Marijuana Use in Opioid Exposed Pregnancy Increases Risk of Preterm Birth

• In Event: Poster Session 07
  In Poster Session: PS 07 Topic - Biological Processes: Psychophysiology

Abstract

Background: The prevalence of opioid use disorder has increased across the United States, but the rural population of Appalachia has been disproportionately impacted. Concurrently, the slow, but steady progress in the legalization of marijuana may be affecting perception of marijuana use in pregnancy. Based on the literature examining marijuana and opioid use during pregnancy independently, it is possible that co-exposure to marijuana and opioids during pregnancy compounds risk for adverse perinatal outcomes.

Objective: The primary aim of the study was to evaluate the association between confirmed marijuana use in late pregnancy and preterm birth in opioid–exposed pregnancies. The secondary aim was to identify, in a sample of women already using opioids, maternal characteristics associated with marijuana use during pregnancy and other perinatal outcomes.

Study Design: A retrospective chart review was conducted that included all births from July 2011 to June 2016 from 6 delivery hospitals in South-Central Appalachia. Out of 18,732 births, 2368 pregnancies indicated opioid use and met remaining inclusion criteria, with 108 of these mothers testing positive for marijuana at delivery. Opioid exposure was determined by multiple methods including self-report, positive UDS at delivery, existing diagnosis of maternal substance use disorder involving opioids (from prenatal records), indication and/or prescription of medication assisted treatment, or determination that an infant had Neonatal Abstinence Syndrome (NAS) based on ICD codes. The study and control group included pregnancies with documented opioid use or exposure. The study group included mothers who were UDS positive while the comparison group included mothers who were UDS negative for THC. Independent sample t–test and Chi–Square analyses compared marijuana and non-marijuana exposed groups on maternal and neonatal outcomes (see Table 1). Regression analyses controlled for confounding variables in predicting preterm birth, small for gestational age, and low birth weight outcomes.

Results/Discussion: Neonates born to marijuana-positive women were more likely to be born preterm, small for gestational age, have low birth weight, and be admitted to NICU than marijuana-negative women (see Table 2). After statistically controlling for parity, marital status, tobacco and benzodiazepine use, preterm birth, and low birth weight remained statistically significant with aOR of 2.35(1.30-4.24) and 2.01 (1.18-3.44) respectively. The effect sizes found for low birth weight is similar to that found in the current sample for both tobacco and benzodiazepine exposure. Marijuana exposure also predicted a significant and nearly double rate of NICU admission after controlling for confounding variables. This effect was somewhat less than that for tobacco and benzodiazepine exposure.

Conclusions: Maternal use of marijuana in any opioid-exposed pregnancy may increase risk of preterm birth and low-birth weight infants. Prospective studies need to examine the dose and timing of marijuana and opioid use in pregnancy to better delineate perinatal effects. Nonetheless, pregnant women using opioids, including recommended medication assisted treatment for opioid use disorder, should be educated about the risks of concurrent marijuana use during pregnancy, and may need to be counseled to abstain from marijuana use during pregnancy for optimal neonatal outcomes.

Authors

• Alyson Chroust, East Tennessee State University
  Presenting Author

• Darshan S. Shah, East Tennessee State University
  Non-Presenting Author

• Emmitt L Turner, East Tennessee State University
  Non-Presenting Author

• Katie Duvall, East Tennessee State University
  Non-Presenting Author

• David Wood, East Tennessee State University
  Non-Presenting Author

• Beth A Bailey, East Tennessee State University
  Non-Presenting Author