Impact of Marijuana Legalization on Prevalence of Maternal Marijuana Use and Perinatal OutcomesFunding This project was completed using resources (REDcap) from the Colorado Clinical and Translational Sciences Institute (CCTSI) with the Development and Informatics Service Center (DISC) grant support (NIH/NCRR Colorado CTSI Grant Number UL1 RR025780). During the completion of this study, T.D.M. was supported by the National Institute on Child Health and Human Development under award number 5K12HD001271–18. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
19 July 2019
26 July 2019
06 September 2019 (online)
Objective We aimed to assess whether marijuana legalization was associated with a difference in prevalence of prenatal use or an increase in incidence of adverse perinatal outcomes.
Study Design The present study is a retrospective cohort of September and October deliveries in the years 2012 through 2015 at a tertiary center in Colorado. Primary outcome of the study was use of marijuana, defined by self-report or biodetection. Secondary outcomes of the study included growth restriction, spontaneous preterm birth, stillbirth, preeclampsia, and neonatal or maternal death. Marijuana use prevalence was compared by year, and secondary outcomes between two periods, before and after the opening of the first recreational dispensary.
Results A total of 2,392 pregnant women were included (1,165 before legalization and 1,227 after). More women used marijuana over the period of legalization (trend p = 0.01). Odds of marijuana use were higher after legalization versus before (adjusted odds ratio [aOR] = 1.8, 95% confidence interval [CI]: 1.2–2.6). Incidence of growth restriction was higher after legalization (2.9 vs. 5.1%, p = 0.0084). This difference persisted after adjustment for ethnicity and other drugs in multivariable modeling (aOR = 1.9, 95%CI: 1.2–3.0).
Conclusion The prevalence of prenatal marijuana use increased over the time of legalization. Further investigation into the population impact of legalization on obstetrical outcomes is warranted given the observed increase in growth restriction.
Keywordsalcohol - cannabis - fetal growth restriction - legalization - marijuana - opioids - pregnancy - prevalence - tobacco
This study was presented as a poster at the Society for Maternal-Fetal Medicine Annual Meeting, Las Vegas, NV, February 11 to 16, 2019.
- 1 Metz TD, Borgelt LM. Marijuana use in pregnancy and while breastfeeding. Obstet Gynecol 2018; 132 (05) 1198-1210
- 2 Metz TD. What is new in Cannabis use in pregnancy?: best articles from the past year. Obstet Gynecol 2018; 131 (03) 594-595
- 3 Metz TD, Allshouse AA, Hogue CJ. , et al. Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. Am J Obstet Gynecol 2017; 217 (04) 478.e1-478.e8
- 4 Ko JY, Farr SL, Tong VT, Creanga AA, Callaghan WM. Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age. Am J Obstet Gynecol 2015; 213 (02) 201.e1-201.e10
- 5 Metz TD, Stickrath EH. Marijuana use in pregnancy and lactation: a review of the evidence. Am J Obstet Gynecol 2015; 213 (06) 761-778
- 6 El Marroun H, Tiemeier H, Steegers EAP. , et al. Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study. J Am Acad Child Adolesc Psychiatry 2009; 48 (12) 1173-1181
- 7 Gray TR, Eiden RD, Leonard KE, Connors GJ, Shisler S, Huestis MA. Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth. Clin Chem 2010; 56 (09) 1442-1450
- 8 Hatch EE, Bracken MB. Effect of marijuana use in pregnancy on fetal growth. Am J Epidemiol 1986; 124 (06) 986-993
- 9 Hingson R, Alpert JJ, Day N. , et al. Effects of maternal drinking and marijuana use on fetal growth and development. Pediatrics 1982; 70 (04) 539-546
- 10 Hurd YL, Wang X, Anderson V, Beck O, Minkoff H, Dow-Edwards D. Marijuana impairs growth in mid-gestation fetuses. Neurotoxicol Teratol 2005; 27 (02) 221-229
- 11 Zuckerman B, Frank DA, Hingson R. , et al. Effects of maternal marijuana and cocaine use on fetal growth. N Engl J Med 1989; 320 (12) 762-768
- 12 Janisse JJ, Bailey BA, Ager J, Sokol RJ. Alcohol, tobacco, cocaine, and marijuana use: relative contributions to preterm delivery and fetal growth restriction. Subst Abus 2014; 35 (01) 60-67
- 13 Kline J, Stein Z, Hutzler M. Cigarettes, alcohol and marijuana: varying associations with birthweight. Int J Epidemiol 1987; 16 (01) 44-51
- 14 Shiono PH, Klebanoff MA, Nugent RP. , et al. The impact of cocaine and marijuana use on low birth weight and preterm birth: a multicenter study. Am J Obstet Gynecol 1995; 172 (1, Pt 1): 19-27
- 15 de Moraes Barros MC, Guinsburg R, de Araújo Peres C, Mitsuhiro S, Chalem E, Laranjeira RR. Exposure to marijuana during pregnancy alters neurobehavior in the early neonatal period. J Pediatr 2006; 149 (06) 781-787
- 16 Fried PA. The Ottawa Prenatal Prospective Study (OPPS): methodological issues and findings--it's easy to throw the baby out with the bath water. Life Sci 1995; 56 (23,24): 2159-2168
- 17 Goldschmidt L, Richardson GA, Willford J, Day NL. Prenatal marijuana exposure and intelligence test performance at age 6. J Am Acad Child Adolesc Psychiatry 2008; 47 (03) 254-263
- 18 Goldschmidt L, Day NL, Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol 2000; 22 (03) 325-336
- 19 Gray KA, Day NL, Leech S, Richardson GA. Prenatal marijuana exposure: effect on child depressive symptoms at ten years of age. Neurotoxicol Teratol 2005; 27 (03) 439-448
- 20 Day NL, Goldschmidt L, Thomas CA. Prenatal marijuana exposure contributes to the prediction of marijuana use at age 14. Addiction 2006; 101 (09) 1313-1322
- 21 Varner MW, Silver RM, Rowland Hogue CJ. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network. Association between stillbirth and illicit drug use and smoking during pregnancy. Obstet Gynecol 2014; 123 (01) 113-125
- 22 Brown QL, Sarvet AL, Shmulewitz D, Martins SS, Wall MM, Hasin DS. Trends in marijuana use among pregnant and nonpregnant reproductive-aged women, 2002-2014. JAMA 2017; 317 (02) 207-209
- 23 Jarlenski M, Koma JW, Zank J, Bodnar LM, Bogen DL, Chang JC. Trends in perception of risk of regular marijuana use among US pregnant and nonpregnant reproductive-aged women. Am J Obstet Gynecol 2017; 217 (06) 705-707
- 24 Ammerman S, Ryan S, Adelman WP. ; Committee on Substance Abuse, the Committee on Adolescence. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics 2015; 135 (03) e769-e785
- 25 Choo EK, Benz M, Zaller N, Warren O, Rising KL, McConnell KJ. The impact of state medical marijuana legislation on adolescent marijuana use. J Adolesc Health 2014; 55 (02) 160-166
- 26 Lynne-Landsman SD, Livingston MD, Wagenaar AC. Effects of state medical marijuana laws on adolescent marijuana use. Am J Public Health 2013; 103 (08) 1500-1506
- 27 Mason WA, Fleming CB, Ringle JL, Hanson K, Gross TJ, Haggerty KP. Prevalence of marijuana and other substance use before and after Washington State's change from legal medical marijuana to legal medical and nonmedical marijuana: Cohort comparisons in a sample of adolescents. Subst Abus 2016; 37 (02) 330-335
- 28 Jones J, Nicole Jones K, Peil J. The impact of the legalization of recreational marijuana on college students. Addict Behav 2018; 77: 255-259
- 29 Miller AM, Rosenman R, Cowan BW. Recreational marijuana legalization and college student use: Early evidence. SSM Popul Health 2017; 3: 649-657
- 30 Wang GS, Davies SD, Halmo LS, Sass A, Mistry RD. Impact of marijuana legalization in Colorado on adolescent emergency and urgent care visits. J Adolesc Health 2018; 63 (02) 239-241
- 31 Monte AA, Zane RD, Heard KJ. The implications of marijuana legalization in Colorado. JAMA 2015; 313 (03) 241-242
- 32 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 33 Pregnancy Risk Assessment Monitoring System (PRAMS). Monitoring trends in marijuana use. Available at: https://www.colorado.gov/pacific/cdphe/pregnancy-risk-assessment-monitoring-system-prams-monitoring-trends-marijuana-use . Accessed September 4, 2018
- 34 Metz TD, Silver RM, McMillin GA. , et al. Prenatal marijuana use by self-report and umbilical cord sampling in a state with marijuana legalization. Obstet Gynecol 2019; 133 (01) 98-104
- 35 Garg M, Garrison L, Leeman L. , et al. Validity of self-reported drug use information among pregnant women. Matern Child Health J 2016; 20 (01) 41-47
- 36 El Marroun H, Tiemeier H, Jaddoe VWV. , et al. Agreement between maternal cannabis use during pregnancy according to self-report and urinalysis in a population-based cohort: the Generation R Study. Eur Addict Res 2011; 17 (01) 37-43