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

项目摘要/摘要 拟议研究的重要性。产前使用大麻越来越普遍，可能会 对孕产妇和胎儿健康的大范围负面影响。大麻合法化导致了大麻的扩散 新的大麻产品具有各种给药模式(例如，蒸发、食用、涂抹钝化)， 不同的效力和二次暴露(例如，尼古丁、蒸发产生的化学品)。然而，我们所知甚少。 关于妇女在怀孕前和怀孕期间如何使用大麻，模式是否随社会人口统计或 地方大麻政策，或模式如何与大麻使用频率、大麻使用障碍、 使用多种物质，在怀孕期间戒除使用，或不良健康后果。为了填补这一重要空白， 文献，我们将对大约310,000个种族和民族多样性进行一项创新的混合方法研究 2021年至2026年在Kaiser Permanente North CA(KPNC)内怀孕，那里的患者普遍 作为标准产前护理的一部分，通过自我报告和尿毒试验对药物使用情况进行筛查。vbl.使用 丰富的电子健康记录数据和大麻零售商和政策数据，我们的研究将审查社会- 孕前和孕期使用方式的人口统计学和政策相关性，并测试使用方式如何与 日常使用、CUD、多物质使用、物质使用障碍(SUD)、在戒烟前或戒烟期间戒烟的风险 怀孕、成瘾治疗以及与大麻相关的精神和医学结果。重点放在 ，我们还将按社会人口统计因素检查关键关联的差异，并测试 在怀孕期间继续使用大麻的社会人口学差异是由 管理模式。为了获得进一步的临床洞察并指导下一步行动，我们将与 孕前和/或孕期吸食大麻孕妇对模式影响因素的了解 不同模式的选择、感知的好处/危害、怀孕期间的模式变化以及体验 就是戒烟。研究结果将立即对公共卫生和临床产生影响，提供关键信息 关于女性服用大麻的不同方式可能会改变研究和临床实践 范例。结果还将提供重要数据，说明当地监管做法(例如大麻)是否 零售商密度、当地政策的限制性、产前使用的警告)与 大麻使用模式的模式，为全美未来法规的发展提供信息。最后， 这一独特的研究队列将为今后研究不同大麻模式的影响提供丰富的资源 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.