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.

抽象的 在美国，怀孕期间使用大麻正在迅速增加。传播合法化和增长 怀孕期间的接受，可及性和使用大麻引起了重要的公共卫生问题 孕妇是我们对发展，行为和心理健康对儿童产生影响的理解 在子宫内暴露于大麻的情况令人震惊地不足。为了解决这个关键的研究差距，我们提出了一个 2010 - 2021年之间在Kaiser Permanente之间出生的420,000多名儿童的纵向出生队列研究 北加州（KPNC）医院。我们将利用KPNC综合电子健康的数据 记录（EHR）和独特的通用产前药物使用筛查计划，筛查40,000名女性 每年通过“黄金标准”自我报告和尿液毒理学测试，用于大麻和其他药物使用。作为 标准护理的一部分，所有儿童均被普遍筛查，以进行健康访问时的发育延迟，并 他们长大的普遍心理健康筛查会捕获抑郁症和药物使用障碍。 有关儿童神经发育，行为和心理健康筛查结果和诊断的信息 从KPNC的EHR确定到与加利福尼亚州发展服务部的联系。我们 将确定有关重要混杂因素的信息（例如，孕产妇的心理健康，母亲年龄，烟草和 来自KPNC的EHR的其他物质使用，早产。妇女出生的孩子 将包括筛选产前大麻和其他药物使用的人。我们将评估 产前大麻暴露与神经发育障碍的风险之间的关联， 行为障碍以及从出生到13岁的心理健康成果，在考虑潜力之后 混淆者。我们还将测试这些关联中的性别差异。其他分析将评估 在母亲仅在怀孕期间对大麻呈阳性的儿童的影响（即没有其他 产前药物使用）。拟议的研究利用了多样性人群，并且具有很高的普遍性， 将是迄今为止最大的。调查结果将具有重大的公共卫生和临床意义，可以使用 妇女在怀孕期间就大麻使用做出明智的决定。此外，研究队列 将成为对产前大麻对长期影响的未来研究的宝贵资源 儿童健康。