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

项目概要/摘要 产前大麻使用越来越被认为是一个重要的公共卫生问题， 对产妇、胎儿和新生儿健康造成大规模负面影响。我们建议进行回顾， 前瞻性纵向队列研究，对超过40万名孕妇进行产前大麻使用筛查， 2009年至2020年的黄金标准自我报告和尿液毒理学数据，利用Kaiser Permanente 北方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， 在乎我们将评估母亲在怀孕期间使用大麻与关键的母亲，胎儿 和新生儿结局，控制潜在混杂因素（例如，吸烟、酗酒和其他毒品 暴露，收入）和比较三个月的暴露。这些分析还利用了 一项独特的自然实验，将研究加州大麻是否在2018年合法化， 监管实践（例如，零售商禁令，怀孕期间使用大麻的突出警告）， 与怀孕期间大麻使用的变化有关。具有高度的普遍性和样本量 与任何其他关于这一主题的研究相比，每个目标的结果都直接影响到 孕妇，同时提供新的见解，以推动未来的流行病学和临床试验为基础的 干预研究。目标1和2将提供可推广和全面的数据，以了解健康状况， 产前使用大麻对母亲及其婴儿的影响。目标3将使我们能够确定 大麻合法化后产前大麻使用，并将告知临床医生，研究人员和政策 未来问题的范围的制造者。最后，研究队列将是未来的宝贵资源， 研究产前使用大麻对孕产妇和儿童福祉的长期影响。

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.