Trajectories of Cannabis Use in Pregnancy

怀孕期间使用大麻正变得越来越普遍，尽管医疗保健提供者和 禁欲专业组织。有证据表明，在子宫内接触大麻，特别是在第一次怀孕后 怀孕三个月与不良妊娠结局的风险和对长期的负面影响有关 暴露的新生儿的神经发育。尽管如此，大约四分之一使用大麻的孕妇 将在她怀孕期间继续使用。 目前存在的数据表明，在怀孕期间继续使用与不良反应的风险最高相关 结果。然而，我们对使用模式的大多数理解来自于横断面调查，并且只包括 持续或禁欲的双重结果。需要纵向数据来评估 在怀孕期间使用大麻，包括减少使用等变化。定义这些轨迹将有助于 进一步描述暴露和结果之间是否存在剂量依赖关系。同样重要的是， 了解与不同大麻使用轨迹相关的基线和时间变化因素 用于为咨询、支持和治疗工作提供信息，最终目标是改善孕产妇和儿童健康。 我们计划招募1200名孕妇，他们在两个不同的临床地点进行产前护理 马里兰州和加利福尼亚州的机构。这一队列将包括800名自我报告在30个月内使用大麻的人 怀孕前几天和400人不承认怀孕。我们将收集基线人口信息、健康和 精神健康史和关于大麻和其他物质使用频率、数量和方式的详细资料 在承认怀孕之前和之后。然后我们将在怀孕期间每月跟踪这些妇女， 使用时间线回传来量化使用情况的电子调查。除了自我报告使用情况外，我们还会使用尿药 正在进行确认测试。将使用潜变量混合模型来确定大麻使用的变化轨迹 怀孕了。为了评估与不同使用轨迹相关的基线和时变因素，我们 还将收集有关心理健康状况、怀孕症状、使用动机和意图以及社交方面的数据 在登记时和整个怀孕期间每三个月一次的健康决定因素。我们会比较出生结果 不同的大麻使用轨迹与不使用大麻的妇女的轨迹之间的差异。 我们打算1)定义在怀孕期间使用大麻的妇女中使用大麻的轨迹 怀孕确认前一个月2)确定基线和与不同 大麻使用轨迹3)比较大麻使用轨迹与孕妇的出生结局 不要使用大麻。 这项研究的结果将有助于开发更全面的大麻使用咨询和 治疗的目标是改善产妇健康和降低新生儿接触物质的比率。 此外，我们的结果将为未来关于宫内使用大麻暴露的影响的研究提供信息。

Cannabis use in pregnancy is becoming increasingly common despite recommendations from healthcare providers and professional organizations for abstinence. Evidence exists that cannabis exposure in utero, particularly after the first trimester, is associated with risks of adverse pregnancy outcomes and negative effects on the long-term neurodevelopment of the exposed neonate. Despite this, approximately one in four pregnant women who uses cannabis will continue to use throughout her pregnancy. The data that exist currently suggest that continued use in pregnancy is associated with the highest risk of adverse outcomes. However, most of our understanding of patterns of use come from cross-sectional surveys and consist only of the binary outcomes of continuation or abstinence. There is a need for longitudinal data evaluating trajectories of cannabis use during pregnancy, including changes such as decreases in use. Defining these trajectories will help to further delineate if a dose-dependent relationship between exposure and outcomes exist. Equally as important, understanding both baseline and time-varying factors that are associated with different cannabis use trajectories can be used to inform counseling, support and treatment efforts with the ultimate goal of improving maternal and child health. We plan to recruit 1,200 pregnant people who present for prenatal care at six different clinical sites across two institutions in Maryland and California. The cohort will include 800 people who self-report cannabis use within the 30 days prior to pregnancy recognition and 400 who do not. We will collect baseline demographic information, health and mental health history and detailed information on frequency, quantity and mode of cannabis use and other substances prior to and since recognition of pregnancy. We will then follow these women throughout pregnancy with monthly, electronic surveys using Timeline Followback to quantify use. In addition to self-report of use, we will use urine drug testing for confirmation. Latent Variable Mixture Modeling will be used to define varying trajectories of cannabis use in pregnancy. In order to evaluate both baseline and time-varying factors associated with differing trajectories of use, we will also capture data on mental health status, pregnancy symptoms, motivations and intentions for use and social determinants of health at enrollment and once per trimester throughout pregnancy. We will compare birth outcomes between different cannabis use trajectories and those of women who do not use. We intend to 1) define trajectories of cannabis use during pregnancy among women who used cannabis within the month prior to pregnancy recognition 2) determine both baseline and time-varying factors associated with different cannabis use trajectories 3) compare birth outcomes across cannabis use trajectories to those of pregnant people who do not use cannabis. The results of this study will aid in the development of more comprehensive approaches to cannabis use counseling and treatment with the goal of improving maternal health and decreasing rates of substance exposed newborns. Additionally, our results will inform future studies on the effects of in utero cannabis use exposure.