Maternal Marijuana Use During Pregnancy, Marijuana Legalization, and Adverse Obstetrical and Neonatal Outcomes: A 12-year Cohort Study

项目摘要/摘要 产前使用大麻越来越被认为是一个重要的公共卫生问题，可能会对 对产妇、胎儿和新生儿健康的大规模负面影响。我们建议进行一次回顾和 基于产前大麻使用筛查的400,000多名孕妇的前瞻性纵向队列研究 利用Kaiser Permanente，从2009年到2020年的黄金标准自我报告和尿毒学数据 北加州的普遍产前物质使用筛查计划是标准产前检查的一部分 关心。我们将评估孕妇在怀孕期间使用大麻与关键的产妇、胎儿 和新生儿结局，控制潜在的混杂因素(例如，烟草使用、酒精和其他药物 风险敞口、收入)，并比较不同孕期的风险敞口。这些分析还利用了 独特的自然实验，并将审查加利福尼亚州大麻合法化是否在2018年和当地 监管做法(例如，零售商禁令，对怀孕期间使用大麻的突出警告)是 与怀孕期间大麻使用的变化有关。具有很高的泛化能力和样本容量 这一主题的任何其他研究都无法与之匹敌，每个目标的结果都对护理有直接的影响 同时为推动未来的流行病学和临床试验提供新的见解 干预研究。目标1和目标2将提供可概括和全面的数据以了解健康状况 产前吸食大麻对母婴的影响。AIM 3将使我们能够确定以下变化趋势 在大麻合法化后产前使用大麻，并将通知临床医生、研究人员和政策 制造者未来的问题范围。最后，研究队列将是未来的宝贵资源 产前吸食大麻对母婴福祉长期影响的研究

PROJECT SUMMARY/ABSTRACT Prenatal marijuana use is increasingly recognized as an important public health problem that could have a large scale negative impact on maternal, fetal and neonatal health. We propose a retrospective and prospective longitudinal cohort study of over 400,000 pregnancies screened for prenatal marijuana use based on gold standard self-reported and urine toxicology data from 2009 to 2020, leveraging Kaiser Permanente Northern California’s universal prenatal substance use screening program that is part of standard prenatal care. We will assess associations between maternal marijuana use during pregnancy and key maternal, fetal and neonatal outcomes, controlling for potential confounders (e.g., tobacco use, alcohol and other drug exposure, income) and comparing exposure across trimesters. These analyses also take advantage of a unique natural experiment and will examine whether California state marijuana legalization in 2018 and local regulatory practices (e.g., retailer bans, prominent warnings on marijuana use during pregnancy) are associated with variation in marijuana use during pregnancy. With high generalizability and a sample size unmatched by any other study on this topic, results from each aim have direct implications for the care of pregnant women while providing novel insight to drive future epidemiological and clinical trial-based intervention studies. Aims 1 and 2 will provide generalizable and comprehensive data to understand the health impact of prenatal marijuana use on mothers and their babies. Aim 3 will allow us to identify changing trends in prenatal marijuana use following marijuana legalization and will inform clinicians, researchers, and policy makers of the future scope of the problem. Finally, the study cohort will be a valuable resource for future research on the long-term impact of prenatal marijuana use on maternal and children’s well-being.