Maternal Marijuana Use and Adverse Perinatal Outcomes

项目摘要 玛丽莎克是怀孕期间最常用的药物，估计使用率为7%， 在高危人群中高达25%。胎盘成分和代谢物穿过胎盘， 可能会影响产妇和新生儿的结局。最近，美国国家科学院发现， 有证据表明产前使用大麻与出生体重降低有关，而且没有足够的证据评估其他 妊娠结局。这些调查结果突出了一个关键的知识差距。随着越来越多的合法化 大麻在美国，关于怀孕期间使用大麻的风险的更高质量的数据是 迫切需要的。 先前的研究受到两方面的限制，即依赖自我报告而不是生物采样，以及缺乏对 重要的混淆因素。结果是关于大麻使用对围产期的影响的持续不确定性 成果。这项拟议的观察性研究使用了来自全国的现有数据和生物标本。 NICHD赞助的监测准妈妈网络（nuMOM2b）。我们假设大麻的使用 怀孕与不良围产期结局的增加有关，与烟草无关， 药物使用和社会人口因素。我们的具体目标是：（1）确定接触大麻是否是 与不良围产期结局相关。我们将使用现有的数据和库存标本从9260 未经生育的妇女参加了nuMoM2b，以通过自我报告和连续生物学来确定大麻的使用情况。 取样.我们将分析整个怀孕期间储存的尿液样本中大麻的生物标志物 暴露，可替宁和其他药物。我们的主要结果是不良结果的复合， 胎盘功能不全：胎儿生长受限、医学指征性早产、死产和高血压 包括先兆子痫和妊娠高血压的疾病。(2)评估是否存在临界窗口 接触或阈值“剂量”的接触与不良围产期结果。我们将使用 先进的统计建模，以澄清大麻暴露对结果的每个组成部分的影响， 并评估暴露的临界窗口。我们将分别研究我们的结果之间的关联 和四种大麻暴露的量化生物标志物，使用一种新的脐带测定。(3)评价 产前大麻使用的不同措施之间的一致性，包括脐带检测，连续尿液 化验和母亲自我报告。 随着大麻合法化的扩大，迫切需要像这样严格的观察性研究， 了解围产期使用大麻的影响。这些发现可以立即用于临床实践 就产前吸食大麻的预期影响向妇女提供咨询。这些目标将共同回答 关于大麻暴露和围产期结局的关键问题，使用高度利用的现有数据， 生物标本，从而克服了以前阻碍这一领域研究的局限性。

Project Summary Marijuana is the most commonly used drug during pregnancy with an estimated use prevalence of 7%, and reaching as high as 25% in high risk groups. Marijuana components and metabolites cross the placenta and may impact maternal and neonatal outcomes. Recently, the National Academy of Sciences found substantial evidence linking prenatal marijuana use to lower birth weight and insufficient evidence to evaluate other pregnancy outcomes. These findings highlight a critical knowledge gap. With increasing legalization of marijuana in the United States, higher quality data about the risks of marijuana use during pregnancy are desperately needed. Prior studies are limited both by reliance on self-report rather than biologic sampling, and lack of adjustment for important confounders. The result is ongoing uncertainty regarding the effect of marijuana use on perinatal outcomes. The proposed observational study uses existing data and biospecimens from the nationwide NICHD-sponsored Monitoring Mothers-to-Be Network (nuMOM2b). We hypothesize that marijuana use during pregnancy will be associated with an increase in adverse perinatal outcomes independent of tobacco, other drug use, and sociodemographic factors. Our specific aims are to: (1) Determine if exposure to marijuana is associated with adverse perinatal outcomes. We will use existing data and banked specimens from 9,260 nulliparous women enrolled in nuMoM2b to ascertain marijuana use by both self-report and serial biological sampling. We will assay stored urine samples from throughout pregnancy for biomarkers of marijuana exposure, cotinine and other drugs. Our primary outcome is a composite of adverse outcomes reflecting placental insufficiency: fetal growth restriction, medically-indicated preterm birth, stillbirth and hypertensive disorders including preeclampsia and gestational hypertension. (2) Evaluate whether there is a critical window of exposure or a threshold “dose” of exposure associated with adverse perinatal outcomes. We will use advanced statistical modeling to clarify the effects of marijuana exposure on each component of the outcome, and evaluate for critical windows of exposure. We will separately examine associations between our outcomes and four quantified biomarkers of marijuana exposure, using a novel umbilical cord assay. (3) Evaluate the agreement between different measures of prenatal marijuana use including umbilical cord assay, serial urine assays and maternal self-report. As marijuana legalization expands, rigorous observational studies such as this are urgently needed to understand the impact of perinatal marijuana use. These findings could immediately be used in clinical practice to counsel women regarding the anticipated effects of prenatal marijuana use. Together these aims will answer key questions regarding marijuana exposure and perinatal outcomes using highly leveraged existing data and biospecimens, thereby overcoming limitations that have previously hindered research in this area.