Maternal Marijuana Use During Pregnancy, Marijuana Legalization, and Adverse Obstetrical and Neonatal Outcomes: A 12-year Cohort Study

项目摘要/摘要 新冠肺炎大流行很有可能导致孕妇中物质使用的广泛增加 妇女(例如，由于广泛的“就地避难所”命令而增加了社会孤立和孤独， 心理和经济困难，对感染的恐惧)。此外，吸烟、蒸气和其他物质的使用可能 增加新冠肺炎及其更严重并发症的风险；孕妇是预防 研究物质使用对新冠肺炎风险和疾病进展的影响，因为它们降低了免疫力 在北加州凯撒永久医院(KPNC)，定期对功能和药物使用情况进行筛查 作为标准产前护理的一部分。拟议的研究是一个无与伦比的机会，可以有效地 通过自我报告和尿毒学测试利用丰富、有效和当代的产前物质使用数据 从我们现有的R01研究(DA047405)以创新的方式。对于目标1，我们利用了独特的自然 使用中断的时间序列分析来检查新冠肺炎大流行是否与 随着产前药物使用量的普遍增加，孕妇中的弱势群体也普遍增加 (例如，那些患有产前抑郁症、社会经济地位较低(SES)的人)使用了约200,000例怀孕的数据 从2018年1月到2021年12月进行了产前物质的普遍筛查。对于目标2，我们将进行 一项对2020年1月至2005年间约10万名孕妇进行的回顾性和前瞻性纵向队列研究 2021年12月，以检查怀孕前一年和怀孕期间的药物使用是否 与新冠肺炎发病风险和疾病严重程度增加有关。新冠肺炎数据将被确定 来自KPNC的创新跟踪和监控系统，其中包括实验室确认的新冠肺炎 感染，接受调查的人有症状但尚未检测，症状严重程度，医疗 并发症和死亡率。这些数据将有效地与已查明的产前物质使用数据联系起来 对于家长助学金，使用电子健康档案，普适性强，样本量大。我们的 结果将提供关于这一大流行对产前发病率的影响的迫切需要的和可推广的数据 物质使用及其对新冠肺炎发病和进展的影响。结果将指导 预防措施、公共卫生干预措施和保健服务，并可提供最佳做法，以保护 预防这一流行病对孕妇可能造成的长期健康后果。

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic has high potential to lead to broad increases in substance use among pregnant women (e.g., via increased social isolation and loneliness due to extensive “shelter-in-place” orders, psychological and financial distress, fear of infection). Further, smoking, vaping and other substance use may increase risk for COVID-19 and its more serious complications; pregnant women are an ideal population to study the effects of substance use on COVID-19 risk and illness progression as they have reduced immune functioning and, in Kaiser Permanente Northern California (KPNC), are routinely screened for substance use as part of standard prenatal care. The proposed study represents an unparalleled opportunity to efficiently leverage rich, valid and contemporary prenatal substance use data by self-report and urine toxicology testing from our existing R01 study (DA047405) in innovative ways. For Aim 1, we take advantage of a unique natural experiment using interrupted time series analyses to examine whether the COVID-19 pandemic is associated with broad increases in prenatal substance use overall and among vulnerable subsets of pregnant women (e.g., those with prenatal depression, low socioeconomic status (SES)) using data from ~200,000 pregnancies universally screened for prenatal substance from January 2018 to December 2021. For Aim 2, we will conduct a retrospective and prospective longitudinal cohort study of ~100,000 pregnant women from January 2020 to December 2021, to examine whether substance use in the year before pregnancy, and during pregnancy, is associated with increased risk of COVID-19 onset and severity of illness. COVID-19 data will be ascertained from KPNC’s innovative tracking and surveillance system which includes laboratory confirmed COVID-19 infection, persons under investigation with symptoms who have not yet been tested, symptom severity, medical complications, and mortality. These data will be efficiently linked to prenatal substance use data ascertained for the parent grant using the electronic health record with high generalizability and a large sample size. Our results will provide sorely needed and generalizable data on the impact of this pandemic on rates of prenatal substance use and the impact of substance use on COVID-19 onset and progression. Results will guide preventive measures, public health interventions, and health services, and can inform best practices to protect pregnant women against potential long-term health consequences of this pandemic.