Armiel Suriaga, PhD
Florida Atlantic University
Co-Authors: Lenny Chiang-Hanisko1, Panagiota Kitsanta1, Acel D Suriaga1, Jessica Mangila2
1Florida Atlantic University, 2Boston University
Background: Intrauterine fetal demise (IUFD) is a critical public health concern, with more than 20,000 cases in 2022, or 1 in 60 births annually in the United States. Several factors could be attributed to IUFD, such as placental issues, increased maternal age, infection, diabetes, and smoking. However, research on the association of cannabis with IUFD is seldom reported.
Despite the warning from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics not to use cannabis during pregnancy, about 9.8 % of women self-reported cannabis use pre-pregnancy, 4.2% during pregnancy, and 5.5% post pregnancy: either due to self-treatment of pain, anxiety, and to relieve nausea and vomiting. However, there is insufficient information about the long-term effects of using cannabis prenatally, including death.
Objectives: 1) Report the intrauterine fetal demise or stillborn among those who were exposed to cannabinoids and other substances. 2) Examine the association of cannabinoid exposure to IUFD.
Methods: This cross-sectional study used de-identified data from the Florida Department of Law Enforcement from 2020 to 2022. We analyzed data using descriptive statistics and regression modeling using Stata 17. The medical examiners ascertained the primary outcome of IUFD through autopsy and toxicology results.
Results: One hundred twelve out of 46,347 decedents with any substances in their system at the time of death were less than a year old. 40 out of 112 of these deaths were considered fetal deaths, and 30 (0.03%) were recorded as intrauterine fetal demise/stillborn. Of the 30 IUFD cases, 21 (70%) were males, 23 (79%) were white, and 100% occurred in urban counties. 11 (36.67%) out of 30 IUFD cases had single drug vs. 19 (63.33%) with polydrug exposures. 4 out of 30 IUFD cases had drug toxicity. Three cases had cannabinoid exposures, 13 cases with opioids, 14 with stimulants, 9 with cocaine, 5 with alcohol, 1 with benzodiazepine, and 1 with mitragynine exposure. No other drugs were observed among those with cannabinoid exposure. In a univariate regression model, the odds of having IUFD among those exposed to cannabinoids were not statistically significant, OR=.36, 95% CI .12-1.20, p=0.09. However, in the multivariate regression model, among those exposed to cannabinoids, the odds of IUFD, OR= .23, 95% CI .07-.82, p=0.02, after adjusting for confounders.
Conclusion: Our results provided evidence of IUFD among those with cannabinoid exposures, particularly as a sole substance, underscoring the need for further research and interventions for this emerging issue.