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

项目概要/摘要 产前吸食大麻越来越被认为是一个重要的公共卫生问题，可能会造成 对孕产妇、胎儿和新生儿健康产生大规模负面影响。我们建议进行回顾和 对超过 400,000 名孕妇进行的前瞻性纵向队列研究，根据产前大麻使用情况进行筛查 利用 Kaiser Permanente，根据 2009 年至 2020 年金标准自我报告和尿液毒理学数据 北加州的通用产前物质使用筛查计划是标准产前的一部分 关心。我们将评估母亲在怀孕期间使用大麻与关键母亲、胎儿之间的关联 和新生儿结局，控制潜在的混杂因素（例如吸烟、饮酒和其他药物） 暴露、收入）并比较三个月内的暴露。这些分析还利用了 独特的自然实验，将检验加利福尼亚州大麻合法化是否在2018年以及当地 监管措施（例如零售商禁令、怀孕期间吸食大麻的显着警告） 与怀孕期间吸食大麻的变化有关。具有较高的通用性和样本量 与该主题的任何其他研究都无法比拟，每个目标的结果都对护理有直接影响 孕妇，同时提供新颖的见解来推动未来的流行病学和临床试验 干预研究。目标 1 和 2 将提供通用且全面的数据来了解健康状况 产前吸食大麻对母亲及其婴儿的影响。目标 3 将使我们能够识别不断变化的趋势 大麻合法化后的产前大麻使用将为临床医生、研究人员和政策提供信息 问题的未来范围的制定者。最后，研究队列将成为未来的宝贵资源 研究产前吸食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.