Omayma Alshaarawy

Prenatal cannabis use may be underreported due to social stigma and fear of legal repercussions. The study assesses the validity of self-reported prenatal cannabis use versus urine toxicology measures and determines correlates of non-disclosure. Data are from a statewide population-based pregnancy cohort (MARCH- Michigan Archive for Research on Child Health). Participants were recruited at first prenatal visit from 22 clinics in 2017-2023. We calculated sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) of self-reported cannabis use using urine toxicology as the criterion standard. 606 participants who self-reported cannabis use data within 30 days of urine collection were considered for analysis. Self-reports identified a prevalence of 14.2% for prenatal cannabis use, whereas urinalysis prevalence was 19.1%. Sensitivity, specificity, PPV, and NPV of self-report were 57.8%, 96.1%, 77.9% and 90.6%, respectively. No significant differences were observed between participants who disclosed and those who did not, except for race and ethnicity. The sensitivity of self-reports among Non-Hispanic Blacks was 45.5% compared to 73.0% for their non-Hispanic White counterparts. Self-reports can underestimate prenatal cannabis use especially among disadvantaged populations. The use of biospecimens to assess cannabis exposure is warranted for reducing misclassification and improving validity in research studies.

Aims: The aim of this study is to evaluate the real‐world prescribing patterns of SGLT2 inhibitors and GLP‐1 receptor agonists (GLP‐1RA) in patients with newly diagnosed Type 2 diabetes (T2DM), particularly among those with high cardiovascular risks or chronic kidney disease, and to identify demographic, clinical, and system‐level factors associated with receiving these medications. Materials and Methods: This cross‐sectional study analyzed electronic medical records (EMRs) of patients with newly diagnosed T2DM from 60 primary care clinics in West Michigan between April 2021 and January 2023. We assessed the documented prescription rates of SGLT2 inhibitors and GLP‐1RAs within 3 months of diagnosis based on EMRs, particularly in high‐risk subgroups. Results: Overall, 19.9% of n = 5783 patients with newly diagnosed T2DM had either an SGLT2 inhibitor or GLP‐1RA prescribed. Prescription rates for these agents were 20.0% for patients with chronic ischemic heart disease and 19.3% for those with impaired kidney function. In adjusted analyses, higher BMI (aOR 2.92 for BMI > 40 kg/m ² , 95% CI 1.58–5.42, ref BMI < 24 kg/m ² ), hyperlipidemia (aOR 1.89, 95% CI 1.28–2.79), chronic ischemic heart disease (aOR 1.55, 95% CI 1.11–2.18), and higher HbA1c (aOR 1.32 per 1% increase, 95% CI 1.22–1.42) were associated with higher odds of receiving prescription of these medications. Conclusions: Despite guideline recommendations, SGLT2 inhibitors and GLP‐1RAs are prescribed to only a minority of patients with newly diagnosed T2DM, even among those with clear indications. Efforts to improve guideline‐adherent care in primary care settings are needed.

Background and Objectives: Prenatal cannabis use prevalence in the United States has increased. Relaxation of state‐level cannabis policy may be contributing to the diminished risk perception of using cannabis. The main psychoactive constituent of cannabis, delta‐9‐tetrahydrocannabinol, crosses the placenta, interacting with functional cannabinoid receptors in the fetus. Here, we assess the association between prenatal cannabis exposure (PCE) and a set of birth outcomes.Methods: Using the Michigan Archive for Research on Child Health, a prospective pregnancy cohort, we linked prenatal survey data with neonatal data from state‐archived birth records. Recruitment occurred in 23 clinics across Michigan. Pregnant participants with live birth records between October 2017 and January 2022, after exclusion for missing data on cannabis use, birth outcomes, and covariates, were included in the final analytic sample (n = 584). Analyses involved generalized linear models.Results: An estimated 15% (95% confidence interval [CI]: 12%, 18%) of participants reported using cannabis during pregnancy. Covariate‐adjusted models revealed an association between PCE and birth size (ß = −0.3; 95% CI: −0.5, −0.003).Discussion and Conclusions: Findings suggest a relationship between PCE and smaller birth size. Clinicians should follow guidelines outlined by the American College of Obstetricians and Gynecologists when counseling pregnant patients on cannabis use.Scientific Significance: We detected a significant association between PCE and birth size. Most studies focus only on the extremes of birth size, however, use of z‐scores allow for assessment of the sex‐specific birth weight‐for‐gestational age distribution, increasing the accuracy of detecting an effect of cannabis exposure on birth size.

Objective: To assess first-trimester recruitment and retention of pregnant patients who regularly used cannabis, but not other substances, measured by willingness to participate in a research study, completion of self-administered electronic questionnaires, and willingness to provide urine samples during each trimester of pregnancy. We designed and launched a prospective feasibility study titled, Cannabis Legalization in Michigan (CALM) – Maternal & Infant Health (MIH), in two Michigan clinics after the recreational use of cannabis became legal for adults 21 years and older. Results: Over half (52%) of patients asked to participate in CALM-MIH were consented to the study. Two-thirds (66%) of screened patients initiated prenatal care during their first trimester of pregnancy and 50% used cannabis, of which the majority did not concurrently use other substances. Of those recruited into the prospective study, all participants completed the first-trimester questionnaire and provided urine samples. Study retention was 80% and all participants who completed follow-up assessments were willing to provide urine samples.

Background: Despite the evidence that energy balance is regulated differently in females and that the endocannabinoid system is sexually dimorphic, previous studies on the endocannabinoid system and energy balance predominantly used male models. Here, we characterize the effects of cannabinoid receptor deletion on body weight gain and glucose metabolism in female C57BL mice.Methods: Female mice lacking the cannabinoid-1 receptor (CB1R^-/-), cannabinoid-2 receptor (CB2R^-/-), or both receptors (CB1R^-/-/CB2R^-/-) and wild-type (WT) mice were fed with a low (LFD; 10% of calories from fat) or high-fat diet (HFD; 45% of calories from fat) for six weeks.Results: Female WT mice fed with HFD gained significantly more weight than WT mice fed with LFD (p < 0.001). Similar pattern was observed for CB2^/- mice fed with HFD compared to CB2R^-/- mice fed with LFD (p < 0.001), but not for CB1R^-/- fed with HFD vs. LFD (p = 0.22) or CB1R^-/-/CB2R^-/- fed with HFD vs. LFD (p = 0.96). Comparing the 4 groups on LFD, weight gain of CB1R^-/- mice was greater than all other genotypes (p < 0.05). When fed with HFD, the deletion of CB1R alone in females did not attenuate weight gain compared to WT mice (p = 0.72). Female CB1R^-/-/CB2R^-/- mice gained less weight than WT mice when fed with HFD (p = 0.007) despite similar food intake and locomotor activity, potentially owing to enhanced thermogenesis in the white adipose tissue. No significant difference in weight gain was observed for female CB2R^-/- and WT mice on LFD or HFD. Fasting glucose, however, was higher in CB2R^-/- mice fed with LFD than all other groups (p < 0.05).Conclusion: The effects of cannabinoid receptor deletion on glucose metabolism in female mice were similar to previously published findings on male mice, yet the effects on body weight gain and thermogenesis were attenuated in CB1R^-/- mice.

In recent years, the legalization and social acceptability of cannabis use have increased in the United States. Concurrently, the prevalence of cannabis use has continued to rise, and cannabis products have diversified. There are growing concerns regarding the health effects of regular and high‐potency cannabis use, and new research has shed light on its potentially negative effects. Here, we review evidence of the gastrointestinal (GI) effects of cannabis and cannabinoids. Dysregulation of the endocannabinoid system might contribute to various GI disorders, including irritable bowel syndrome and cyclic vomiting syndrome, and endocannabinoids have been found to regulate visceral sensation, nausea, vomiting, and the gut microbiome. Cannabis has been shown to have antiemetic properties, and the US Food and Drug Administration has approved cannabis‐based medications for treating chemotherapy‐induced nausea and vomiting. Yet, chronic heavy cannabis use has been linked to recurrent episodes of severe nausea and intractable vomiting (cannabinoid hyperemesis syndrome). Given the considerable heterogeneity in the scientific literature, it is unclear if cannabinoid hyperemesis syndrome is truly a distinct entity or a subtype of cyclic vomiting that is unmasked by heavy cannabis use and the associated dysregulation of the endocannabinoid system. The changes in cannabis legalization, availability, and public risk perceptions have outpaced research in this area and there is a need for robust, prospective, large‐scale studies to understand the effects of cannabis use on GI health.

Background and Objectives: The prevalence of cocaine use has increased in the United States, with an estimated 5.5 million people have used it at least once in 2019. We report trends in cocaine use for reproductive age females who participated in the National Survey on Drug Use and Health (NSDUH, 2005–2019).Methods: Interviewers for NSDUH recruited and assessed a representative sample of the US noninstitutionalized population. The prevalence of cocaine use was estimated annually for females (15–44 years; n = 295,751). Joinpoint regression was then used to test for significant changes in trends.Results: Approximately 2.4% of females (n = 8136) reported past 12‐month cocaine use. Joinpoint regression revealed an initial decline in cocaine use prevalence between 2005 and 2011, followed by a robust increase (2011–2019 annual percent change = 5.2; 95% confidence interval = 2.6, 7.8%). This nonlinear trend was observed for all subgroups, except for adolescent and pregnant females for whom a decrease in cocaine use prevalence was observed.Discussion and Conclusions: Although the prevalence of cocaine use remains scarce among US females, the uptake in use after a period of initial decline is concerning, highlighting the need for continued public health awareness and action.Scientific Significance: Cocaine use among females of reproductive age is particularly concerning given the increased likelihood of transitioning to disordered use and the risk of use during pregnancy. Previous studies have not reported cocaine use estimates specific to reproductive age females or only reported co‐drug use patterns, without detail of specific cocaine use trends.

Background: While prescription psychotherapeutic drug use (PPDU) and nicotine use pose substantial problems in isolation, they pose an increased risk in combination. This study aimed to estimate the prevalence of PPDU for young people, stratified by nicotine use status. A trend analysis was used to examine changes in PPDU and nicotine use over time. Methods: We used a cross-sectional population-based sample of young people aged 16-25 years (n = 10,454) from the National Health and Nutrition Examination Survey (NHANES, 2003-2018). For each data cycle, the prevalence of self-reported PPDU and nicotine including pain relievers, sedatives, stimulants, and tranquilizers was estimated. Using Joinpoint regression, we tested for significant changes in trends using a log-linear model and permutation test approach and produced the average data cycle percentage change (ADCPC). Results: From 2003 to 2018, 6.7% of young people had PPDU and 27.3% used nicotine. The prevalence of cigarette smoking decreased while other nicotine product use increased (p's < 0.001). Those who used nicotine were more likely to have PPDU (8.2%; 95% CI = 6.5%, 9.8%) vs. non-nicotine use (6.1%; 95% CI = 5.1%, 7.0%; p = 0.01). Results indicated a decreasing trend for nicotine use (ADCPC = -3.8, 95% CI = -7.2, -0.3; p = 0.04), but not for PPDU (ADCPC = 1.3; 95% CI = -4.7, 7.8; p = 0.61). On further examination, opioid use decreased, sedative use remained stable, and stimulant and tranquilizer use increased over time. Conclusions: From 2003 to 2018, young people who used nicotine had a higher prevalence of PPDU than those who did not. Clinicians should communicate the association between nicotine use and prescription drugs when prescribing or managing young patients' medications.