Maternal Marijuana Use During Pregnancy, Marijuana Legalization, and Adverse Obstetrical and Neonatal Outcomes: A 12-year Cohort Study

母亲在怀孕期间吸食大麻、大麻合法化以及不良产科和新生儿结局：一项为期 12 年的队列研究

• 批准号: 10165276
• 负责人: Lyndsay Ammon Avalos
• 金额: $ 16.21万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165276
• 关键词: Address; Affect; Alcohol or Other Drugs use; Behavior; Birth; Breast Feeding; COVID-19; COVID-19 pandemic; California; Cessation of life; Clinical; Cohort Studies; Data; Disease Outbreaks; Distress; Electronic Health Record; Epidemiology; Exposure to; Fetus; Financial Hardship; Fright; Funding; Future; Gold; Health; Health Services; Healthcare Systems; Hot Spot; Incidence; Individual; Infection; Interruption; Investigation; Laboratories; Lead; Link; Literature; Loneliness; Longitudinal cohort study; Lung; Measures; Mental Health; Modeling; National Institute of Drug Abuse; Natural experiment; Onset of illness; Opioid; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Pneumonia; Population; Predisposition; Pregnancy; Pregnant Women; Prenatal care; Preventive measure; Prospective cohort; Prospective cohort study; Psychosocial Factor; Recovery; Research; Respiratory Failure; Respiratory System; Respiratory Tract Infections; Retrospective cohort; Risk; Sample Size; Sampling; Septic Shock; Series; Severities; Severity of illness; Shelter facility; Smoke; Smoking; Social isolation; Socioeconomic Status; Subgroup; Symptoms; System; Testing; Time; Time Series Analysis; Tobacco; Toxicology; Urine; Viral; Vulnerable Populations; Woman; antepartum depression; drug abuse in pregnancy; drug use screening; electronic data; immune function; in utero; innovation; low socioeconomic status; marijuana legalization; marijuana use; marijuana use in pregnancy; marijuana vaping; maternal marijuana use; medical complication; mortality; neonatal outcome; novel coronavirus; obstetric outcomes; opioid use; pandemic disease; parent grant; pregnant; prenatal; prenatal testing; prospective; psychological distress; public health intervention; public health relevance; racial and ethnic; respiratory; response; routine screening; screening program; sociodemographics; surveillance data; vaping; violence exposure

PROJECT SUMMARY/ABSTRACT The COVID-19 pandemic has high potential to lead to broad increases in substance use among pregnant women (e.g., via increased social isolation and loneliness due to extensive “shelter-in-place” orders, psychological and financial distress, fear of infection). Further, smoking, vaping and other substance use may increase risk for COVID-19 and its more serious complications; pregnant women are an ideal population to study the effects of substance use on COVID-19 risk and illness progression as they have reduced immune functioning and, in Kaiser Permanente Northern California (KPNC), are routinely screened for substance use as part of standard prenatal care. The proposed study represents an unparalleled opportunity to efficiently leverage rich, valid and contemporary prenatal substance use data by self-report and urine toxicology testing from our existing R01 study (DA047405) in innovative ways. For Aim 1, we take advantage of a unique natural experiment using interrupted time series analyses to examine whether the COVID-19 pandemic is associated with broad increases in prenatal substance use overall and among vulnerable subsets of pregnant women (e.g., those with prenatal depression, low socioeconomic status (SES)) using data from ~200,000 pregnancies universally screened for prenatal substance from January 2018 to December 2021. For Aim 2, we will conduct a retrospective and prospective longitudinal cohort study of ~100,000 pregnant women from January 2020 to December 2021, to examine whether substance use in the year before pregnancy, and during pregnancy, is associated with increased risk of COVID-19 onset and severity of illness. COVID-19 data will be ascertained from KPNC’s innovative tracking and surveillance system which includes laboratory confirmed COVID-19 infection, persons under investigation with symptoms who have not yet been tested, symptom severity, medical complications, and mortality. These data will be efficiently linked to prenatal substance use data ascertained for the parent grant using the electronic health record with high generalizability and a large sample size. Our results will provide sorely needed and generalizable data on the impact of this pandemic on rates of prenatal substance use and the impact of substance use on COVID-19 onset and progression. Results will guide preventive measures, public health interventions, and health services, and can inform best practices to protect pregnant women against potential long-term health consequences of this pandemic.

项目概要/摘要 COVID-19 大流行很可能导致孕妇药物使用广泛增加 妇女（例如，由于广泛的“就地避难”命令而增加了社会隔离和孤独感， 此外，吸烟、电子烟和其他药物的使用可能会 增加感染 COVID-19 及其更严重并发症的风险； 研究物质使用对 COVID-19 风险和疾病进展的影响，因为它们降低了免疫力 在北加州凯撒医疗机构 (KPNC)，定期对药物使用情况进行筛查 作为标准产前护理的一部分，拟议的研究提供了一个无与伦比的机会，可以有效地进行产前护理。 通过自我报告和尿液毒理学测试，利用丰富、有效和当代的产前药物使用数据 根据我们现有的 R01 研究 (DA047405)，我们以创新的方式利用了独特的天然优势。 使用中断时间序列分析来检查 COVID-19 大流行是否相关的实验 总体上以及孕妇弱势群体中产前药物使用量大幅增加 （例如，患有产前抑郁症、低社会经济地位 (SES) 的人）使用约 200,000 次怀孕的数据 从 2018 年 1 月到 2021 年 12 月，对产前物质进行普遍筛查。对于目标 2，我们将进行 一项从 2020 年 1 月到 2020 年 1 月期间对约 100,000 名孕妇进行的回顾性和前瞻性纵向队列研究 2021 年 12 月，检查怀孕前一年和怀孕期间的药物使用是否符合规定 将确定与 COVID-19 发病风险增加和疾病严重程度相关的信息。 来自 KPNC 的创新跟踪和监视系统，其中包括实验室确认的 COVID-19 感染、有症状但尚未接受检测的接受调查者、症状严重程度、医疗情况 这些数据将与确定的产前药物使用数据有效地联系起来。 使用具有高通用性和大样本量的电子健康记录进行家长补助金。 结果将提供急需且可概括的数据，说明这一流行病对产前死亡率的影响 物质使用以及物质使用对 COVID-19 发病和进展的影响结果将提供指导。 预防措施、公共卫生干预措施和卫生服务，并可以提供最佳实践以保护 孕妇应对这一流行病潜在的长期健康后果。