Association between gestational cannabis exposure and maternal, perinatal, placental, and childhood outcomes

Abstract Globally, the availability and formulations for the administration of cannabis are changing with decriminalization or legalization of recreational use in some jurisdictions, and the prescription of cannabis also occurring. These changes are likely to affect the prevalence of use, including by women of childbearing age. The effects of in utero and infant alcohol and tobacco exposure are well-documented, but the outcomes of cannabis exposure are less certain. The content of delta-9-tetrahydrocannabinol (THC), the psychoactive component of cannabis has progressively increased over several decades. This review explores the limited knowledge surrounding the epidemiology of gestational and postnatal cannabis exposure and implications for the mother–placenta–fetus/neonate triad. We examine cannabis’ effects from antenatal and lactation exposure on (a) pregnancy and perinatal outcomes, (b) placental health, and (c) longer term cardiometabolic and neurodevelopmental risks and outcomes. Though definitive outcomes are lacking, gestational cannabis has been associated with increased risk of other substance use during pregnancy; impaired placental blood flow; increased risk of small for gestational age births; and associated complications. Childhood and adolescent outcomes are sparsely assessed, with suggested outcomes including increased risk of depression and attention-deficit hyperactivity disorder. Cardiometabolic implications of gestational cannabis use may include maternal fatty liver, obesity, insulin resistance, and increased risk of gestational diabetes mellitus (GDM), with potential consequences for the fetus. Clinical implications for pediatric practice were explored in a bid to understand any potential risk or impact on child health and development.

Download Full-text

The significance of oligohydramnios in the genesis of perinatal pathology

Vladikavkaz Medico-Biological Bulletin ◽

10.12737/18549 ◽

2016 ◽

Vol 21 (32) ◽

pp. 57-62

Author(s):

Каркусова ◽

Alla Karkusova ◽

Бураева ◽

Zarina Buraeva

Keyword(s):

Blood Flow ◽

Growth Retardation ◽

Congenital Malformations ◽

Perinatal Outcomes ◽

Fetal Growth Retardation ◽

Congenital Diseases ◽

Perinatal Pathology ◽

Placental Blood ◽

Detailed Search ◽

Placental Blood Flow

Perinatal pathology, including congenital malformations of the fetus, is a serious problem of today’s society. The purpose of this study was to identify the significance of oligohydramnios in the diagnosis of congenital diseases in children. The study involved 140 pregnant women aged 18 to 42 years. It was found that while simultaneous revealing of oligohydramnios, fetal growth retardation, abnormal cardiotocography types, hemodynamic disturbances in the utero-placental blood flow risk of having children with congenital malformations is increased by 1.5 times. Thus, a more detailed search for the ultrasonic markers of congenital diseases, timely consulting of families in medical genetics facilities while oligohydramnios allows to prevent severe perinatal outcomes.

Download Full-text

Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Viruses ◽

10.3390/v13050853 ◽

2021 ◽

Vol 13 (5) ◽

pp. 853

Author(s):

Sara Cruz Melguizo ◽

María Luisa de la Cruz Conty ◽

Paola Carmona Payán ◽

Alejandra Abascal-Saiz ◽

Pilar Pintando Recarte ◽

...

Keyword(s):

Pregnant Women ◽

Perinatal Outcomes ◽

Preterm Births ◽

Hypertensive Disorder ◽

Obstetric Emergency ◽

Increased Risk ◽

Emergency Group ◽

Adverse Perinatal Outcomes ◽

Maternal Disease ◽

The Relationship

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients’ information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

Download Full-text

Treatment of attention deficit/hyperactivity disorder in children with CHD

Cardiology in the Young ◽

10.1017/s1047951120004965 ◽

2021 ◽

pp. 1-4

Author(s):

Alyson R. Pierick ◽

Melodie Lynn ◽

Courtney M. McCracken ◽

Matthew E. Oster ◽

Glen J. Iannucci

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

General Population ◽

Adverse Events ◽

Supraventricular Tachycardia ◽

Medical Therapy ◽

Attention Deficit ◽

Case Reports ◽

Single Centre ◽

Hyperactivity Disorder ◽

Increased Risk

Abstract Introduction: The prevalence of attention deficit/hyperactivity disorder in the general population is common and is now diagnosed in 4%–12% of children. Children with CHD have been shown to be at increased risk for attention deficit/hyperactivity disorder. Case reports have led to concern regarding the use of attention deficit/hyperactivity disorder medications in children with underlying CHD. We hypothesised that medical therapy for patients with CHD and attention deficit/hyperactivity disorder is safe. Methods: A single-centre, retrospective chart review was performed evaluating for adverse events in patients aged 4–21 years with CHD who received attention deficit/hyperactivity disorder therapy over a 5-year span. Inclusion criteria were a diagnosis of CHD and concomitant medical therapy with amphetamines, methylphenidate, or atomoxetine. Patients with trivial or spontaneously resolved CHD were excluded from analysis. Results: In 831 patients with CHD who received stimulants with a mean age of 12.9 years, there was only one adverse cardiovascular event identified. Using sensitivity analysis, our median follow-up time was 686 days and a prevalence rate of 0.21% of adverse events. This episode consisted of increased frequency of supraventricular tachycardia in a patient who had this condition prior to initiation of medical therapy; the condition improved with discontinuation of attention deficit/hyperactivity disorder therapy. Conclusion: The incidence of significant adverse cardiovascular events in our population was similar to the prevalence of supraventricular tachycardia in the general population. Our single-centre experience demonstrated no increased risk in adverse events related to medical therapy for children with attention deficit/hyperactivity disorder and underlying CHD. Further population-based studies are indicated to validate these findings.

Download Full-text

Adolescent, Pregnant, and HIV-Infected: Risk of Adverse Pregnancy and Perinatal Outcomes in Young Women from Southern Mozambique

Journal of Clinical Medicine ◽

10.3390/jcm10081564 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1564

Author(s):

Clara Pons-Duran ◽

Aina Casellas ◽

Azucena Bardají ◽

Anifa Valá ◽

Esperança Sevene ◽

...

Keyword(s):

Hiv Infection ◽

Maternal Morbidity ◽

Low Birthweight ◽

Negative Binomial ◽

Perinatal Outcomes ◽

Sub Saharan Africa ◽

P Value ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Impact

Sub-Saharan Africa concentrates the burden of HIV and the highest adolescent fertility rates. However, there is limited information about the impact of the interaction between adolescence and HIV infection on maternal health in the region. Data collected prospectively from three clinical trials conducted between 2003 and 2014 were analysed to evaluate the association between age, HIV infection, and their interaction, with the risk of maternal morbidity and adverse pregnancy and perinatal outcomes in women from southern Mozambique. Logistic regression and negative binomial models were used. A total of 2352 women were included in the analyses; 31% were adolescents (≤19 years) and 29% HIV-infected women. The effect of age on maternal morbidity and pregnancy and perinatal adverse outcomes was not modified by HIV status. Adolescence was associated with an increased incidence of hospital admissions (IRR 0.55, 95%CI 0.37–0.80 for women 20–24 years; IRR 0.60, 95%CI 0.42–0.85 for women >25 years compared to adolescents; p-value < 0.01) and outpatient visits (IRR 0.86, 95%CI 0.71–1.04; IRR 0.76, 95%CI 0.63–0.92; p-value = 0.02), and an increased likelihood of having a small-for-gestational age newborn (OR 0.50, 95%CI 0.38–0.65; OR 0.43, 95%CI 0.34–0.56; p-value < 0.001), a low birthweight (OR 0.40, 95%CI 0.27–0.59; OR 0.37, 95%CI 0.26–0.53; p-value <0.001) and a premature birth (OR 0.42, 95%CI 0.24–0.72; OR 0.51, 95%CI 0.32–0.82; p-value < 0.01). Adolescence was associated with an increased risk of poor morbidity, pregnancy and perinatal outcomes, irrespective of HIV infection. In addition to provision of a specific maternity care package for this vulnerable group interventions are imperative to prevent adolescent pregnancy.

Download Full-text

Risk Factors for Disability Pension among Young Adults Diagnosed with Attention-deficit Hyperactivity Disorder (ADHD) in Adulthood

Journal of Attention Disorders ◽

10.1177/10870547211025605 ◽

2021 ◽

pp. 108705472110256

Author(s):

Lingjing Chen ◽

Ellenor Mittendorfer-Rutz ◽

Emma Björkenstam ◽

Syed Rahman ◽

Klas Gustafsson ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Disability Pension ◽

Cox Regression ◽

Related Factors ◽

Adult Age ◽

Work Related ◽

Hyperactivity Disorder ◽

Increased Risk ◽

Similar Risk

Objective: To investigate risk factors of disability pension (DP) in young adults diagnosed with ADHD in Sweden. Method: In total, 9718 individuals diagnosed with incident ADHD in young adult age (19–29 years) 2006 to 2011, were identified through national registers. They were followed for 5 years and Cox regression models were applied to analyze the DP risk (overall and by sex), associated with socio-demographics, work-related factors, and comorbid disorders. Results: Twenty-one percent of all received DP. Being younger at diagnosis (hazard ratio [HR] = 1.54; 95%confidence interval [CI] 1.39–1.71); low educational level (HR = 1.97; 95%CI 1.60–2.43 for <10 years); work-related factors at baseline (no income from work [HR = 2.64; 95%CI 2.35–2.98] and sickness absence >90 days [HR = 2.48; 95%CI2.17–2.83]); and schizophrenia/psychoses (HR = 2.16; 95%CI 1.66–2.80), autism (HR = 1.87; 95%CI 1.42–2.46), anxiety (HR = 1.34; 95%CI 1.22–1.49) were significantly associated with an increased risk of DP. Similar risk patterns were found in men and women. Conclusion: Work-related factors and comorbid mental disorders need to be highlighted in early vocational rehabilitation for individuals with ADHD.

Download Full-text

Fetal CHD and perinatal outcomes

Cardiology in the Young ◽

10.1017/s1047951120000785 ◽

2020 ◽

Vol 30 (5) ◽

pp. 686-691

Author(s):

Christina J. Ge ◽

Amanda C. Mahle ◽

Irina Burd ◽

Eric B. Jelin ◽

Priya Sekar ◽

...

Keyword(s):

Cohort Study ◽

Preterm Delivery ◽

Odds Ratio ◽

Retrospective Cohort ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fold Increase ◽

Cesarean Sections ◽

Increased Risk ◽

Gestational Age At Delivery

AbstractObjective:To evaluate delivery management and outcomes in fetuses prenatally diagnosed with CHD.Study design:A retrospective cohort study was conducted on 6194 fetuses (born between 2013 and 2016), comparing prenatally diagnosed with CHD (170) to those with non-cardiac (234) and no anomalies (5790). Primary outcomes included the incidence of preterm delivery and mode of delivery.Results:Gestational age at delivery was significantly lower between the CHD and non-anomalous cohorts (38.6 and 39.1 weeks, respectively). Neonates with CHD had a significantly lower birth weights (p < 0.001). There was an approximately 1.5-fold increase in the rate of primary cesarean sections associated with prenatally diagnosed CHD with an odds ratio of 1.49 (95% CI 1.06–2.10).Conclusions:Our study provides additional evidence that the prenatal diagnosis of CHD is associated with a lower birth weight, preterm delivery, and with an increased risk of delivery by primary cesarean section.

Download Full-text

Exposure therapy for PTSD during pregnancy: a feasibility, acceptability, and case series study of Narrative Exposure Therapy (NET)

BMC Psychology ◽

10.1186/s40359-020-00503-4 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Natalie R. Stevens ◽

Michelle L. Miller ◽

Christina Soibatian ◽

Caitlin Otwell ◽

Anne K. Rufa ◽

...

Keyword(s):

Mental Health Treatment ◽

Exposure Therapy ◽

Case Series ◽

Perinatal Outcomes ◽

Post Treatment ◽

Depression Symptoms ◽

Narrative Exposure Therapy ◽

Ptsd Treatment ◽

Case Series Study ◽

Increased Risk

Abstract Background Prenatal posttraumatic stress disorder (PTSD) is a significant complication of pregnancy linked to increased risk of adverse perinatal outcomes. Although 1 in 5 pregnant trauma-exposed individuals have PTSD, most PTSD treatment trials exclude participants who are pregnant, and none focus on treatment specifically during pregnancy. Moreover, access to mental health treatment is particularly challenging in low-resource settings with high rates of trauma. This study examined implementation of Narrative Exposure Therapy (NET), a short-term evidence-based PTSD treatment, in an urban prenatal care setting. Partial telehealth delivery was used to increase accessibility. Study aims were to examine (a) feasibility, (b) acceptability, and (c) case-based treatment outcomes associated with NET participation. Method Eight pregnant participants (median age = 27, median gestational week in pregnancy = 22.5) received up to six sessions of NET with partial telehealth delivery. PTSD and depression symptoms were assessed at pre-treatment intake (T1), at each session (T2), and 1-week post-treatment (T3). A multiple case study approach was used to examine recruitment and engagement, retention, treatment completion, treatment barriers, use of telehealth, participants’ experiences of treatment, and PTSD and depression symptoms. Results Nine of the 16 participants (56%) who were invited to participate engaged in treatment, and one dropped out after the first session. Eight participants completed the minimum “dose” of 4 NET sessions (N = 8/9, 89%). Seven participants gave the highest ratings of treatment acceptability. The most frequently reported barriers to treatment were competing priorities of work and caring for other children. Pre-post treatment symptom measures revealed clinically meaningful change in PTSD severity for nearly all participants (7/8, 88%). Conclusions Results suggest that a brief exposure therapy PTSD treatment can be successfully implemented during pregnancy, suggesting promising results for conducting a larger-scale investigation. Trial registration ClinicalTrials.gov, NCT04525469. Registered 20 August 2020–Retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U00058T2&ts=3&sid=S000A59A&cx=-w1vnvn

Download Full-text

Twin Studies in Medical Genetics

Acta geneticae medicae et gemellologiae ◽

10.1017/s0001566000014215 ◽

1976 ◽

Vol 25 (1) ◽

pp. 249-258 ◽

Cited By ~ 12

Author(s):

P. Propping ◽

F. Vogel

Keyword(s):

Representative Sample ◽

Interindividual Variability ◽

Case Reports ◽

Twin Studies ◽

Medical Genetics ◽

Genetic Component ◽

Systematic Method ◽

Newborn Period ◽

Placental Blood ◽

Placental Blood Flow

It is the aim of twin studies to obtain results which are not only valid for twins, but apply to the whole population. Therefore the following questions have to be answered first: do twins differ from non-twins in the trait under study? Do different nongenetic factors act upon MZ and DZ twins which alter the probability of manifestation of a trait, even before birth? There are important differences in embryogenesis and placental blood flow in mono- and dichorionic twins; this can influence the normal fetal development. Therefore the value of twin studies alone in analysing the genetic component in the etiology of congenital malformations is rather ambiguous. Twin studies beyond the newborn period can be classified into four approaches: (1) Case reports; (2) Accumulated case reports; (3) Limited representative sample; (4) Unlimited representative sample. The most frequent systematic method in medical genetics is the establishment of all twins in a defined population of probands (3). Another successful application in the last few years has been in pharmacogenetics. Although no simple mode of inheritance could be discovered, it was possible to estimate the genetic component within the interindividual variability of the metabolism of certain drugs (nortriptyline, antipyrine, phenylbutazone, ethanol). Now, additional non-twin research is needed to work out single factors within the observed polygenic systems.

Download Full-text

Non-invasive evaluation of placental blood flow: lessons from animal models

Reproduction ◽

10.1530/rep-16-0428 ◽

2017 ◽

Vol 153 (3) ◽

pp. R85-R96 ◽

Cited By ~ 8

Author(s):

E Mourier ◽

A Tarrade ◽

J Duan ◽

C Richard ◽

C Bertholdt ◽

...

Keyword(s):

Blood Flow ◽

Animal Models ◽

Ultrasound Contrast Agents ◽

Valuable Insight ◽

Non Invasive ◽

Placental Blood ◽

2D And 3D ◽

Reliable Methods ◽

Placental Blood Flow ◽

Invasive Evaluation

In human obstetrics, placental vascularisation impairment is frequent as well as linked to severe pathological events (preeclampsia and intrauterine growth restriction), and there is a need for reliable methods allowing non-invasive evaluation of placental blood flow. Uteroplacental vascularisation is complex, and animal models are essential for the technical development and safety assessment of these imaging tools for human clinical use; however, these techniques can also be applied in the veterinary context. This paper reviews how ultrasound-based imaging methods such as 2D and 3D Doppler can provide valuable insight for the exploration of placental blood flow both in humans and animals and how new approaches such as the use of ultrasound contrast agents or ultrafast Doppler may allow to discriminate between maternal (non-pulsatile) and foetal (pulsatile) blood flow in the placenta. Finally, functional magnetic resonance imaging could also be used to evaluate placental blood flow, as indicated by studies in animal models, but its safety in human pregnancy still requires to be confirmed.

Download Full-text