Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function.

Importance: Cannabis use is increasing among reproductive-age individuals and the risks associated with cannabis exposure during pregnancy remain uncertain. Objective: To evaluate the association between maternal cannabis use and adverse pregnancy outcomes known to be related to placental function. Design, Setting, and Participants: Ancillary analysis of nulliparous individuals treated at 8 US medical centers with stored urine samples and abstracted pregnancy outcome data available. Participants in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort were recruited from 2010 through 2013; the drug assays and analyses for this ancillary project were completed from June 2020 through April 2023. Exposure: Cannabis exposure was ascertained by urine immunoassay for 11-nor-9-carboxy-Δ9-tetrahydrocannabinol using frozen stored urine samples from study visits during the pregnancy gestational age windows of 6 weeks and 0 days to 13 weeks and 6 days (visit 1); 16 weeks and 0 days to 21 weeks and 6 days (visit 2); and 22 weeks and 0 days to 29 weeks and 6 days (visit 3). Positive results were confirmed with liquid chromatography tandem mass spectrometry. The timing of cannabis exposure was defined as only during the first trimester or ongoing exposure beyond the first trimester. Main Outcome and Measure: The dichotomous primary composite outcome included small-for-gestational-age birth, medically indicated preterm birth, stillbirth, or hypertensive disorders of pregnancy ascertained by medical record abstraction by trained perinatal research staff with adjudication of outcomes by site investigators. Results: Of 10 038 participants, 9257 were eligible for this analysis. Of the 610 participants (6.6%) with cannabis use, 32.4% (n = 197) had cannabis exposure only during the first trimester and 67.6% (n = 413) had ongoing exposure beyond the first trimester. Cannabis exposure was associated with the primary composite outcome (25.9% in the cannabis exposure group vs 17.4% in the no exposure group; adjusted relative risk, 1.27 [95% CI, 1.07-1.49]) in the propensity score-weighted analyses after adjustment for sociodemographic characteristics, body mass index, medical comorbidities, and active nicotine use ascertained via urine cotinine assays. In a 3-category cannabis exposure model (no exposure, exposure only during the first trimester, or ongoing exposure), cannabis use during the first trimester only was not associated with the primary composite outcome; however, ongoing cannabis use was associated with the primary composite outcome (adjusted relative risk, 1.32 [95% CI, 1.09-1.60]). Conclusions and Relevance: In this multicenter cohort, maternal cannabis use ascertained by biological sampling was associated with adverse pregnancy outcomes related to placental dysfunction.

Estrogen excretion in pregnant women with leprosy: evidence of diminished fetoplacental function.

Estrogen excretion was assayed in 64 women with leprosy and 15 healthy control women. The mean estrogen excretion was lower in women with leprosy than in controls and the incidence of subnormal estrogen values was higher in the leprosy patients than in the controls. There was an association between infant birth weight and frequency of subnormal estrogen excretion. These features were most marked in women with lepromatous leprosy and are further evidence of diminished fetoplacental function in women with leprosy.

Prenatal diagnosis of placental sulphatase deficiency.

A gas chromatographic procedure for the quantitation of neutral steroid sulphates in maternal urine and its application to a suspected case of placental sulphatase deficiency is described. Low levels of oestriol coincident with elevated 16-hydroxylated metabolites of dehydroepiandrosterone in the maternal urine are shown to occur in this particular condition, and thus provide a convenient differentiation from fetal adrenal hypoplasia before birth.

[A critical analysis of the present state of recognizing the fetal hazard in pregnancy, via hormonal determinations (author's transl)]. / Kritische Analyse des heutigen Stands der fetalen Risikoerkennung in der Schwangerschaft durch Hormonbestimmungen.

The experience published in medical literature on the pregnancy hormones HPL and estrogens, is subjected to a critical review. The reported studies are examined in detail, first of all, with regard to the performance of the pregnancy hormones in fetal risk situations, taking certain pregnancy complications into account. The ranking of these paremeters in arriving at obstetric decisions in fetal emergency situations, is then described. This is followed by an assessment of the importance of the pregnancy hormones as prognostic parameters for forecasting fetal hazard in cases where pregnancy appears to have taken an uneventful courese, basing on few results available to date. All findings indicate that biochemical monitoring during pregnancy contributes toward individualization of the obstetric decisions.

Urinary estriol for assessment of fetoplacental function.

A total of 1,607 urinary estriol determinations were performed in 447 patients with normal and complicated pregnancies. In general, the test provided reliable information concerning fetal status, particularly in pregnancies complicated by toxemia, diabetes, and postmaturity. When measured consecutively, a drop of 50% or more in estriol level usually should be considered a significant index of fetal distress. Limitations of the test and several compensatory measures aimed at minimizing inaccuracy are discussed.

[Effect of the protein-free calf-blood-extract (Solcoseryl) on the excretion of estrogens in chronic placental insufficiency]. / Einfluss eines proteinfreien Kälberblutextraktes (Solcoseryl) auf die Ostrogenausscheidung bei chronischer Plazentainsuffizienz

In a double blind study the action of Solcoseryl was tested in 31 patients during late pregnancy with chronic placental insufficiency. Under treatment with Solcoseryl a significant increase in urinary estrogen excretion occurred in relation to the placebo-group.

[Experiences with the dehydroepiandrosterone sulfate test at the end of pregnancy]. / Erfahrungen mit dem Dehydroepiandrosteronsulfat-Test am Ende der Schwangerschaft

Results of DHAS-tests are calculated according to 4 methods (recovery of injected DHAS as total oestrogens measured in 24 hour urine specimens; changes of oestrogen excretion peaks measured in two hour intervals; recovery of injected DHAS as total oestrogens measured in 2 hour urine specimens; classification according to a scheme of oestrogen excretion pattern measured in two hour intervals). The results are critically compared with the general development of pregnancy and with the condition of the newborn. The discrepancies observed show that the DHAS-test is of little practical value.