1. US Security from Michael_Novakhov (88 sites): Eurasia Review: More Women Using Cannabis Daily Before And During Pregnancy

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The number of women using cannabis in the year before they get
pregnant and early in their pregnancies is increasing, and their
frequency of use is also rising, according to new data from Kaiser
Permanente.

The research, published in JAMA Network Open, examined self-reported cannabis use among 276,991 pregnant women (representing 367,403 pregnancies) in Northern California over 9 years and found that cannabis use has increased over time.

From 2009 to 2017, the adjusted prevalence of self-reported
cannabis use in the year before pregnancy increased from 6.8% to 12.5%,
and the adjusted prevalence of self-reported cannabis use during
pregnancy increased from 1.9% to 3.4% (rates were adjusted for
demographics). Annual rates of change in self-reported daily, weekly,
and monthly-or-less cannabis use increased significantly, though daily
use increased most rapidly.

Among women who self-reported cannabis use during the year before
pregnancy, the proportion who were daily users increased from 17% to
25%, and weekly users increased from 20% to 22%, while monthly-or-less
users decreased from 63% to 53% during the study period. Similarly,
among women who self-reported cannabis use during pregnancy, the
proportion who were daily users increased from 15% to 21%, and weekly
users from 25% to 27%, while monthly users decreased from 60% to 52%.

“These findings should alert women’s health clinicians to be
aware of potential increases in daily and weekly cannabis use among
their patients,” said lead author Kelly Young-Wolff, PhD, MPH, a
research scientist with the Kaiser Permanente Division of Research. “The
actual numbers are likely higher, as women may be unwilling to disclose
their substance use to a medical professional.”

In addition, the prevalence of daily and weekly cannabis use may
have risen even further in the past year and a half following
legalization of cannabis for recreational use in California in 2018,
Young-Wolff said.

The data come from women’s initial prenatal visits at Kaiser
Permanente in Northern California, which usually take place at around 8
weeks gestation, and do not reflect continued use throughout pregnancy.
Investigators were unable to differentiate whether self-reported
cannabis use during pregnancy occurred before or after women were aware
that they were pregnant.

While the current findings are based on women’s self-reporting, the
results are supported by the Kaiser Permanente research team’s December
2017 JAMA Research Letter showing an increase in prenatal cannabis use
via urine toxicology testing. In this newer study, the authors focus on
trends in frequency of use in the year before and during pregnancy.

Some women may use cannabis during pregnancy to manage morning
sickness, the authors noted. The authors’ previous work published in
JAMA Internal Medicine in 2018 found women with severe nausea and
vomiting in pregnancy were nearly 4 times more likely to use cannabis
during the first trimester of pregnancy.

Women may get the impression from cannabis product marketing and
online media that cannabis use is safe during pregnancy, said
Young-Wolff. However, there is substantial evidence that exposure to
cannabis in pregnancy is associated with having a low-birthweight baby,
and the American College of Obstetricians and Gynecologists recommends
women who are pregnant or contemplating pregnancy discontinue cannabis
use because of concerns about impaired neurodevelopment and exposure to
the adverse effects of smoking.

“There is still much that is unknown on the topic, including what
type of cannabis products pregnant women are using and whether the
health consequences differ based on mode of cannabis administration and
frequency of prenatal cannabis use,” Young-Wolff noted.

More research is needed to offer women better, specific advice,
said study senior author Nancy Goler, MD, an obstetrician/gynecologist
and associate executive director of The Permanente Medical Group.

“There is an urgent need to better understand the effects of
prenatal cannabis exposure as cannabis becomes legalized in more states
and more widely accepted and used,” Dr. Goler said. “Until such time as
we fully understand the specific health risks cannabis poses for
pregnant women and their fetuses, we are recommending stopping all
cannabis use prior to conceiving and certainly once a woman knows she is
pregnant.”

The study was supported by a grant from the National Institute on Drug Abuse.

Young-Wolff and Kaiser Permanente Division of Research colleague
Lindsay Avalos, PhD, MPH, have received a new 5-year grant from NIDA to
support further research on maternal cannabis use during pregnancy. They
plan to study whether prenatal cannabis use is associated with
increased risk of adverse maternal, fetal, and neonatal outcomes using
data from urine toxicology testing, self-reported frequency of prenatal
cannabis use, and mode of cannabis administration. They will also test
whether legalization of cannabis for recreational use in 2018 and local
regulatory practices (such as retailer bans) are associated with
variation in prenatal cannabis use.

Eurasia Review

1. US Security from Michael_Novakhov (88 sites)


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