Elsevier

The Journal of Pediatrics

Volume 197, June 2018, Pages 90-96
The Journal of Pediatrics

Original Articles
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

https://doi.org/10.1016/j.jpeds.2018.02.005Get rights and content

Objectives

To evaluate state-level prevalence estimates of prenatal and early postnatal cannabis use in a state with legalized medical and recreational marijuana and the association with adverse neonatal outcomes.

Study design

We conducted a cross-sectional study on 3,207 respondents from the 2014-2015 Colorado Pregnancy Risk Assessment Monitoring System with state-developed questions on cannabis use. Differences in perinatal cannabis use were evaluated according to maternal characteristics, breastfeeding patterns, and pregnancy intendedness. Multiple logistic regression models evaluated the relationship between prenatal cannabis use and adverse neonatal outcomes including low birth weight, small for gestational age, preterm birth, and admission to the neonatal intensive care unit.

Results

The self-reported prevalence of cannabis use at any time during pregnancy was 5.7 ± 0.5% and the prevalence of early postnatal cannabis use among women who breastfed was 5.0% (95% CI, 4.1%-6.2%). Prenatal cannabis use was associated with a 50% increased likelihood of low birth weight, independent of maternal age, race/ethnicity, level of education, and tobacco use during pregnancy (OR, 1.5; 95% CI, 1.1-2.1; P = .02). Small for gestational age, preterm birth, and neonatal intensive care unit admission were not associated with prenatal cannabis use, independent of prenatal tobacco use.

Conclusions

Our findings underscore the importance of screening for cannabis use during prenatal care and the need for provider counselling about the adverse health consequences of continued use during pregnancy and lactation.

Section snippets

Methods

A cross-sectional study was conducted using data from the 2014 and 2015 Colorado PRAMS. The Colorado Department of Public Health and Environment collected population-based data regarding cannabis use during and after pregnancy from a stratified random sample of women who delivered a live-born infant between January 1, 2014, and December 31, 2015 (n = 3285). Data collection procedures were implemented according to the Centers for Disease Control and Prevention PRAMS methodology.26 Exclusion

Results

The total number of live births in Colorado between January 1, 2014, and December 31, 2015, was 132 381. Colorado PRAMS questionnaires were obtained from 3285 women who gave birth to live infants between January 1, 2014, and December 31, 2015. The response rate was 59% in 2014 and 63% in 2015. Over the 2-year study period, 78 respondents had missing data on the cannabis questions and, thus, were excluded from the analysis. The final analytic cohort included PRAMS questionnaires from 3207 women

Discussion

Our results provide insight into prenatal and early postnatal cannabis use patterns in a state with both legalized medical and recreational cannabis. Among pregnant women in Colorado, the overall prevalence of cannabis use at any time during pregnancy was 5.7%, first trimester use was 4.8%, and last trimester use was 2.4%. The prevalence of early postnatal cannabis use among women who reported any level of breastfeeding was 5.0%. Further, we found that maternal cannabis use at any time during

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    Funding for the Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) Survey is provided by the Centers for Disease Control and Prevention (U01 DP003144-04). The funding source had no role in the conduct or design of research. L.B. serves as an unpaid scientific advisor on the Colorado Department of Public Health and Environment Scientific Advisory Committee on Retail Marijuana. The other authors declare no conflicts of interest.

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