1.1 Amphetamines (speed) Study ref Study design LoE Sample size Aim/methods Findings Comments () SLR IV 10 cohort studies Aim: to systematically review the relationship between amphetamine exposure in pregnancy and birth outcomes. Methods: Electronic databases were searched to identify relevant studies. Data from included studies were extracted by 2 reviewers. Summary odds ratio (OR) and confidence intervals (Cis) were calculated using the random effects model. Significant increases in unadjusted risks of preterm birth (OR 4.11; 95%CI, 3.05 to 5.55), low birthweight (OR 3.97; 95%CI, 2.45 to 6.43), and small for gestational age (OR 5.79; 95%CI 1.39 to 24.06) were identified among women exposed to amphetamines in pregnancy. Mean birthweight was significantly lower among amphetamine-exposed pregnancies (MD –279 g; 95% CI, –485 to -74 g). Two studies provided adjusted estimates on different outcomes, and their results were consistent with the findings from the unadjusted data. 1.2 Opioids ref Study design LoE Sample size Aim/methods Findings Comments
1.4 Cannabis (marijuana) ref Study design LoE Sample size Aim/methods Findings Comments () SLR IV 31 cohort and studies Aim: To estimate whether marijuana use in pregnancy increases risks for adverse neonatal outcomes and clarify if any increased risk is attributable to marijuana use itself or to confounding factors such as tobacco use. Methods: Two authors performed a search of the data through August 2015 utilizing PubMed, Embase, Scopus, Cochrane reviews, ClinicalTrials.gov, and Cumulative Index to Nursing and Allied Health. Observational studies that compared rates of prespecified adverse neonatal outcomes in women who used marijuana during pregnancy with women who did not were linique. Primary outcomes were low birth weight (<2,500 g) and preterm delivery <37 weeks. Secondary outcomes were birth weight, gestational age at delivery, small for gestational age, level II or greater nursery admission, stillbirth, spontaneous abortion, low Apgar score, placental abruption, and perinatal death. Based on pooled unadjusted data, marijuana use during pregnancy was associated with an increased risk of low birth weight (15.4% compared with 10.4%, pooled relative risk [RR] 1.43, 95%CI 1.27 to 1.62) and preterm delivery (15.3% compared with 9.6%, pooled RR 1.32, 95%CI 1.14-1.54). However, pooled data adjusted for tobacco use and other confounding factors showed no statistically significant increased risk for low birth weight (pooled RR 1.16, 95%CI 0.98 to 1.37) or preterm delivery (pooled RR 1.08, 95%CI 0.82 to 1.43). Maternal marijuana use during pregnancy is not an independent risk factor for adverse neonatal outcomes after adjusting for confounding factors. The association between maternal marijuana use and adverse outcomes appears attributable to concomitant tobacco use and other confounding factors.
() SLR I 24 cohort, and studies Aim: To assess the effects of use of cannabis during pregnancy on maternal and outcomes. Methods: Seven electronic databases were searched from inception to 1 April 2014. Case-control studies, cross-sectional and cohort studies that investigated the effects of use of cannabis during pregnancy on maternal and fetal outcomes were included. Data synthesis was undertaken via systematic review and meta-analysis of available evidence. Meta-analyses were conducted on variables that had three or more studies that measured an outcome in a consistent manner, these included: anaemia, birth weight, low birth weight, neonatal length, placement in the neonatal intensive care unit, gestational age, head circumference and preterm birth. who used cannabis during pregnancy had an increase in the odds of anaemia (pooled OR (pOR) 1.36: 95%CI 1.10 to 1.69) compared with women who did not. Infants exposed to cannabis in utero had a decrease in birth weight (low birth weight pOR 1.77: 95% CI 1.04 to 3.01; pooled mean difference (pMD) for birth weight 109.42 g: 38.72 to 180.12) compared with infants were not. Infants exposed to cannabis in utero were also more likely to need placement in the neonatal intensive care unit compared with infants whose mothers did not use cannabis during pregnancy (pOR=2.02: 1.27 to 3.21). As use of cannabis gains social acceptance, pregnant women and their providers could benefit from health education on potential adverse effects of use of cannabis during pregnancy. 1.5 Excluded studies Background papers Background information will inform revision of the narrative.
Minozzi, S., et al. (2013). "Maintenance agonist treatments for opiate-dependent pregnant Cochrane Database of Systematic Reviews(12): CD006318. Duplicate Mitchell, A. M., et al. (2010). "An overview of opiate use during pregnancy: An evidence-based approach to treatment." Minerva Psichiatrica 51(4): 271-280. Narrative review Newman, R. G. and S. G. Gevertz (2011). "Efficacy versus effectiveness of buprenorphine and methadone maintenance in pregnancy." Journal of Addictive Diseases 30(4): 318-322. Editorial Niccols A, Milligan K, Sword W et al (2010) Maternal mental health and integrated programs for mothers with substance abuse issues. Psychol Addict Behav 24(3): 466-74. Not specific to target population Niccols A, Milligan K, Smith A et al (2012a) Integrated programs for mothers with substance abuse issues and their children: a systematic review of studies reporting on child outcomes. Child Abuse Negl 36(4): 308-22. Not specific to target population Niccols A, Milligan K, Sword W et al (2012b) Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes. Harm Reduct J 9: 14. Not specific to target population N., et al. (2017). "Substance use and preconception care: A review of the literature." International Journal of Women's Health and Reproduction Sciences 5(1): 3-10. Not specific to target population Shah, P. S., et al. (2010). "Maternal cocaine use and effects of intervention for reducing or eliminating cocaine use on pregnancy outcomes: A systematic review and meta-analysis." Paediatrics and Child Health 15: 24A. Does not meet criteria for grading (abstract only) Shiu, J. R. and M. H. H. (2012). "Dosing and monitoring of methadone in pregnancy: Literature review." Canadian Journal of Hospital Pharmacy 65(5): 380-386. Beyond scope of guidelines M. (2013). "Buprenorphine use in pregnant opioid users: A critical review." CNS Drugs 27(8): 653-662. Narrative review