ involvement in peripartum (0.34), income level (0.58), prepregnancy body mass index medical management is vital to improving overall obstetric (0.32), maternal smoking (1.31), alcohol use (0.58), opioid use and perinatal care. Though there is room for improvement (0.43), antenatal care (0.45), and year of birth (0.14). in this new composite measure—linking administrative data Preterm birth before 37 weeks’ gestation was 12.0% sources, updating coding algorithms—this is a potentially among reported cannabis users and 6.1% among women who useful quality measure to achieve favorable outcomes. did not use cannabis [risk difference = 5.88%; 95% confidence interval (CI), 5.22%-6.54%]. Also, the risk of preterm birth was greater among reported cannabis users across all gestational age categories. Reported cannabis use was also associated with statistically significant increases in SGA [6.1% vs. 4.0%; relative Association Between Self-reported risk (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), neonatal intensive care Prenatal Cannabis Use and Maternal, admission (19.3% vs. 13.8%; RR= 1.40; 95% CI, 1.36-1.44), and Apgar score of <4 at 5 minutes (1.1% vs. 0.9%; RR= 1.28; 95% Perinatal, and Neonatal Outcomes CI, 1.13-1.45). However, cannabis use was associated with a Corsi D., Walsh L., Weiss D., Hsu H., El-Chaar D., 0.5% reduction in the incidence of preeclampsia (RR = 0.90; 95% CI, 0.86-0.95) and gestational diabetes (RR= 0.91; 95% Hawken S., Fell D., and Walker M. CI, 0.86-0.96). It should be noted that these effects may be associated with the ingestion of combustible carbon monoxide. (JAMA. 2019;322:145–152) In summary, pregnant women in Ontario, Canada who reported cannabis use were at significantly increased Ottawa Hospital Research Institute, Ottawa, ON, Canada risk of preterm birth. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/01.aoa.0000661352.00928.f0 Topics: Drug Abuse in Pregnancy, Maternal Morbidity and Mor- tality, Neonatal Morbidity and Mortality Guidelines for Postoperative Care in Cesarean Delivery: Enhanced he rate of cannabis use among pregnant women in Canada Recovery After Surgery (ERAS) Society T was 2% in 2017. With recent legalization, it is anticipated that cannabis use among pregnant women will continue to rise. Recommendations (Part 3) Cannabinoids can cross the placenta and enter the fetal blood supply. Previous studies have demonstrated a relationship Macones G.A., Caughey A.B., Wood S.L., between pregnant mothers who use cannabinoids and increased Wrench I.J., Huang J., Norman M., Pettersson K., incidence of low birth weight, small for gestational age (SGA), Fawcett W.J., Shalabi M.M., Metcalfe A., stillbirth, and admission to neonatal intensive care. The aim of Gramlich L., Nelson G., and Wilson R.D. this study was to evaluate associations between reported pre- natal cannabis use and maternal, perinatal, and neonatal outcomes. (Am J Obstet Gynecol. 2019;221:247.e1–247.e9) Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. www.obstetricanesthesia.com | 69

Journal

Obstetric Anesthesia DigestWolters Kluwer Health

Published: Jun 22, 2020

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