Marijuana During Pregnancy: An Overview

Transcription

1 Marijuana During Pregnancy: An Overview

2 Marijuana: Epidemiology Marijuana is the most commonly used illicit drug and, after alcohol and tobacco, the most commonly used drug during pregnancy (1) 48-60% of marijuana users continue use during pregnancy (2,3) 2.5% of pregnant women worldwide report some use of marijuana during pregnancy (4) 2012 NSDUH = 11% in pregnancy (SAMHSA) Chasnoff: 9% of >200,000 pregnant women (5)

3 Marijuana: Epidemiology Marijuana use in pregnancy is frequently accompanied by other forms of drug use: 12% concurrently identified as using opioids 10% as using stimulants 4% have alcohol related dx during pregnancy 50% smoke >10 cigarettes per day So, need prompt investigation into exposure to other substances (6)

4 Epidemiology: Women and Illegal Drugs West Virginia: 1 st prenatal visit (7) 706 tested, 227 (32%) positive for one or more illegal drugs 74% marijuana 23% opiates/6% methadone 12% benzodiazepines and hypnotics (Xanax, Lunesta, Ambien) 4% cocaine Alcohol? Nicotine?

5 Human Teratogens: Critical Periods

6 Marijuana: Prenatal Exposure No firm link between gestational cannabis use and congenital malformations but Few studies have found link with anencephaly/1 st month neural tube closure (but less likely to take folic acid) (8) 2x risk of stillbirth (9) Found to increase the risk of neonatal intensive care unit (NICU) admissions, predominantly for prematurity (12)

7 Marijuana: Growth Effects Use during pregnancy was found to be associated with growth restriction in midpregnancy and late pregnancy (10) Effects on low birth weight most pronounced if use continued throughout pregnancy (10) Growth effects remained significant even after adjustment for potential confounds such as smoking (10)

8 Marijuana: Prenatal Exposure Great concern, because of cannabis lipophilic nature Readily crosses many types of cell barriers, including blood/brain and transplacental membranes Cannabis metabolites easily detectable in placenta, amniotic fluid and the fetus (11)

9 Marijuana: Lactation Cannabis and its metabolites readily pass in to breast milk in variable concentrations that depend on amount of drug ingested by mother When cannabis regularly consumed, human milk THC concentrations may be higher than maternal plasma concentrations (14) Postnatal exposure effects hard to delineate from prenatal use, as most mothers will not begin use after birth (13)

10 Marijuana: Newborns Subtle neurobehavioral disturbances such as exaggerated and prolonged startle reflexes and increased hand-mouth behavior (15) High-pitched cries (16) Sleep cycle disturbances with EEG changes (17) Suggests that prenatal cannabis affects newborn neurophysiological function But confounded by polysubstance abuse

11 Marijuana: Infants Safe sleeping guidelines very important: Nighttime Sudden Infant Death Syndrome (SIDS) is significantly higher in cannabisexposed infants, for as yet uncertain reasons Continued paternal cannabis use triples the risk of SIDS (18) Cannabis use on mother s decision making ability?

12 Marijuana: Later Development Children exposed to marijuana in utero: Lower scores on tests of visual problem solving Visual-motor coordination Visual analysis Decreased attention span Increased behavioral problems Predicted marijuana use by age 14 years (19-25)

13 Elephants in the Living Room Inadequate Social Services Educational Inequality Poverty Familial Genetics Mental Health Environment Polydrug Exposure Parental Substance Abuse

14 Marijuana: Social and Environmental Considerations Difficult to isolate the effects of marijuana exposure from its correlates and from environmental risk factors such as maternal mental health, exposure to violence, limited access to medical and social services, absence of a male figure in the household, and fewer social support networks; many are associated with maternal marijuana use.

15 Marijuana: Summary Cannabis use both during pregnancy and lactation may adversely affect neurodevelopment, especially during periods of critical brain growth both in the developing fetal brain and during adolescent maturation

16 References: 1) Day et al. (2011). Neurotoxicol Teratol, 33(1), ) Passey et al. (2014). Drug Alcohol Depend, 134: ) Moore et al. (2010). J Psychopharmacol, 24, ) Hayatbakhsh et al. (2011). Drug Alcohol Rev, 30(2), ) Chasnoff, I. (2014). NTI Upstream, 6) Burns et al. (2006). Addiction, 101(6), ) Harold, Z. (2011). West Virginia Gazette, 8) van Gelder, et al. (2009), Epidemiology, 20:60-6

17 References: 9) Varner et al. (2014). Obstet Gynecol, 123: ) El Marroun et al. (2009). J Am Acad Child Adolesc Psychiatry, 48(12): ) Harbison et al. (1977). J Pharmacol Exp Ther, 202(2), ) Hayatbakhsh et al. (2012). Pediatr Res, 71: ) Jacques et al. (2014). J Perinatol, 34(6), ) Perez-Reyes et al. (1982). N Engl J Med, 307(13): ) Fried PA. (1995). Life Sci, 56(23-24): ) Lester et al. (1989). Child Dev, 60:

18 References: 17) Scher et al. (1988). Pediatr Res, 24(1), ) Klonoff et al. (2001). Arch Pediatr Adolesc Med, 155(7), ) Wilford et al. (2010). Neurotoxicol Teratol, 32: ) Fried et al. (2000). Neurotoxicol Teratol, 22: ) Fried et al. (2003). Neurotoxicol Teratol, 25: ) Chandler et al. (1996). Alcohol Clin Exp Res, 20: ) Fried et al. (2001). Neurotoxicol Teratol, 23: ) Day et al. (2006). Addiction, 101: ) Goldschmidt et al. (2000). Neurotoxicol Teratol, 22:325-36