Modes of Cannabis Administration and Polysubstance Use among Women Before and During Pregnancy

项目概要/摘要 建议研究的重要性。产前使用大麻越来越普遍， 对产妇和胎儿健康造成大规模的负面影响。大麻合法化导致了 具有各种给药方式的新大麻产品（例如，vaping，edibles，dabbing blunts）that 不同的THC效力和二次暴露（例如，尼古丁，来自vaping的化学物质）。然而，我们所知甚少 关于妇女如何在怀孕前和怀孕期间使用大麻，无论模式是否因社会人口统计而异， 地方大麻政策，或模式如何与大麻使用频率，大麻使用障碍（CUD）， 多物质使用，在怀孕期间戒烟，或不良健康后果。为了填补这一重要空白， 文学，我们将进行创新的混合方法研究~ 310，000种族和民族多样化 从2021年到2026年，Kaiser Permanente北方CA（KPNC）内的妊娠，患者普遍 作为标准产前护理的一部分，通过自我报告和尿液毒理学测试筛查药物使用情况。使用 丰富的电子健康记录数据和大麻零售商和政策数据，我们的研究将研究社会， 孕前和孕期使用模式的人口统计学和政策相关性，并测试使用模式与 日常使用、CUD、多种物质使用、物质使用障碍（SUD）、戒烟前或戒烟期间的风险 怀孕，成瘾治疗和大麻相关的精神和医疗结果。重点是 差异，我们还将研究社会人口因素的关键关联的差异，并测试是否 怀孕期间继续使用大麻的社会人口统计学差异是由以下差异介导的： 管理方式。为了获得进一步的临床见解并指导下一步，我们将与以下人员进行访谈： 在怀孕前和/或怀孕期间使用大麻的孕妇了解影响模式的因素 选择，不同模式的感知益处/危害，怀孕期间模式的变化，以及经验 放弃研究结果将立即产生公共卫生和临床影响，提供关键信息 关于女性服用大麻的多种方式可能会改变研究和临床实践， 范例结果还将提供有关当地监管做法（例如，大麻 零售商密度、当地政策的限制性、产前使用警告）与 大麻使用模式的模式，为整个美国未来法规的制定提供信息。最后， 这一独特的研究队列将成为未来研究不同形式大麻影响的丰富资源。 给药对胎儿和新生儿结局的影响。

PROJECT SUMMARY/ABSTRACT Importance of the proposed research. Prenatal cannabis use is increasingly common and could have largescale negative impacts on maternal and fetal health. Legalization of cannabis has led to the proliferation of new cannabis products with various modes of administration (e.g., vaping, edibles, dabbing blunts) that differ by THC potency and secondary exposures (e.g., nicotine, chemicals from vaping). Yet, we know little about how women use cannabis pre- and during pregnancy, whether modes vary with socio-demographics or local cannabis policies, or how modes relate to cannabis use frequency, cannabis use disorder (CUD), polysubstance use, quitting use in pregnancy, or adverse health outcomes. To fill this important gap in the literature, we will conduct an innovative mixed-methods study of ~310,000 racially and ethnically diverse pregnancies within Kaiser Permanente Northern CA (KPNC) from 2021 to 2026, where patients are universally screened for substance use as part of standard prenatal care via self-report and urine toxicology testing. Using rich electronic health record data and cannabis retailer and policy data, our study will examine socio- demographic and policy correlates of modes of use pre- and during pregnancy and test how modes relate to the risk of daily use, CUD, polysubstance use, substance use disorders (SUD), quitting pre- or during pregnancy, addiction treatment, and cannabis-related psychiatric and medical outcomes. With a focus on disparities, we will also examine differences in key associations by socio-demographic factors and test whether socio-demographic differences in continued cannabis use during pregnancy are mediated by differences in modes of administration. To gain further clinical insight and guide next steps, we will conduct interviews with pregnant women who used cannabis before and/or during pregnancy to understand factors influencing mode choice, perceived benefits/harms of different modes, changes in modes during pregnancy, and experiences with quitting. Findings will have immediate public health and clinical implications, providing critical information about the diverse ways in which women administer cannabis that could shift research and clinical practice paradigms. Results will also provide important data on whether local regulatory practices (e.g., cannabis retailer density, restrictiveness of local policies, warnings on prenatal use) are associated with variation in patterns of modes of cannabis use, informing the development of future regulations throughout the US. Finally, this unique study cohort will be a rich resource for future research on the impact of different modes of cannabis administration on fetal and neonatal outcomes.