The association of concomitant maternal marijuana use on health outcomes for opioid exposed newborns in Massachusetts, 2003-2009
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Stein et al. The Journal of Pediatrics, 2019 Article
Dhivya Ramalingam, Ph.D.
Tags: Maternal opioid use; Neonatal abstinence syndrome; Marijuana; Cannabis
The problem: Opioid use during pregnancy is on the rise, resulting in an increase in neonatal abstinence syndrome (NAS, which refers to withdrawal that occurs in newborns that were exposed to illicit drugs in utero). This is further complicated by the increase in the use of cannabis during pregnancy. However, very few studies have addressed the effect of concomitant opioid + cannabis use during pregnancy and infant health.
Why do this study? The aim of this study was to identify associations between concomitant maternal opioid and cannabis use on neonatal health outcomes.
The study: This study identified live births in Massachusetts (through the PELL and BSAS datasets) from women exposed to opioids between January 1, 2003, and December 31, 2009. The BSAS dataset provided in-depth treatment records following drug-abuse, while the PELL dataset contained all birth/ death records. In addition, opioid exposure was identified using the EMSANT-W tool. Among 4,584 singleton births, 430 (9.4%) infants had been exposed to both cannabis and opioids in utero. The authors estimated the adjusted odds ratio (aOR) to estimate the strength of the association between cannabis/opioid use and outcomes such as preterm birth. An aOR>1 typically indicates a stronger association and vice versa. The study showed that infants exposed to cannabis and opioids were more likely to have a preterm birth (aOR= 1.72) and low birth weight (aOR=1.46), compared to those with opioid exposure alone. Interestingly, infants exposed to opioid plus cannabis were less likely to have NAS (aOR= 0.7) or prolonged hospital stays (aOR= 0.66).
Conclusions: Maternal use of opioids and cannabis during pregnancy poses significant health risks (e.g. premature birth, low birth weight) to newborns. The risk for NAS in newborns appears to decrease with concomitant opioid and marijuana use.
What does this study add? Previous studies have addressed the effect of prenatal marijuana exposure on neonatal health. This study is novel because it explores the association between maternal opioid and marijuana use on neonatal health outcomes.
Funder: Not provided.
Author conflicts: None
Commentary: This study addresses a key public health problem—prenatal drug exposure and subsequent health outcomes in newborns. It included a large, population-based cohort which allows for a robust analysis. However, it relied on existing data, so the analysis could not be adjusted based on timing or amount of exposure. Most of the dose/ exposure information were self-reported and hence could be underestimations of actual use. Therefore, the lowered risk of NAS with concomitant opioid+ cannabis use should be interpreted with caution. It is worth noting that a substantial percent of mothers who used both opioids and marijuana during pregnancy also reported psychiatric conditions. As substance abuse often goes hand-in-hand with mental illness, the study also highlights the need for mental health services among pregnant women who use drugs.