The Association Between Preconception Cannabis Use and Gestational Diabetes Mellitus: The Preconception Period Analysis of Risks and Exposures Influencing Health and Development (PrePARED) Consortium

Overview

Journal Paediatr Perinat Epidemiol

Specialties Gynecology & Obstetrics
Pediatrics
Public Health

Date 2023 Sep 26

PMID 37751914

Authors

Ke Pan

Anne Marie Jukic

Gita D Mishra

Sunni L Mumford

Lauren A Wise

Enrique F Schisterman

Sylvia H Ley

Brittany M Charlton

Jorge E Chavarro

Jaime E Hart

Stephen Sidney

Xu Xiong

Celestina Barbosa-Leiker

Karen C Schliep

Jeffrey G Shaffer

Lydia A Bazzano

Emily W Harville

Affiliations

Soon will be listed here.

Abstract

Background: The metabolic changes that ultimately lead to gestational diabetes mellitus (GDM) likely begin before pregnancy. Cannabis use might increase the risk of GDM by increasing appetite or promoting fat deposition and adipogenesis.

Objectives: We aimed to assess the association between preconception cannabis use and GDM incidence.

Methods: We analysed individual-level data from eight prospective cohort studies. We identified the first, or index, pregnancy (lasting ≥20 weeks of gestation with GDM status) after cannabis use. In analyses of pooled individual-level data, we used logistic regression to estimate study-type-specific odds ratios (OR) and 95% confidence intervals (CI), adjusting for potential confounders using random effect meta-analysis to combine study-type-specific ORs and 95% CIs. Stratified analyses assessed potential effect modification by preconception tobacco use and pre-pregnancy body mass index (BMI).

Results: Of 17,880 participants with an index pregnancy, 1198 (6.7%) were diagnosed with GDM. Before the index pregnancy, 12.5% of participants used cannabis in the past year. Overall, there was no association between preconception cannabis use in the past year and GDM (OR 0.97, 95% CI 0.79, 1.18). Among participants who never used tobacco, however, those who used cannabis more than weekly had a higher risk of developing GDM than those who did not use cannabis in the past year (OR 2.65, 95% CI 1.15, 6.09). This association was not present among former or current tobacco users. Results were similar across all preconception BMI groups.

Conclusions: In this pooled analysis of preconception cohort studies, preconception cannabis use was associated with a higher risk of developing GDM among individuals who never used tobacco but not among individuals who formerly or currently used tobacco. Future studies with more detailed measurements are needed to investigate the influence of preconception cannabis use on pregnancy complications.

References

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

Robbins C, Boulet S, Morgan I, DAngelo D, Zapata L, Morrow B . Disparities in Preconception Health Indicators -  Behavioral Risk Factor Surveillance System, 2013-2015, and Pregnancy Risk Assessment Monitoring System, 2013-2014. MMWR Surveill Summ. 2018; 67(1):1-16. PMC: 5829866. DOI: 10.15585/mmwr.ss6701a1. View

Vidot D, Prado G, Hlaing W, Florez H, Arheart K, Messiah S . Metabolic Syndrome Among Marijuana Users in the United States: An Analysis of National Health and Nutrition Examination Survey Data. Am J Med. 2015; 129(2):173-9. PMC: 4718895. DOI: 10.1016/j.amjmed.2015.10.019. View

Porr C, Rios P, Bajaj H, Egan A, Huot C, Batten R . The effects of recreational cannabis use on glycemic outcomes and self-management behaviours in people with type 1 and type 2 diabetes: a rapid review. Syst Rev. 2020; 9(1):187. PMC: 7433109. DOI: 10.1186/s13643-020-01411-9. View

Young-Wolff K, Sarovar V, Tucker L, Avalos L, Conway A, Armstrong M . Association of Nausea and Vomiting in Pregnancy With Prenatal Marijuana Use. JAMA Intern Med. 2018; 178(10):1423-1424. PMC: 6233758. DOI: 10.1001/jamainternmed.2018.3581. View

Wang J, Cao S, Hu R, Wang M . Association between cigarette smoking during pregnancy and gestational diabetes mellitus: a meta-analysis. J Matern Fetal Neonatal Med. 2018; 33(5):758-767. DOI: 10.1080/14767058.2018.1500547. View

Gunasekaran N, Long L, Dawson B, Hansen G, Richardson D, Li K . Reintoxication: the release of fat-stored delta(9)-tetrahydrocannabinol (THC) into blood is enhanced by food deprivation or ACTH exposure. Br J Pharmacol. 2009; 158(5):1330-7. PMC: 2782342. DOI: 10.1111/j.1476-5381.2009.00399.x. View

Stephenson J, Heslehurst N, Hall J, Schoenaker D, Hutchinson J, Cade J . Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018; 391(10132):1830-1841. PMC: 6075697. DOI: 10.1016/S0140-6736(18)30311-8. View

Gunderson E, Sun B, Catov J, Carnethon M, Lewis C, Allen N . Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife: The CARDIA Study. Circulation. 2021; 143(10):974-987. PMC: 7940578. DOI: 10.1161/CIRCULATIONAHA.120.047320. View

10.

Chiolero A, Faeh D, Paccaud F, Cornuz J . Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr. 2008; 87(4):801-9. DOI: 10.1093/ajcn/87.4.801. View

11.

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

12.

Osei-Hyiaman D, Depetrillo M, Pacher P, Liu J, Radaeva S, Batkai S . Endocannabinoid activation at hepatic CB1 receptors stimulates fatty acid synthesis and contributes to diet-induced obesity. J Clin Invest. 2005; 115(5):1298-305. PMC: 1087161. DOI: 10.1172/JCI23057. View

13.

Liemburg E, Bruins J, van Beveren N, Islam M, Alizadeh B . Cannabis and a lower BMI in psychosis: What is the role of AKT1?. Schizophr Res. 2016; 176(2-3):95-99. DOI: 10.1016/j.schres.2016.08.014. View

14.

Frati A, Iniestra F, Ariza C . Acute effect of cigarette smoking on glucose tolerance and other cardiovascular risk factors. Diabetes Care. 1996; 19(2):112-8. DOI: 10.2337/diacare.19.2.112. View

15.

Harper T, Kuohung W, Sayres L, Willis M, Wise L . Optimizing preconception care and interventions for improved population health. Fertil Steril. 2022; 120(3 Pt 1):438-448. DOI: 10.1016/j.fertnstert.2022.12.014. View

16.

Rajavashisth T, Shaheen M, Norris K, Pan D, Sinha S, Ortega J . Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III. BMJ Open. 2012; 2:e000494. PMC: 3289985. DOI: 10.1136/bmjopen-2011-000494. View

17.

Pino E, Zuo Y, Maciel De Olivera C, Mahalingaiah S, Keiser O, Moore L . Cohort profile: The MULTI sTUdy Diabetes rEsearch (MULTITUDE) consortium. BMJ Open. 2018; 8(5):e020640. PMC: 5942412. DOI: 10.1136/bmjopen-2017-020640. View

18.

Braun J, Messerlian C, Hauser R . Fathers Matter: Why It's Time to Consider the Impact of Paternal Environmental Exposures on Children's Health. Curr Epidemiol Rep. 2017; 4(1):46-55. PMC: 5571868. DOI: 10.1007/s40471-017-0098-8. View

19.

Xiong X, Saunders L, Wang F, Demianczuk N . Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet. 2001; 75(3):221-8. DOI: 10.1016/s0020-7292(01)00496-9. View

20.

Ayonrinde O, Ayonrinde O, Van Rooyen D, Tait R, Dunn M, Mehta S . Association between gestational cannabis exposure and maternal, perinatal, placental, and childhood outcomes. J Dev Orig Health Dis. 2020; 12(5):694-703. DOI: 10.1017/S2040174420001166. View