Does Marijuana Use In Opioid Exposed Pregnancies Increase the Risk of Preterm Birth and Low Birthweight

Background: Opioid maintenance therapy has been advocated by American College of Obstetrics and Gynecology (ACOG) along with American Society of Addiction Medicine (ASAM) for opioid use disorder in pregnancy. Marijuana use has been increasing with legalization of marijuana in many states along with reported benefit of antiemetic effect in pregnancy. Both have been independently implicated in adverse neonatal outcome but they haven\u27t been studied for concurrent use in pregnancy. Objective: Objective of the study was to look in to the use of opioid and marijuana in pregnancy related with neonatal outcomes; birth weight, Apgar scores,low birth weight, preterm birth along with social determinant of opioid and marijuana use in pregnancy. Design/Methods: A retrospective chart review from July 2011 to June 2016 of all births from 6 delivery hospitals in South-Central Appalachia was conducted to determine pregnancy and neonatal outcomes of pregnancies exposed to any form of opioid and positive urine drug screen (UDS) for marijuana(THC) at the time of delivery. Inclusion criteria were UDS positive for THC at delivery and exposure to opioid during pregnancy.18730 births were identified during the study period, 2638 pregnancy were opioid exposed, and 2375 pregnancies met the inclusion criteria were included for analysis with 108 pregnancies positive for THC in UDS at the time of delivery. Maternal characteristics, delivery and perinatal outcome were studied. Student t-test and Chi-Square test were used for group comparison for presence and absence of marijuana. Logistic regression was done for significant confounding variables like parity, maternal status, tobacco, and benzodiazepine to find aOR for marijuana exposure for NAS diagnosis, premature birth, and low birth weight (LBW). Results: Among opioid using women, marijuana positive women were more likely to be unmarried, nulliparous, and use tobacco and benzodiazepines. Infants born to the marijuana users were likely to be of earlier gestational age (3 days), lower birth weight, and preterm; with preterm birth and low birth weight (mean difference = 265 gms) increased two fold even after controlling for parity, marital status, tobacco and benzodiazepine use with aOR of 2.35 (1.30-4.23) and 2.02 (1.18-3.47) respectively. Conclusion(s): In view of ACOG and ASAM guidelines for continuing opioid for opioid use disorder during pregnancy, finding of increased prematurity along with LBW carries significance of advocating counseling against use of marijuana in pregnancy exposed to opioids