Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI (Dr Vanderziel); Department of Family Medicine (Drs Vanderziel and Alshaarawy); Department of Epidemiology and Biostatistics (Drs Vanderziel, Anthony, Barondess, and Kerver), College of Human Medicine, Michigan State University, East Lansing, MI.
Department of Epidemiology and Biostatistics (Drs Vanderziel, Anthony, Barondess, and Kerver), College of Human Medicine, Michigan State University, East Lansing, MI.
Am J Obstet Gynecol MFM. 2023 Dec;5(12):101171. doi: 10.1016/j.ajogmf.2023.101171. Epub 2023 Sep 29.
Nausea and vomiting of pregnancy, also referred to as morning sickness, affects more than 70% of all pregnancies. Symptoms range from mild to severe and, in some cases, can be debilitating, resulting in a reduced quality of life. Moreover, prenatal cannabis use prevalence has doubled in the United States, and cannabis potency, measured by the concentration of delta-9-tetrahydrocannabiniol, has increased from 10% in 2009 to 14% in 2019. State-level recreational legalization of cannabis may contribute to the liberalization of its use and reduced risk perception. Furthermore, the relatively recent discovery of cannabinoid hyperemesis syndrome may contribute to the mischaracterization of morning sickness in individuals who use cannabis during pregnancy. Although cannabis has well-documented antiemetic properties, there is insufficient research on the topic. Therefore, it is essential to establish a tangible understanding of the association between nausea and vomiting of pregnancy and prenatal cannabis use.
This study aimed to estimate the degree to which nausea and vomiting of pregnancy might be associated with prenatal cannabis use in a sample of pregnant people in Michigan, a state where recreational cannabis use became legal in December 2018.
This was a prospective study of participants from the Michigan Archive for Research on Child Health, a population-based pregnancy cohort that was recruited using a probability-based sampling approach. Participants were recruited from 22 prenatal clinics located throughout Michigan's lower peninsula. Cross-sectional analyses were performed for data available between October 2017 and January 2022.
Among this sample of Michigan pregnant people, 14% (95% confidence interval, 11%-16%) reported cannabis use. Participants who experienced increasing morning sickness severity had higher odds of using cannabis (adjust odds ratio, 1.2; 95% confidence interval, 1.1-1.2). When the sample was restricted to first-trimester morning sickness and cannabis use, the results remained statistically robust. When the direction of the association was reversed, an increase in morning sickness severity was detected among participants who used cannabis during pregnancy (ß, 0.2; 95% confidence interval, 0.1-0.2). Lastly, the association between prepregnancy cannabis use and first-trimester morning sickness was investigated. Study findings suggest an increase in morning sickness severity among people who used cannabis in the 3 months before pregnancy compared with those who did not use cannabis (ß, 0.1; 95% confidence interval, 0.003-0.200).
Study findings indicated a link between nausea and vomiting of pregnancy and prenatal cannabis use. Moreover, this study revealed that using cannabis in the 3 months before pregnancy is associated with first-trimester morning sickness severity. The strengths of our study contribute to the scant epidemiologic evidence in this area of research. More fine-grained, time-specific data on nausea and vomiting of pregnancy and prenatal cannabis use are necessary to draw inferences about cause-effect relationships. Our study might provide a basis to discourage cannabis use during pregnancy until more evidence is collected.
妊娠恶心和呕吐，也称为晨吐，影响了超过 70%的所有妊娠。症状从轻微到严重不等，在某些情况下，可能会使人衰弱，导致生活质量下降。此外，美国产前大麻使用的流行率增加了一倍，大麻的效力（以 delta-9-四氢大麻酚的浓度衡量）从 2009 年的 10%增加到 2019 年的 14%。大麻的娱乐合法化可能会导致其使用的自由化和风险认知的降低。此外，相对较新的大麻诱发的恶心呕吐综合征的发现可能导致在怀孕期间使用大麻的个体对晨吐的特征发生误解。尽管大麻具有良好的止吐作用，但关于这个问题的研究还不够充分。因此，有必要对妊娠恶心和呕吐与产前大麻使用之间的关联建立一个明确的认识。
本研究旨在评估在密歇根州的一群孕妇中，妊娠恶心和呕吐与产前大麻使用之间的关联程度，密歇根州是 2018 年 12 月大麻娱乐合法化的州。
这是一项针对密歇根儿种健康档案研究参与者的前瞻性研究，这是一个基于人群的妊娠队列，使用基于概率的抽样方法进行招募。参与者来自密歇根下半岛的 22 家产前诊所。在 2017 年 10 月至 2022 年 1 月期间进行了横断面分析。
在这个密歇根州孕妇样本中，14%（95%置信区间，11%-16%）报告了大麻的使用。经历晨吐严重程度增加的参与者使用大麻的几率更高（调整后的优势比，1.2；95%置信区间，1.1-1.2）。当样本仅限于第一孕期晨吐和大麻使用时，结果仍然具有统计学意义。当关联的方向相反时，在怀孕期间使用大麻的参与者中检测到晨吐加重（ß，0.2；95%置信区间，0.1-0.2）。最后，研究了产前大麻使用与第一孕期晨吐之间的关系。研究结果表明，与未使用大麻的参与者相比，在怀孕前 3 个月使用大麻的参与者的晨吐严重程度增加（ß，0.1；95%置信区间，0.003-0.200）。
研究结果表明，妊娠恶心和呕吐与产前大麻使用之间存在联系。此外，本研究表明，在怀孕前 3 个月使用大麻与第一孕期晨吐的严重程度有关。我们研究的优势为这一研究领域的稀缺流行病学证据做出了贡献。需要更精细、更具体的关于妊娠恶心和呕吐以及产前大麻使用的时间特异性数据，以便对因果关系做出推断。我们的研究可能为劝阻在怀孕期间使用大麻提供一个依据，直到收集到更多的证据。
