CANNABIS USE AND REPRODUCTIVE HEALTH: AN INVESTIGATION OF TIME TRENDS AND ADVERSE BIRTH OUTCOMES Public Deposited

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  • March 21, 2019
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  • Chawla, Devika
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Cannabis is the most commonly used illicit drug among men and women of reproductive age in the United States (U.S.) [2-4]. The adverse and beneficial health effects of cannabis use are widely debated, but recent evidence suggests that cannabis use may have negative effects on reproductive health [5-7]. Despite changing policies and attitudes, little is known about how patterns of cannabis use are changing among populations of reproductive age, or about how cannabis use might affect fetal development. Understanding how trends change over time requires careful consideration of underlying demographic factors, such as age effects, generational effects, and period effects due to significant events such as legalization. Therefore, our first objective is to estimate age, period, and cohort effects of past-month cannabis use among populations of reproductive age in the U.S. from 2002-2014 using the National Survey of Drug Use and Health (NSDUH, n=534,679). As policies and patterns of cannabis use continue to change, the reproductive health effects are increasingly important to understand. Animal and human studies show that cannabis affects sperm quality and may alter DNA packaging, but potential effects on fetal development are unknown. Therefore, our second objective is to estimate the effect of paternal preconception cannabis use on risk of structural birth defects in the National Birth Defects and Prevention Study (NBDPS, n=34,320). Past-month cannabis use among U.S. populations of reproductive age increased from 9.2% in 2002 to 12.3% in 2014. Distinct age, period, and cohort effects were observed, though age effects were largest in magnitude. Compared to participants ages 35-49, participants ages 18-21 (PR: 2.91, 95% CI: 2.57, 3.30) and 22-25 (PR: 2.28, 95% CI: 2.03, 2.57 had higher prevalence of past-month cannabis use. In the NBDPS, cannabis use during the 3-month preconception period was reported for 8.8% of control-fathers. After adjustment for confounders, paternal cannabis use was significantly associated with gastroschisis (aOR: 1.23, 95% CI: 1.00, 1.52), and meaningfully associated with diaphragmatic hernia (aOR: 1.33, 95% CI: 0.99, 1.80), cleft lip alone (aOR: 1.23, 95% CI: 0.95, 1.60), and hypoplastic left heart syndrome (aOR: 1.38, 95% CI: 0.99, 1.92). Past-month cannabis use is prevalent and increasing among men and women of reproductive age. While distinct age, period, and cohort effects are at play, age remains the strongest correlate of past-month cannabis use in this population, especially among 18-25 year olds. Moreover, our results are consistent with increased risk of some structural birth defects following paternal cannabis use during the preconception period. Future research is needed to understand how paternal cannabis use affects fetal development, especially in light of changing cannabis policies and documented increases in prevalence of use.
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Advisor
  • Olshan, Andrew
  • Westreich, Daniel
  • Desrosiers, Tania
  • Daniels, Julie
  • Yang, Claire
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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