Impact of in utero Marijuana Exposure on Neurodevelopment, Behavior and Mental Health: A Longitudinal Birth Cohort Study

子宫内大麻暴露对神经发育、行为和心理健康的影响：纵向出生队列研究

• 批准号: 10206084
• 负责人: Lyndsay Ammon Avalos
• 金额: $ 65.26万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10206084
• 关键词: 13 year old; Accounting; Address; Adolescent; Adverse effects; Affect; Antiemetics; Anxiety; Attention deficit hyperactivity disorder; Behavior; Behavior Disorders; Biological; Birth; California; Child; Child Development; Child Health; Clinical; Clinical Data; Code; Cognition Disorders; Cohort Studies; Data; Development; Developmental Delay Disorders; Diagnosis; Disease; Drug usage; Electronic Health Record; Exposure to; Fetal Development; First Pregnancy Trimester; Gold; Hospitals; ICD-9; Information Systems; Integrated Health Care Systems; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); Legal; Marijuana; Marijuana Smoking; Maternal Age; Measures; Mental Depression; Mental Health; Methodology; Mothers; Nervous System Physiology; Neurodevelopmental Impairment; Outcome; Patient Self-Report; Personal Satisfaction; Policies; Population Heterogeneity; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Prevention program; Public Health; Recommendation; Reporting; Research; Resources; Risk; Sampling; Services; Sex Differences; Substance Use Disorder; Testing; Tetrahydrocannabinol; Tobacco; Toxicology; United States National Academy of Sciences; Urine; Well Child Visits; Woman; autism spectrum disorder; boys; cohort; design; drug abuse in pregnancy; drug use screening; endogenous cannabinoid system; epidemiology study; experience; externalizing behavior; fetal; fetal marijuana exposure; girls; in utero; innovation; marijuana use; marijuana use in pregnancy; marijuana user; motor disorder; multidisciplinary; neurodevelopment; offspring; pregnant; prenatal; prenatal exposure; prenatal testing; public health relevance; screening; screening program; sex; standard care; substance use; treatment program; young adult

ABSTRACT Marijuana use during pregnancy is increasing rapidly in the US. The spreading legalization and growing acceptance, accessibility, and use of marijuana during pregnancy raise important public health concerns for pregnant women as our understanding of the developmental, behavior, and mental health impacts on children exposed to marijuana in utero is alarmingly inadequate. To address this critical research gap, we propose a longitudinal birth cohort study of over 420,000 children born between 2010-2021 at Kaiser Permanente Northern California (KPNC) hospitals. We will leverage data from KPNC's comprehensive electronic health records (EHR) and unique universal prenatal drug use screening program which screens 40,000 women annually via “gold standard” self-report and urine toxicology tests for marijuana and other substance use. As part of standard care, all children are universally screened for developmental delays at well-child visits and as they grow older universal mental health screening captures depression and substance use disorders. Information on child neurodevelopment, behavior and mental health screening outcomes and diagnoses will be ascertained from KPNC's EHR and through linkage to California's Department of Developmental Services. We will ascertain information on important confounders (e.g., maternal mental health, maternal age, tobacco and other substance use, preterm delivery) from KPNC's EHR. Children born to women with singleton gestations who are screened for prenatal marijuana and other substance use will be included. We will evaluate associations between prenatal marijuana exposure and the risk of neurodevelopmental impairments, behavioral disorders, and mental health outcomes from birth to 13 years of age, after accounting for potential confounders. We will also test for sex differences in these associations. Additional analyses will assess the effects in children whose mothers screened positive for marijuana only during pregnancy (i.e., no other prenatal substance use). The proposed study leverages a diverse population, and with high generalizability, will be the largest to date. Findings will have significant public health and clinical implications and can be used by women to make informed decisions about marijuana use during pregnancy. Additionally, the study cohort will be a valuable resource for future research on the longer-term impact of prenatal marijuana use on children's health.

摘要 在美国，怀孕期间使用避孕药的人数正在迅速增加。合法化的蔓延和增长 怀孕期间大麻的接受、可及性和使用引发了重要的公共卫生问题， 孕妇作为我们对儿童发育，行为和心理健康影响的理解 在子宫内接触大麻是远远不够的为了解决这一关键的研究差距，我们提出了一个 对2010-2021年间在Kaiser Permanente出生的42万多名儿童进行的纵向出生队列研究 北方加州（KPNC）医院。我们将利用KPNC综合电子健康数据 电子健康记录（EHR）和独特的普遍产前药物使用筛查计划，该计划筛查了40，000名妇女 每年通过“黄金标准”自我报告和大麻和其他物质使用的尿液毒理学测试。作为 作为标准护理的一部分，所有儿童在健康儿童访问时普遍接受发育迟缓筛查， 普遍的精神健康筛查可以捕捉抑郁症和物质使用障碍。 儿童神经发育，行为和心理健康筛查结果和诊断的信息将 从KPNC的EHR和通过链接到加州的发展服务部确定。我们 将确定关于重要混杂因素的信息（例如，产妇心理健康，产妇年龄，烟草和 其他物质的使用，早产）从KPNC的EHR。单胎妊娠妇女所生子女 接受产前大麻和其他物质使用筛查的人也将被包括在内。我们将评估 产前接触大麻与神经发育障碍风险之间的关联， 行为障碍，以及从出生到13岁的心理健康结果，在考虑了潜在的 混杂因素。我们还将测试这些关联中的性别差异。其他分析将评估 对母亲仅在怀孕期间大麻筛查呈阳性的儿童的影响（即，没有其他 产前物质使用）。拟议的研究利用了多样化的人群，具有高度的普遍性， 将是迄今为止最大的。研究结果将具有重大的公共卫生和临床意义， 让妇女在怀孕期间对大麻的使用做出明智的决定。此外，研究队列 将是未来研究产前大麻使用对胎儿的长期影响的宝贵资源。 儿童健康。