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ABSTRACT
In two Copenhagen University Hospital 12.885 pregnant women, seen under det period 1.8.1992 two 30.04.1995, answered question aires angående consumption of alcohol, tobacco, cannabis og andre drugs. The prevalence of cannabis use was 0.8%. Women using cannabis but no other ILLICIT drugs were hvert retrospectively matched with four randomly valgte pregnant women in the same period and the same age group and with same parity. Eighty-four cannabis users were included. These women were socioeconomically disadvantaged and had a højere prevalence of gift and past use of alcohol, tobacco and Other Drugs. No. demonstrated significantly difference in pregnancy, delivery or puerperal outcome was found. Children of women using cannabis were 150 g lighter, 1.2 cm shorter and had 0.2 cm smaller head circumference than the control infants. Controlling for the child's sex and maternal use of alcohol did not eliminera the betydelig forskelle in birthweight and length; Men, theywere eliminated by controlling for maternal tobacco smoking. It is avslutade, att use of cannabis is not a major prognostic factor om outcome of pregnancy, but is an indicator of low socio økonomisk status and use of andre Substances.
Summary
Introduction : The objective was to investigate the effect of cannabis consumption on pregnancy, fetal development, birth, puerperium and neonatal child's condition, to determine the extent of the problem in Copenhagen and thereby obtain a basis for preparing recommendations for pregnancy counseling.
MATERIALS AND METHODS: From 1.8.1992 to 30.4.1995 pregnant women in Copenhagen in history taking at first prenatal were asked about their current and past consumption of alcohol and other drugs. The material was 12,885 food records. Pregnant women with a current cannabis consumption, without simultaneous consumption of tranquilizers, narcotics, amphetamines or cocaine matchedes each with four randomly selected pregnant women followed at the same hospital in the same period of the same age and of the same parity and the outcome was assessed retrospectively. Eighty-four pregnant women met the inclusion criteria.
Results: 0.8% reported themselves to use cannabis. The cannabis-using pregnant women living in poor social conditions and had a heavier medical history for other drugs. There was no significant difference in the incidence of pregnancy, birth, neonatal or puerperale complications. The cannabis exposed children were at birth 150 g lighter, 1.2 cm shorter and had 0.2 cm smaller head circumference than the control children. The significant differences in birth weight and length did not disappear after controlling for child's sex and heavy drinking among pregnant, but after controlling for smoking.
Conclusion: Based on literature and own data assessed cannabis consumption among pregnant women not to be a prognostic factor for a poor course of pregnancy, fetal development, birth, puerperium or neonatal period. Cannabis consumption is a marker for poor social conditions and increased consumption of tobacco, alcohol and other drugs.
Cannabis is the most widely used illegal drug in Denmark (1). The supply of cannabis in Denmark from 1983 to 1995 is stable and consumption of cannabis is stable from 1990 to 1995 (1). About 40% of adults under 45 have used cannabis (1). Significantly fewer have smoked cannabis within the last year: about 5%, this proportion is highest in the youngest age groups, ranging up to about 20% (1). Among adults, the highest prevalence among the socially marginalized groups, as well as in major cities (1). There is generally a lower prevalence in women than men (1). Danish figures for cannabis consumption among pregnant women is not known. Foreign studies find prevalence of marihuanaforbrug among pregnant women aged between 3 and 16% (2).
negative impact of cannabis on physical health is modest compared to eg alcohol. This is primarily on respiratory symptoms and lung function. Marihuanarygning achieved by a 3-fold increase in the amount of tar inhaled and a 5-fold increase in the blood concentration of carbon monoxide as compared with conventional cigarette smoking, including due to the particular inhalation. Marihuanarygeres fertility is probably reduced (3). There is evidence that cannabis can trigger schizophrenic episodes in susceptible and aggravate a schizophrenic state, and that there is a relationship between cannabis use and mental dysfunction, but it is uncertain whether cannabis causes or simply an indicator of mental illness (3). Cannabis consumption reduces further psychomotor function, memory and learning (3).
They mentioned effects on adults involves a natural interest in whether cannabis consumption among pregnant women, nursing and parents affect the course of pregnancy, birth, fetal development, the child's condition perinatal and its further forecast not least because the psychoactive component of cannabis (delta-9-tetrahydrocannabinol) cross the placenta and accumulate in breast milk (2). Furthermore, the substance in several mammalian species led to reduced fertility, reduced maternal weight, increased resorption, small litter size, intrauterine growth retardation, failure to thrive and immaturity of the central nervous system (4). The relationship between marihuanaforbrug and obstetric and neonatal complications are not well studied. Several studies have found correlation between cannabis consumption and low gestational age, birth weight or birth length, even after statistically confounder control (5, 6), while other studies have not (2, 7, 8). There are problems with the available information on substance use and differences in demographics and lifestyle between users and non-users (7). It is difficult to distinguish a specific effect of prenatal cannabiseksposition from the negative effects of the drug-using environment, while consumption of cigarettes, alcohol and other drugs (7). There is no effect of marijuana on growth beyond the neonatal period (7). Most studies have failed to demonstrate correlation between cannabiseksposition and physical injuries, including malformations, but there are case reports and one major study showing correlation between cannabiseksposition and features characteristic of fetal alcohol syndrome (8). Some studies show signs of neuropsychological effects on children, as they show disturbance of sleep, crying and cognitive functions (7). A case-control study has shown that children of mothers who smoke marijuana before or during pregnancy, had a ten times greater risk of leukemia (9).
This is the hallmark of foreign studies (7, 8) that deals with consumer marijuana (plants), which contains 1-5% of delta-9-tetrahydrocannabinol (10). In Denmark, however hashish (resin) containing 6-10% of the substance (10), the most common form of cannabis (1, 3). It is therefore of interest to make a Danish study. A more potent cannabis plant, known as skunk (or nederwiet), with a content of 10-15%, has in recent years emerged in Denmark (1, 11).
The purposes of this study to investigate the effect of cannabis on pregnancy, fetal development , childbirth, puerperium, the child's condition neonatal and its further prognosis and with background herein to obtain a basis for preparing recommendations for pregnancy counseling. Furthermore, it is of interest to examine the prevalence of cannabis use in pregnant women in a Danish material in order to assess the extent of the problem.
Materials and methods
Since 1.8.1992 pregnant women in Copenhagen at the first antenatal visit at Rigshospitalet and Hvidovre Hospital of either the doctor or midwife in the journal recording were asked about their current and past use of tobacco, alcohol and other drugs. The women who reported having a current consumption of drugs, including cannabis, is offered an advisory conversation and multidisciplinary follow-up of the Family Clinic, instead of the traditional obstetric auspices.
study the nature of a journal based longitudinal study based on an initial routine interview. Pregnant women who for the first antenatal visit during the period 1.8.1992 to 30.4.1995 reported current cannabis consumption matched with four randomly selected pregnant women without current cannabis consumption, followed at the same hospital during the same period, the same age (younger than 20, 20-24, 25-29, 30-34, 35-39, over 40 years), and of the same parity (zero, one, two or more). Exclusion criteria are the consumption of tranquilizers, narcotics (heroin, morphine, Ketogan), amphetamines, cocaine, lack of information on substance use, multiple births, habitual abortion, previous induced abortion in the second trimester, previous or current serious, chronic disease such as diabetes mellitus, hepatitis or HIV.
addition of a material on 12,885 food records with information about substance use reported 122 to have a current cannabis consumption. In 19 of these it appeared to be due to an error answering the questions, ie. the prevalence of cannabis consumption among pregnant women at first pregnancy examination in Copenhagen based on self-reporting can be estimated at 0.8%. Eighty-four cannabis smoking during pregnancy met the inclusion criteria; this corresponds to a control group of 336th Material 12,885 records corresponding to 75% of referred pregnant during the period (figures from CHC, Medical Professionals office). The remaining 25% is not the midwife or doctor been presented to systematic issues related to substance use, but has also gone through the period usual svangreforløb. Apostasy is partly due to oversights, and that many do not speak Danish pregnant women in resource account is not questioned.
Data obtained from obstetric and / or pediatric records. Information on current and past substance use is based on self-reporting in connection with the systematic questioning. Job descriptions are divided by the Social Research Institute's social group division (12) in social groups IV, although only used job titles and inactive people classified separately.
Quantitative results expressed as mean (± 2 SD in parentheses). Where the distributions are very right-leaning states average (90-percentile in brackets). Consumption groups are compared with the use of conventional methods for the paired data, with the modifications that are necessary when there is more than one control for each user of cannabis control group. For the quantitative variables, it depends on a t-test applied to cannabis user value minus the average of her control (paired, two-sided t-test). Alternatively, when a property is unevenly distributed, performed a ranking position within each such group, and the average ranks are compared by z test (analogous to Friedman's test) (alternative tests). That alternative test can be extended by the appropriate weighting for situations where the number of checks varies between the groups (alternative test with unequal number of controls). For binary data (yes / no answers), see Rothman (13) (binary test). Percentage unenlightened was low and indicated below only when the figure was> 10%. As significance level chosen p = 0.05.
Results
Demographic data are listed in Table 1 (see UFL 161/36 p 5006, September 6, 1999). It is seen that the control group were older in age group despite matching. There was no significant difference in height and weight. A small part of the cannabis-using pregnant cohabiting. Eighty-three percent of the cannabis-using pregnant women were Danish language, 2% foreign language and 14% unknown, compared with 82%, 11% and 7% in the control group (binary test, p = 0.006, subject due to the unenlightened). Get the cannabis-using pregnant and baby fathers belonging to the high social groups 1-3, and fewer are working.
They cannabis-using pregnant women parity is after the match, as the control group, on average, 1.4 (3.0). There are an increasing number of previous abortions in the hash-smoking pregnant women at 0.9 (2.0) against the control group 0.4 (1.0) (alternative test p = 0.0004). There is thus a significantly increased number of previous pregnancies in the group of cannabis-using pregnant women, namely 2.5 (5.0) against the control group 1.9 (3.0) (alternative test, p = 0.002). The number of previously occurring spontaneous abortions or ekstrauterine pregnancies are not different (alternative test, p = 0.67, respectively. Binary test p = 0.42).
Information on consumption of beer, wine and spirits in the weeks prior to the first pregnancy examination is made of Table 2 (see UFL 161/36 pp. 5006, Sept. 6, 1999). The cannabis-using pregnant women have higher consumption than the control group. Current consumption of cannabis, sedatives, narcotics, amphetamines or cocaine resulting from the inclusion criteria. The previous consumption of these substances are manufactured in Table 3 (see UFL 161/36 pp. 5006, Sept. 6, 1999). Since cannabis consumption dropped in very different ways (grams, joints, pipe, puff), and then the strength of the fabric used is unknown, is a retrospective quantification of the consumption impossible. Of the 26 cannabis-using pregnant women who were followed for Family Clinic, smoke 69% continue to hash in the second trimester (15% unknown), while 46% (19% unknown) continued to smoke marijuana in the third trimester.
They cannabis-using pregnant women smoke more tobacco than the control group, namely 7.7 cigarettes per day (15.0) for the control group 3.0 cigarettes per day (12.5) (alternative test, p <105). Among the cannabis-using pregnant women smoke 83% against 31% in the control group (binary test, p <0.0001).
Of the 84 cannabis-using pregnant women had 26 (31%) had no contact with the Family Clinic, 32 (38%) received advice on one occasion , 26 (31%) were followed for Familieambulatoriets level. Of the control group 336 pregnant women received seven (2%) counseling due to excessive alcohol consumption.
were 96% of live births in the group of cannabis users (2 miscarriages and an abortus inhibitus) compared with 99% in the control group (two miscarriages, one abortus inhibitus, a abortion and stillborn). The difference is not significant (binary test, p = 0.10) and there is not enough data to comment on a possible excess risk of stillbirth in the group of cannabis users. None of the other obstetric variables showed significant difference (p everywhere> 0.09), this is true: the two groups in weight gain during pregnancy, gestational age, Apgar score after one and after five minutes, the proportion of children with Apgar score less than or equal seven after one or five minutes, umbilical cord or placental pH. Only one placenta had two vessels, the rest had three. There were also no significant differences in the incidence of complicated pregnancies, selected pregnancy complications (pre-eclampsia, eclampsia, severe hyperemesis, molimina, hydramnion, threatening miscarriage, pre-term birth, premature water outlet, placentainsufficiens, removal of the placenta), complicated births, complicated puerperier, intervention in pregnancy, childbirth or puerperium or selected interventions (vestimulation, vacuum extraction, caesarean section).
As shown in Table 4 (see UFL 161/36 pp. 5006, Sept. 6, 1999) is the cannabis-exposed children's birth weight and birth length was significantly lower, while no difference on the main level. Fifty-eight percent of the cannabis exposed children were boys (1% unknown, abortions) against 53% in the control group (1% unknown, abortions), a non-significant difference (binary test, p = 0.14). Birth weight, length and head circumference checked the sex of the child, so that cannabis exposed only compared with control children of the same sex, this eliminates However, the significant difference between the two of the three variables (alternative test with unequal number of controls, p = 0.03, p = 0.03 and p = 0.16). It is shown that the alcohol in the moderate to high levels (> 2 drinks / day) reduces birth weight (14). The effect of alcohol consumption on birth weight, length, and head circumference sought to be eliminated in that in the test for controlling the sex of the baby is eliminated data derived from pregnant women with an alcohol higher than two drinks per day, but this does not eliminate the significant difference in birth weight and birth length ( alternative test with unequal number of controls, p = 0.04, p = 0.04 and p = 0.16). It is shown that pregnant tobacco leads to low birth weight, birth length and head circumference (15). The effect of tobacco smoking sought to be eliminated by comparing controls with the same smoking status (yes / no); then there was no significant difference (paired, two-sided t-test: p = 0.29, p = 0.96, p = 0.77 based n = 63, n = 62 and n = 51 comparisons). In addition, offered the cannabis-exposed children, with one exception (below), not just vaguely significant differences from control children in terms of: total hospital stay, admission to neonatal ward or pediatric department, incidence of malformations, birth trauma, respiratory diagnoses, treatment (beyond afnavling and suction) or discharge to home. Of the cannabis-exposed children offered 25% 'other clinical conditions' as opposed to 16% of control group children. This is significant (binary test, p = 0.03), but 'other clinical conditions' is a residual group of largely insignificant findings.
Discussion
When they were questioned, gave up 0.8% of pregnant a current cannabis consumption at first pregnancy examination at Rigshospitalet and Hvidovre Hospital. The primary dropout rate of 25% due to lack of systematic questioning about substance use affects hardly the results of the matched study, and dropout due to oversight from staff also assessed to have only a modest effect on prævalensestimatet. Cancelling not speak Danish can probably have led to overestimation of the prevalence, our results suggest namely that cannabis is used less often among foreign language. The rate may be lower than the actual prevalence, since it is based on self-reporting and lower than in foreign studies (2). Compared with the prevalence of alcohol consumption and smoking are extent of the problem, however modest (14, 15).
Compared to the control group, the group of cannabis-using pregnant characterized by poor social conditions, as assessed by a number of parameters. The cannabis-using pregnant women had a greater past and current use of other drugs.
, there was no significant difference in the incidence of pregnancy, birth, neonatal or puerperale complications. The cannabis exposed children were lighter, shorter and had smaller head circumference. After controlling for tobacco consumption, there was no significant difference in birth weight and length. This raises, but does not prove directly that smoking habits are responsible for the otherwise observed difference in birth weight and length. Any observed differences after controlling for sex, alcohol and tobacco consumption would be partly explained by poorer social conditions, even when taking into account smoking and other confounders, results in lower birth weight (16). There were no differences in other neonatal parameters, diagnoses or hospitalizations. To cannabis-exposed children had higher incidence of 'other clinical conditions' can be explained by a better observation of these children, for example, withdrawal signs.
A study (5) shows significant correlation between urine samples positive for marijuana and decreased birth weight and length, but no association between self-reported consumption and growth retardation, perhaps because urine test all things being equal appoint them with high consumption (5). It is possible that small effects on the clinical course could have been realized if consumption had been quantified.
Based on the literature and the present study assessed cannabis consumption among pregnant women not to be a significant prognostic factor for poor obstetric course. Cannabis is a marker for poor social conditions and high consumption of tobacco, alcohol and other drugs. With this background, there is no reason to launch svangreprofylaktiske measures for pregnant specifically target cannabis consumption, but the presence of this should trigger increased attention and support because of these other risk factors. It must be emphasized, however, that nothing certain is known about problems with breastfeeding (cannabis concentrated in breast milk), early mother-child contact, passive smoking cannabis and growing up in a cannabis-using environment. Furthermore, it has not been possible to elucidate abstinensudvikling or neuropsychological functions in the exposed children. These factors could have an impact on children's continued health, development and upbringing.
Source: Cannabis and pregnancy
In two Copenhagen University Hospital 12.885 pregnant women, seen under det period 1.8.1992 two 30.04.1995, answered question aires angående consumption of alcohol, tobacco, cannabis og andre drugs. The prevalence of cannabis use was 0.8%. Women using cannabis but no other ILLICIT drugs were hvert retrospectively matched with four randomly valgte pregnant women in the same period and the same age group and with same parity. Eighty-four cannabis users were included. These women were socioeconomically disadvantaged and had a højere prevalence of gift and past use of alcohol, tobacco and Other Drugs. No. demonstrated significantly difference in pregnancy, delivery or puerperal outcome was found. Children of women using cannabis were 150 g lighter, 1.2 cm shorter and had 0.2 cm smaller head circumference than the control infants. Controlling for the child's sex and maternal use of alcohol did not eliminera the betydelig forskelle in birthweight and length; Men, theywere eliminated by controlling for maternal tobacco smoking. It is avslutade, att use of cannabis is not a major prognostic factor om outcome of pregnancy, but is an indicator of low socio økonomisk status and use of andre Substances.
Summary
Introduction : The objective was to investigate the effect of cannabis consumption on pregnancy, fetal development, birth, puerperium and neonatal child's condition, to determine the extent of the problem in Copenhagen and thereby obtain a basis for preparing recommendations for pregnancy counseling.
MATERIALS AND METHODS: From 1.8.1992 to 30.4.1995 pregnant women in Copenhagen in history taking at first prenatal were asked about their current and past consumption of alcohol and other drugs. The material was 12,885 food records. Pregnant women with a current cannabis consumption, without simultaneous consumption of tranquilizers, narcotics, amphetamines or cocaine matchedes each with four randomly selected pregnant women followed at the same hospital in the same period of the same age and of the same parity and the outcome was assessed retrospectively. Eighty-four pregnant women met the inclusion criteria.
Results: 0.8% reported themselves to use cannabis. The cannabis-using pregnant women living in poor social conditions and had a heavier medical history for other drugs. There was no significant difference in the incidence of pregnancy, birth, neonatal or puerperale complications. The cannabis exposed children were at birth 150 g lighter, 1.2 cm shorter and had 0.2 cm smaller head circumference than the control children. The significant differences in birth weight and length did not disappear after controlling for child's sex and heavy drinking among pregnant, but after controlling for smoking.
Conclusion: Based on literature and own data assessed cannabis consumption among pregnant women not to be a prognostic factor for a poor course of pregnancy, fetal development, birth, puerperium or neonatal period. Cannabis consumption is a marker for poor social conditions and increased consumption of tobacco, alcohol and other drugs.
Cannabis is the most widely used illegal drug in Denmark (1). The supply of cannabis in Denmark from 1983 to 1995 is stable and consumption of cannabis is stable from 1990 to 1995 (1). About 40% of adults under 45 have used cannabis (1). Significantly fewer have smoked cannabis within the last year: about 5%, this proportion is highest in the youngest age groups, ranging up to about 20% (1). Among adults, the highest prevalence among the socially marginalized groups, as well as in major cities (1). There is generally a lower prevalence in women than men (1). Danish figures for cannabis consumption among pregnant women is not known. Foreign studies find prevalence of marihuanaforbrug among pregnant women aged between 3 and 16% (2).
negative impact of cannabis on physical health is modest compared to eg alcohol. This is primarily on respiratory symptoms and lung function. Marihuanarygning achieved by a 3-fold increase in the amount of tar inhaled and a 5-fold increase in the blood concentration of carbon monoxide as compared with conventional cigarette smoking, including due to the particular inhalation. Marihuanarygeres fertility is probably reduced (3). There is evidence that cannabis can trigger schizophrenic episodes in susceptible and aggravate a schizophrenic state, and that there is a relationship between cannabis use and mental dysfunction, but it is uncertain whether cannabis causes or simply an indicator of mental illness (3). Cannabis consumption reduces further psychomotor function, memory and learning (3).
They mentioned effects on adults involves a natural interest in whether cannabis consumption among pregnant women, nursing and parents affect the course of pregnancy, birth, fetal development, the child's condition perinatal and its further forecast not least because the psychoactive component of cannabis (delta-9-tetrahydrocannabinol) cross the placenta and accumulate in breast milk (2). Furthermore, the substance in several mammalian species led to reduced fertility, reduced maternal weight, increased resorption, small litter size, intrauterine growth retardation, failure to thrive and immaturity of the central nervous system (4). The relationship between marihuanaforbrug and obstetric and neonatal complications are not well studied. Several studies have found correlation between cannabis consumption and low gestational age, birth weight or birth length, even after statistically confounder control (5, 6), while other studies have not (2, 7, 8). There are problems with the available information on substance use and differences in demographics and lifestyle between users and non-users (7). It is difficult to distinguish a specific effect of prenatal cannabiseksposition from the negative effects of the drug-using environment, while consumption of cigarettes, alcohol and other drugs (7). There is no effect of marijuana on growth beyond the neonatal period (7). Most studies have failed to demonstrate correlation between cannabiseksposition and physical injuries, including malformations, but there are case reports and one major study showing correlation between cannabiseksposition and features characteristic of fetal alcohol syndrome (8). Some studies show signs of neuropsychological effects on children, as they show disturbance of sleep, crying and cognitive functions (7). A case-control study has shown that children of mothers who smoke marijuana before or during pregnancy, had a ten times greater risk of leukemia (9).
This is the hallmark of foreign studies (7, 8) that deals with consumer marijuana (plants), which contains 1-5% of delta-9-tetrahydrocannabinol (10). In Denmark, however hashish (resin) containing 6-10% of the substance (10), the most common form of cannabis (1, 3). It is therefore of interest to make a Danish study. A more potent cannabis plant, known as skunk (or nederwiet), with a content of 10-15%, has in recent years emerged in Denmark (1, 11).
The purposes of this study to investigate the effect of cannabis on pregnancy, fetal development , childbirth, puerperium, the child's condition neonatal and its further prognosis and with background herein to obtain a basis for preparing recommendations for pregnancy counseling. Furthermore, it is of interest to examine the prevalence of cannabis use in pregnant women in a Danish material in order to assess the extent of the problem.
Materials and methods
Since 1.8.1992 pregnant women in Copenhagen at the first antenatal visit at Rigshospitalet and Hvidovre Hospital of either the doctor or midwife in the journal recording were asked about their current and past use of tobacco, alcohol and other drugs. The women who reported having a current consumption of drugs, including cannabis, is offered an advisory conversation and multidisciplinary follow-up of the Family Clinic, instead of the traditional obstetric auspices.
study the nature of a journal based longitudinal study based on an initial routine interview. Pregnant women who for the first antenatal visit during the period 1.8.1992 to 30.4.1995 reported current cannabis consumption matched with four randomly selected pregnant women without current cannabis consumption, followed at the same hospital during the same period, the same age (younger than 20, 20-24, 25-29, 30-34, 35-39, over 40 years), and of the same parity (zero, one, two or more). Exclusion criteria are the consumption of tranquilizers, narcotics (heroin, morphine, Ketogan), amphetamines, cocaine, lack of information on substance use, multiple births, habitual abortion, previous induced abortion in the second trimester, previous or current serious, chronic disease such as diabetes mellitus, hepatitis or HIV.
addition of a material on 12,885 food records with information about substance use reported 122 to have a current cannabis consumption. In 19 of these it appeared to be due to an error answering the questions, ie. the prevalence of cannabis consumption among pregnant women at first pregnancy examination in Copenhagen based on self-reporting can be estimated at 0.8%. Eighty-four cannabis smoking during pregnancy met the inclusion criteria; this corresponds to a control group of 336th Material 12,885 records corresponding to 75% of referred pregnant during the period (figures from CHC, Medical Professionals office). The remaining 25% is not the midwife or doctor been presented to systematic issues related to substance use, but has also gone through the period usual svangreforløb. Apostasy is partly due to oversights, and that many do not speak Danish pregnant women in resource account is not questioned.
Data obtained from obstetric and / or pediatric records. Information on current and past substance use is based on self-reporting in connection with the systematic questioning. Job descriptions are divided by the Social Research Institute's social group division (12) in social groups IV, although only used job titles and inactive people classified separately.
Quantitative results expressed as mean (± 2 SD in parentheses). Where the distributions are very right-leaning states average (90-percentile in brackets). Consumption groups are compared with the use of conventional methods for the paired data, with the modifications that are necessary when there is more than one control for each user of cannabis control group. For the quantitative variables, it depends on a t-test applied to cannabis user value minus the average of her control (paired, two-sided t-test). Alternatively, when a property is unevenly distributed, performed a ranking position within each such group, and the average ranks are compared by z test (analogous to Friedman's test) (alternative tests). That alternative test can be extended by the appropriate weighting for situations where the number of checks varies between the groups (alternative test with unequal number of controls). For binary data (yes / no answers), see Rothman (13) (binary test). Percentage unenlightened was low and indicated below only when the figure was> 10%. As significance level chosen p = 0.05.
Results
Demographic data are listed in Table 1 (see UFL 161/36 p 5006, September 6, 1999). It is seen that the control group were older in age group despite matching. There was no significant difference in height and weight. A small part of the cannabis-using pregnant cohabiting. Eighty-three percent of the cannabis-using pregnant women were Danish language, 2% foreign language and 14% unknown, compared with 82%, 11% and 7% in the control group (binary test, p = 0.006, subject due to the unenlightened). Get the cannabis-using pregnant and baby fathers belonging to the high social groups 1-3, and fewer are working.
They cannabis-using pregnant women parity is after the match, as the control group, on average, 1.4 (3.0). There are an increasing number of previous abortions in the hash-smoking pregnant women at 0.9 (2.0) against the control group 0.4 (1.0) (alternative test p = 0.0004). There is thus a significantly increased number of previous pregnancies in the group of cannabis-using pregnant women, namely 2.5 (5.0) against the control group 1.9 (3.0) (alternative test, p = 0.002). The number of previously occurring spontaneous abortions or ekstrauterine pregnancies are not different (alternative test, p = 0.67, respectively. Binary test p = 0.42).
Information on consumption of beer, wine and spirits in the weeks prior to the first pregnancy examination is made of Table 2 (see UFL 161/36 pp. 5006, Sept. 6, 1999). The cannabis-using pregnant women have higher consumption than the control group. Current consumption of cannabis, sedatives, narcotics, amphetamines or cocaine resulting from the inclusion criteria. The previous consumption of these substances are manufactured in Table 3 (see UFL 161/36 pp. 5006, Sept. 6, 1999). Since cannabis consumption dropped in very different ways (grams, joints, pipe, puff), and then the strength of the fabric used is unknown, is a retrospective quantification of the consumption impossible. Of the 26 cannabis-using pregnant women who were followed for Family Clinic, smoke 69% continue to hash in the second trimester (15% unknown), while 46% (19% unknown) continued to smoke marijuana in the third trimester.
They cannabis-using pregnant women smoke more tobacco than the control group, namely 7.7 cigarettes per day (15.0) for the control group 3.0 cigarettes per day (12.5) (alternative test, p <105). Among the cannabis-using pregnant women smoke 83% against 31% in the control group (binary test, p <0.0001).
Of the 84 cannabis-using pregnant women had 26 (31%) had no contact with the Family Clinic, 32 (38%) received advice on one occasion , 26 (31%) were followed for Familieambulatoriets level. Of the control group 336 pregnant women received seven (2%) counseling due to excessive alcohol consumption.
were 96% of live births in the group of cannabis users (2 miscarriages and an abortus inhibitus) compared with 99% in the control group (two miscarriages, one abortus inhibitus, a abortion and stillborn). The difference is not significant (binary test, p = 0.10) and there is not enough data to comment on a possible excess risk of stillbirth in the group of cannabis users. None of the other obstetric variables showed significant difference (p everywhere> 0.09), this is true: the two groups in weight gain during pregnancy, gestational age, Apgar score after one and after five minutes, the proportion of children with Apgar score less than or equal seven after one or five minutes, umbilical cord or placental pH. Only one placenta had two vessels, the rest had three. There were also no significant differences in the incidence of complicated pregnancies, selected pregnancy complications (pre-eclampsia, eclampsia, severe hyperemesis, molimina, hydramnion, threatening miscarriage, pre-term birth, premature water outlet, placentainsufficiens, removal of the placenta), complicated births, complicated puerperier, intervention in pregnancy, childbirth or puerperium or selected interventions (vestimulation, vacuum extraction, caesarean section).
As shown in Table 4 (see UFL 161/36 pp. 5006, Sept. 6, 1999) is the cannabis-exposed children's birth weight and birth length was significantly lower, while no difference on the main level. Fifty-eight percent of the cannabis exposed children were boys (1% unknown, abortions) against 53% in the control group (1% unknown, abortions), a non-significant difference (binary test, p = 0.14). Birth weight, length and head circumference checked the sex of the child, so that cannabis exposed only compared with control children of the same sex, this eliminates However, the significant difference between the two of the three variables (alternative test with unequal number of controls, p = 0.03, p = 0.03 and p = 0.16). It is shown that the alcohol in the moderate to high levels (> 2 drinks / day) reduces birth weight (14). The effect of alcohol consumption on birth weight, length, and head circumference sought to be eliminated in that in the test for controlling the sex of the baby is eliminated data derived from pregnant women with an alcohol higher than two drinks per day, but this does not eliminate the significant difference in birth weight and birth length ( alternative test with unequal number of controls, p = 0.04, p = 0.04 and p = 0.16). It is shown that pregnant tobacco leads to low birth weight, birth length and head circumference (15). The effect of tobacco smoking sought to be eliminated by comparing controls with the same smoking status (yes / no); then there was no significant difference (paired, two-sided t-test: p = 0.29, p = 0.96, p = 0.77 based n = 63, n = 62 and n = 51 comparisons). In addition, offered the cannabis-exposed children, with one exception (below), not just vaguely significant differences from control children in terms of: total hospital stay, admission to neonatal ward or pediatric department, incidence of malformations, birth trauma, respiratory diagnoses, treatment (beyond afnavling and suction) or discharge to home. Of the cannabis-exposed children offered 25% 'other clinical conditions' as opposed to 16% of control group children. This is significant (binary test, p = 0.03), but 'other clinical conditions' is a residual group of largely insignificant findings.
Discussion
When they were questioned, gave up 0.8% of pregnant a current cannabis consumption at first pregnancy examination at Rigshospitalet and Hvidovre Hospital. The primary dropout rate of 25% due to lack of systematic questioning about substance use affects hardly the results of the matched study, and dropout due to oversight from staff also assessed to have only a modest effect on prævalensestimatet. Cancelling not speak Danish can probably have led to overestimation of the prevalence, our results suggest namely that cannabis is used less often among foreign language. The rate may be lower than the actual prevalence, since it is based on self-reporting and lower than in foreign studies (2). Compared with the prevalence of alcohol consumption and smoking are extent of the problem, however modest (14, 15).
Compared to the control group, the group of cannabis-using pregnant characterized by poor social conditions, as assessed by a number of parameters. The cannabis-using pregnant women had a greater past and current use of other drugs.
, there was no significant difference in the incidence of pregnancy, birth, neonatal or puerperale complications. The cannabis exposed children were lighter, shorter and had smaller head circumference. After controlling for tobacco consumption, there was no significant difference in birth weight and length. This raises, but does not prove directly that smoking habits are responsible for the otherwise observed difference in birth weight and length. Any observed differences after controlling for sex, alcohol and tobacco consumption would be partly explained by poorer social conditions, even when taking into account smoking and other confounders, results in lower birth weight (16). There were no differences in other neonatal parameters, diagnoses or hospitalizations. To cannabis-exposed children had higher incidence of 'other clinical conditions' can be explained by a better observation of these children, for example, withdrawal signs.
A study (5) shows significant correlation between urine samples positive for marijuana and decreased birth weight and length, but no association between self-reported consumption and growth retardation, perhaps because urine test all things being equal appoint them with high consumption (5). It is possible that small effects on the clinical course could have been realized if consumption had been quantified.
Based on the literature and the present study assessed cannabis consumption among pregnant women not to be a significant prognostic factor for poor obstetric course. Cannabis is a marker for poor social conditions and high consumption of tobacco, alcohol and other drugs. With this background, there is no reason to launch svangreprofylaktiske measures for pregnant specifically target cannabis consumption, but the presence of this should trigger increased attention and support because of these other risk factors. It must be emphasized, however, that nothing certain is known about problems with breastfeeding (cannabis concentrated in breast milk), early mother-child contact, passive smoking cannabis and growing up in a cannabis-using environment. Furthermore, it has not been possible to elucidate abstinensudvikling or neuropsychological functions in the exposed children. These factors could have an impact on children's continued health, development and upbringing.
Source: Cannabis and pregnancy
