目的:评估精神疾病和物质使用障碍(SUD)之间的关联强度,以及怀孕早期使用大麻和大麻使用障碍(CUD)。
方法:观察性研究。
方法:KaiserPermanente北加州,美国。
方法:2011年1月至2021年12月(2020年除外),在北加利福尼亚州KaiserPermanente的产前护理入口处,通过自我报告和尿液毒理学测试,从227555名个体中筛查了大麻使用。样品为62.5%非白色,平均(标准差)年龄为31.1(5.5)岁;6.8%使用大麻;0.2%患有CUD.
方法:暴露变量包括基于电子健康记录的注意缺陷多动的精神病诊断,焦虑,双极,抑郁,个性,创伤后应激和精神障碍;和酒精,阿片类药物兴奋剂和烟草使用障碍,在怀孕前两年直至产前物质使用筛查日期的前一天。结果变量是任何大麻的使用,怀孕早期自我报告使用大麻和CUD的频率。
结果:精神病患病率范围为0.2%(精神病)至14.3%(焦虑),SUD范围从0.3%(兴奋剂/阿片类药物)到3.8%(烟草)。精神疾病与大麻使用和CUD有关,与双相情感障碍的任何用途的相关性最强(调整后比值比[aOR]=2.83;95%置信区间[CI]=2.53~3.17),与精神病性障碍的CUD的相关性最强(aOR=10.01,95%CI=6.52~15.37).SUD与大麻使用和CUD有关,与烟草使用障碍的任何用途的相关性最强(aOR=4.03,95%CI=3.82-4.24),与兴奋剂使用障碍的CUD的相关性最强(aOR=21.99,95%CI=16.53-29.26).焦虑,双极,抑郁障碍和烟草使用障碍与每日使用大麻的几率大于每月使用大麻的几率或较少使用大麻的几率相关.
结论:精神疾病和物质使用障碍似乎与怀孕早期任何频繁使用大麻以及大麻使用障碍的几率升高有关。在大多数情况下,药物使用障碍与大麻结局的关联比其他精神疾病更强.
OBJECTIVE: To estimate the strength of association between psychiatric disorders and substance use disorders (SUD), and cannabis use and cannabis use disorder (CUD) during early pregnancy.
METHODS: Observational study.
METHODS: Kaiser Permanente Northern California, USA.
METHODS: 299 496 pregnancies from 227 555 individuals screened for cannabis use by self-report and a urine toxicology test at entrance to prenatal care in Kaiser Permanente Northern California during January 2011-December 2021 (excepting year 2020). The sample was 62.5% non-White, with a mean (standard deviation) age of 31.1 (5.5) years; 6.8% used cannabis; 0.2% had a CUD.
METHODS: Exposure variables included electronic health record-based psychiatric diagnoses of attention deficit hyperactivity, anxiety, bipolar, depressive, personality, posttraumatic stress and psychotic disorders; and alcohol, opioid, stimulant and tobacco use disorders, during the two years prior to pregnancy up to the day before the prenatal substance use screening date. Outcome variables were any cannabis use, frequency of self-reported cannabis use and CUD during early pregnancy.
RESULTS: Psychiatric disorder prevalence ranged from 0.2% (psychotic) to 14.3% (anxiety), and SUD ranged from 0.3% (stimulant/opioid) to 3.8% (tobacco). Psychiatric disorders were associated with cannabis use and CUD, with the strongest association for any use found for bipolar disorder (adjusted odds ratio [aOR] = 2.83; 95% confidence interval [CI] = 2.53-3.17) and the strongest association for CUD found for psychotic disorders (aOR = 10.01, 95% CI = 6.52-15.37). SUDs were associated with cannabis use and CUD, with the strongest association for any use found for tobacco use disorder (aOR = 4.03, 95% CI = 3.82-4.24) and the strongest association for CUD found for stimulant use disorder (aOR = 21.99, 95% CI = 16.53-29.26). Anxiety, bipolar, depressive disorders and tobacco use disorder were associated with greater odds of daily than monthly or less cannabis use.
CONCLUSIONS: Psychiatric disorders and substance use disorders appear to be associated with elevated odds of any and frequent cannabis use as well as cannabis use disorder during early pregnancy. In most cases, the associations with cannabis outcomes were stronger for substance use disorders than other psychiatric disorders.