Intrauterine Cannabis Exposure Affects Fetal Growth Trajectories: The Generation R Study

doi:10.1097/CHI.0b013e3181bfa8ee

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 48, Issue 12, December 2009, Pages 1173-1181

https://doi.org/10.1097/CHI.0b013e3181bfa8ee Get rights and content

Abstract

Objective

Cannabis is the most commonly consumed illicit drug among pregnant women. Intrauterine exposure to cannabis may result in risks for the developing fetus. The importance of intrauterine growth on subsequent psychological and behavioral child development has been demonstrated. This study examined the relation between maternal cannabis use and fetal growth until birth in a population-based sample.

Method

Approximately 7,452 mothers enrolled during pregnancy and provided information on substance use and fetal growth. Fetal growth was determined using ultrasound measures in early, mid-, and late pregnancy. Additionally, birth weight was assessed.

Results

Maternal cannabis use during pregnancy was associated with growth restriction in mid-and late pregnancy and with lower birth weight. This growth reduction was most pronounced for fetuses exposed to continued maternal cannabis use during pregnancy. Fetal weight in cannabis-exposed fetuses showed a growth reduction of −14.44 g/week (95% confidence interval −22.94 to −5.94, p = .001) and head circumference (−0.21 mm/week, 95% confidence interval −0.42 to 0.02, p = .07), compared with nonexposed fetuses. Maternal cannabis use during pregnancy resulted in more pronounced growth restriction than maternal tobacco use. Paternal cannabis use was not associated with fetal growth restriction.

Conclusions

Maternal cannabis use, even for a short period, may be associated with several adverse fetal growth trajectories.

Section snippets

Method

This study was embedded in the Generation R Study, a multiethnic population-based prospective cohort study from fetal life onwards, designed to identify early environmental and genetic determinants of growth, development, and health.38, 39 The cohort included 9,778 mothers and their children living in Rotterdam, the Netherlands. Enrollment was aimed at early pregnancy (gestational age <18 weeks) but was possible until birth of the child. Measurements were planned in early (<18 weeks), mid-

Results

Table 1 shows the characteristics of pregnant women per cannabis use category (n = 7,452). In this study sample, 245 women (3.3%) used cannabis only before pregnancy, and 214 women (2.9%) used cannabis before and during early pregnancy. Of these 214 women, 173 (81%) quit using cannabis in early pregnancy, whereas 41 (19%) continued using cannabis throughout pregnancy. In total, 1,453 mothers (19.5%) smoked tobacco during pregnancy (but used no cannabis). All other women (n = 5,540) did not use

Discussion

This population-based study shows that exposure to potent cannabis in utero may be related to reduced fetal growth and fetal head size, known risk factors for neurodevelopmental and behavioral problems. Importantly, we found that cannabis use during pregnancy, often combined with tobacco, has an additive effect in late pregnancy and at birth over and above tobacco use. In contrast, in mid-pregnancy, fetal growth deficits seem to be due to tobacco use only. Our findings further suggest that this

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This study was funded by the Erasmus MC Rotterdam, the Erasmus University Rotterdam, and the Netherlands Organization for Health Research and Development (ZonMw). The work reported was supported by an additional grant from the Sophia Children's Hospital Foundation [project number 450].

The Generation R Study is conducted by the Erasmus MC Rotterdam in collaboration with the Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond. The authors appreciate the contribution of general practitioners, hospitals, midwives, and pharmacies in Rotterdam.

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New ResearchIntrauterine Cannabis Exposure Affects Fetal Growth Trajectories: The Generation R Study

Abstract

Objective

Method

Results

Conclusions

Section snippets

Method

Results

Discussion

Obstet Gynecol

Semin Perinatol

Trends Pharmacol Sci

Regul Pept

Cell Calcium

J Nutr

Clin Perinatol

Neurotoxicol Teratol

Neurotoxicol Teratol

Neurotoxicol Teratol

Neurotoxicol Teratol

Neurotoxicol Teratol

Neurotoxicol Teratol

Bjog

Neurotoxicol Teratol

Am J Obstet Gynecol

Life Sci

Trends Neurosci

Strong increase in total delta-THC in cannabis preparations sold in Dutch coffee shops

Addict Biol

Prenatal toxicity, maternal distribution and placental transfer of tetrahydrocannabinol

J Pharmacol Exp Ther

Short and long-term effects of pre-natal cannabis inhalation upon rat offspring

Psychopharmacology (Berl)

Multiple roles for the endocannabinoid system during the earliest stages of life: pre- and postnatal development

J Neuroendocrinol

Characterization of the endocannabinoid system in early human pregnancy

J Clin Endocrinol Metab

Small body size at birth and behavioural symptoms of ADHD in children aged five to six years

J Child Psychol Psychiatry

Fetal programming of temperamental negative affectivity among children born healthy at term

Dev Psychobiol

A prospective twin study of birth weight discordance and child problem behavior

Biol Psychiatry

New Research
Intrauterine Cannabis Exposure Affects Fetal Growth Trajectories: The Generation R Study