Associations between self-reported maternal marijuana use during the periconceptional period and selected birth defects in the National Birth Defects Prevention Study, 1997-2011 Open Access
Olson, Samantha (Summer 2018)
Abstract
Background: Marijuana is the most widely used recreational drug during pregnancy and use is rapidly changing in the United States. More states have legalized its recreational and medical use, and its sales, acceptance, and access have increased. Further, the delta-9 tetrahydrocannabinol (THC) content has reached an all-time high.
Study Objectives: To update prevalence estimates for self-reported marijuana use during pregnancy and reassess associations between marijuana use in the periconceptional period (one month prior to pregnancy through the first three months of pregnancy) and selected birth defects.
Methods: The National Birth Defects Prevention Study is a multi-state, population-based case control study from 1997-2011. Cases in the study had one or more eligible birth defects and were liveborn, stillborn, or electively terminated. Controls were liveborn infants without birth defects who were randomly selected either from birth certificates or birth hospital records. Mothers of cases and controls were interviewed and asked about marijuana use and other potential confounders. Logistic regression models were used to calculate unadjusted and adjusted odds ratios (aOR) and 95% confidence intervals. A total of 72 fully adjusted models were fit that included maternal age at delivery, race, education, smoking and binge drinking in the periconceptional period, pre-pregnancy body mass index, use of folic acid, and other illicit drugs.
Results: Among 43,267 mothers, 4.4% of mothers of cases and 3.9% of mothers of controls used marijuana during the periconceptional period. Periconceptional marijuana users were more likely than non-users to be younger, have less education, smoke cigarettes, binge drink, use other illicit drug, and have a partner who used marijuana during their pregnancy. After adjusting for potential confounders, gastroschisis (aOR=1.33 (1.06, 1.67)) and anencephaly (aOR= 1.68 (1.10, 2.57)) had an increased odds among periconceptional marijuana users compared to nonusers. For heterotaxia (aOR= 0.44 (0.21, 0.92)) and tetralogy of Fallot (aOR= 0.67 (0.45, 0.98)) there was a protective association among users.
Conclusions: This analysis found an association between periconceptional marijuana use and two non-heart defects. This included gastroschisis which is increasing in prevalence and a more common outcome among younger mothers. Marijuana use is also increasing and could be contributing to this.
Table of Contents
Chapter 1: Marijuana and Birth Defects Literature Review 1
Introduction 1
Birth Defects 1
Marijuana 6
Marijuana and Pregnancy 7
History of Use 7
Prevalence 11
Population 12
Marijuana use during Pregnancy and Birth Defects 12
Marijuana use during Pregnancy and Other Adverse Outcomes 15
Strengthens of the National Birth Defects Prevention Study 18
Conclusion 20
References 22
Chapter 2: Associations between self-reported maternal marijuana use during the periconceptional period and selected birth defects in the National Birth Defects Prevention Study, 1997-2011 32
Abstract 32
Introduction 33
Methods 35
Results 37
Discussion 39
Conclusion 42
References 43
Tables 48
Table 1 48
Table 2 50
Figures/ Figure Legends 54
Figure 1 54
Figure 2a 55
Figure 2b 56
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