This dissertation will address three study aims: Aim 1 will estimate the size of a suspected causal influence of prenatal cannabis exposure on a set of inter-related birth outcomes: birth size, gestational age, 5-minute Apgar score, and neonatal intensive care unit admission. Aim 2 will investigate the degree to which morning sickness might be associated with higher odds of cannabis use. Aim 3 is to conduct a feasibility study to assess the recruitment and retention of pregnant people who regularly use cannabis, measured by willingness to participate and complete the study survey; willingness to provide urine samples; the percentage of participants who are cannabis-only users; and the percentage of pregnant people retained for the three follow-up assessments. Aims 1 and 2 use data for the Michigan Archive for Research on Child Health, a prospective cohort of pregnant people recruited from 11 sites across Michigan between 2017 and 2021. Aim 1 and Aim 2 analytic sample sizes are n= 584 and n= 826, respectively. Results of Aim 1 suggest a modest but statistically significant association between prenatal cannabis exposure and birth size z-score after model adjustment for potential confounding variables (betamodel4= -0.3; 95% CI: -0.5, -0.003). Results of Aim 2 suggest higher odds of prenatal cannabis use with increasing morning sickness severity (ORmodel4= 1.2; 95% CI: 1.1, 1.2). Sensitivity analyses indicate higher odds of using cannabis during the first trimester with increasing morning sickness severity (ORmodel4= 1.1; 95% CI: 1.01, 1.2). Similarly, findings indicate higher odds of cannabis use in the second or third trimester of pregnancy with increasing morning sickness severity (ORmodel4= 1.2; 95% CI: 1.1, 1.4). Sensitivity analyses also suggest an association between pre-pregnancy and prenatal cannabis use and morning sickness severity (betamodel4= 0.1; 95% CI: 0.003, 0.2 and betamodel4= 0.2; 95% CI: 0.1, 0.2, respectively). For Aim 3, Cannabis Legalization in Michigan-Maternal & Infant Health, a prospective feasibility study, was designed to better understand the recruitment and retention of pregnant people who regularly use cannabis. The study recruited n= 77 baseline participants of which n= 15 were prospectively followed and assessed during each trimester of pregnancy and once post-delivery. Of the participants recruited at baseline, 42% reported using cannabis during pregnancy, of which 87% were cannabis-only users (i.e., no reported polysubstance use). All prospective participants were willing to provide urine samples; the concordance between self-reported cannabis use and urinalysis was 100% in the first and second trimesters and 92% in the third trimester of pregnancy. Study retention of the prospective sample was 80%; of n= 15 first trimester participants, n= 3 were loss-to-follow-up. Of the remaining 12 participants, 83% had complete data across all four timepoints.Findings from this dissertation reveal that pregnant people are willing to participate in a study that explores the health effects of prenatal cannabis use on birth outcomes and maternal health. Larger studies are warranted to assess the association between prenatal cannabis exposure and fetal growth and development, as well as the relationship between morning sickness and cannabis use. This dissertation also detected an association between prenatal cannabis exposure and lower birth size, suggesting that pregnant people, or people contemplating pregnancy, should be cautioned against using cannabis until more studies are conducted to establish causality between prenatal cannabis use and neonatal health.
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