The research, published July 19, 2019, in JAMA Network Open, examined self-reported cannabis use among 276,991 pregnant women (representing 367,403 pregnancies) in Northern California over 9 years and found that cannabis use has increased over time.

From 2009 to 2017, the adjusted prevalence of self-reported cannabis use in the year before pregnancy increased from 6.8% to 12.5%, and the adjusted prevalence of self-reported cannabis use during pregnancy increased from 1.9% to 3.4% (rates were adjusted for demographics). Annual rates of change in self-reported daily, weekly, and monthly-or-less cannabis use increased significantly, though daily use increased most rapidly.

Among women who self-reported cannabis use during the year before pregnancy, the proportion who were daily users increased from 17% to 25%, and weekly users increased from 20% to 22%, while monthly-or-less users decreased from 63% to 53% during the study period. Similarly, among women who self-reported cannabis use during pregnancy, the proportion who were daily users increased from 15% to 21%, and weekly users from 25% to 27%, while monthly users decreased from 60% to 52%.

“These findings should alert women’s health clinicians to be aware of potential increases in daily and weekly cannabis use among their patients,” said lead author Kelly Young-Wolff, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research. “The actual numbers are likely higher, as women may be unwilling to disclose their substance use to a medical professional.”

In addition, the prevalence of daily and weekly cannabis use may have risen even further in the past year and a half following legalization of cannabis for recreational use in California in 2018, Young-Wolff said.

The data come from women’s initial prenatal visits at Kaiser Permanente in Northern California, which usually take place at around 8 weeks gestation, and do not reflect continued use throughout pregnancy. Investigators were unable to differentiate whether self-reported cannabis use during pregnancy occurred before or after women were aware that they were pregnant.

While the current findings are based on women’s self-reporting, the results are supported by the Kaiser Permanente research team’s December 2017 JAMA Research Letter showing an increase in prenatal cannabis use via urine toxicology testing. In this newer study, the authors focus on trends in frequency of use in the year before and during pregnancy.

Some women may use cannabis during pregnancy to manage morning sickness, the authors noted. The authors’ previous work published in JAMA Internal Medicine in 2018 found women with severe nausea and vomiting in pregnancy were nearly 4 times more likely to use cannabis during the first trimester of pregnancy.

Women may get the impression from cannabis product marketing and online media that cannabis use is safe during pregnancy, said Young-Wolff. However, there is substantial evidence that exposure to cannabis in pregnancy is associated with having a low-birthweight baby, and the American College of Obstetricians and Gynecologists recommends women who are pregnant or contemplating pregnancy discontinue cannabis use because of concerns about impaired neurodevelopment and exposure to the adverse effects of smoking.

“There is still much that is unknown on the topic, including what type of cannabis products pregnant women are using and whether the health consequences differ based on mode of cannabis administration and frequency of prenatal cannabis use,” Young-Wolff noted.

More research is needed to offer women better, specific advice, said study senior author Nancy Goler, MD, an obstetrician/gynecologist and associate executive director of The Permanente Medical Group.

“There is an urgent need to better understand the effects of prenatal cannabis exposure as cannabis becomes legalized in more states and more widely accepted and used,” Dr. Goler said. “Until such time as we fully understand the specific health risks cannabis poses for pregnant women and their fetuses, we are recommending stopping all cannabis use prior to conceiving and certainly once a woman knows she is pregnant.”

The study was supported by a grant from the National Institute on Drug Abuse.

Young-Wolff and Kaiser Permanente Division of Research colleague Lindsay Avalos, PhD, MPH, have received a new 5-year grant from NIDA to support further research on maternal cannabis use during pregnancy. They plan to study whether prenatal cannabis use is associated with increased risk of adverse maternal, fetal, and neonatal outcomes using data from urine toxicology testing, self-reported frequency of prenatal cannabis use, and mode of cannabis administration. They will also test whether legalization of cannabis for recreational use in 2018 and local regulatory practices (such as retailer bans) are associated with variation in prenatal cannabis use.

Additional authors were Constance Weisner, DrPH, MSW, Varada Sarovar, PhD, Lue-Yen Tucker, Mary Anne Armstrong, MA, and Stacey Alexeeff, PhD, of the Kaiser Permanente Northern California Division of Research; and Amy Conway, MPH, of the Kaiser Permanente Northern California Early Start Program.

This trend is evident in even in resource-poor countries, say the researchers.

While many parts of the world have made good economic progress, women’s rights have often been overlooked, say the researchers. This is despite many countries having signed the international bill of rights for women, formally known as The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW).

The researchers wanted to find out if there might be a link between protection of women’s rights, and health improvement and sustainable development, and if ultimately, women’s rights might have more of an impact than economic and social, or civil and political rights alone.

They analysed databases which held information on health, human rights, and economic and social rights for 162 countries for the period 2004 to 2010.

Countries were grouped according to the respect they afforded to women’s economic and social rights: high (44); moderate (51); and poor (63).

Analysis of the data showed that strong economic and social rights were associated with better/improving health outcomes, possibly because of the spend on health per head of the population, say the researchers.

But this wasn’t the case when looking at countries based on women’s economic and social rights.

Overall, countries with strong women’s rights had better/improving health than those where women’s rights were only moderately or poorly respected.

These health indicators include disease prevention, such as vaccination, reproductive health, death rates and life expectancy.

In countries where human rights, to include women’s rights, were highly respected, but where access to hospital beds and doctors was nevertheless below average, health outcomes were still consistently better than average, the analysis showed.

“The results confirm that even with a lack of resources, if a country has a strong human rights structure, the health outcomes are better,” the researchers write.

But countries where civil and political rights alone were highly valued had varying levels of health.

And despite some countries respecting economic, social and cultural rights, they still didn’t protect women’s economic and social rights.

This is an observational study, which used average health values, and as such, can’t establish cause. Further research over longer time periods in countries with similar human rights trends is needed to pinpoint overarching trends, say the researchers.

But gender equality is not just a women’s issue, but a development issue, they suggest.

“Since the promotion and protection of women’s rights play a fundamental role for progress for states as they unite health, human rights and development, nations that have the ability to promote [women’s social and economic rights]…are missing a crucial component in positive health outcomes,” they write.

“Today, the value of human rights has often been questioned from an economic standpoint; however, our data find that rather than limit progress, human rights, and [women’s economic and social rights] in particular, can only benefit them,” they conclude.

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“When we looked through all known studies, we noticed significant disparities in terms of the approaches and findings,” said Shahab Haghayegh, a Ph.D. candidate in the Department of Biomedical Engineering and lead author on the paper. “The only way to make an accurate determination of whether sleep can in fact be improved was to combine all the past data and look at it through a new lens.”

The paper explaining their method was recently published in the journal Sleep Medicine Reviews.

In collaboration with the UT Health Science Center at Houston and the University of Southern California, the UT researchers reviewed 5,322 studies. They extracted pertinent information from publications meeting predefined inclusion and exclusion criteria to explore the effects of water-based passive body heating on a number of sleep-related conditions: sleep onset latency — the length of time it takes to accomplish the transition from full wakefulness to sleep; total sleep time; sleep efficiency — the amount of time spent asleep relative to the total amount of time spent in bed intended for sleep; and subjective sleep quality.

Meta-analytical tools were then used to assess the consistency between relevant studies and showed that an optimum temperature of between 104 and 109 degrees Fahrenheit improved overall sleep quality. When scheduled 1-2 hours before bedtime, it can also hasten the speed of falling asleep by an average of 10 minutes.

Much of the science to support links between water-based body heating and improved sleep is already well-established. For example, it is understood that both sleep and our body’s core temperature are regulated by a circadian clock located within the brain’s hypothalamus that drives the 24-hour patterns of many biological processes, including sleep and wakefulness.

Body temperature, which is involved in the regulation of the sleep/wake cycle, exhibits a circadian cycle, being 2-3 degrees Fahrenheit higher in the late afternoon/early evening than during sleep, when it is the lowest. The average person’s circadian cycle is characterized by a reduction in core body temperature of about 0.5 to 1 F around an hour before usual sleep time, dropping to its lowest level between the middle and later span of nighttime sleep. It then begins to rise, acting as a kind of a biological alarm clock wake-up signal. The temperature cycle leads the sleep cycle and is an essential factor in achieving rapid sleep onset and high efficiency sleep.

The researchers found the optimal timing of bathing for cooling down of core body temperature in order to improve sleep quality is about 90 minutes before going to bed. Warm baths and showers stimulate the body’s thermoregulatory system, causing a marked increase in the circulation of blood from the internal core of the body to the peripheral sites of the hands and feet, resulting in efficient removal of body heat and decline in body temperature. Therefore, if baths are taken at the right biological time — 1-2 hours before bedtime — they will aid the natural circadian process and increase one’s chances of not only falling asleep quickly but also of experiencing better quality sleep.

The research team is now working with UT’s Office of Technology Commercialization in the hopes of designing a commercially viable bed system with UT-patented Selective Thermal Stimulation technology. It allows thermoregulatory function to be manipulated on demand and dual temperature zone temperature control that can be tailored to maintain an individual’s optimum temperatures throughout the night.

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The authors hope their work leads to diabetes treatments — beyond blood sugar monitoring and insulin therapy — that target the molecular source of its damaging effects on the vascular system.

The same team previously found that high blood glucose, the hallmark symptom of diabetes, activates an enzyme known as protein kinase A (PKA), which increases calcium channel activity and constricts blood vessels.

“This was a surprise, since PKA is typically associated with blood vessel widening and wasn’t really on our radar,” said senior author Manuel Navedo, professor of pharmacology at UC Davis Health. “We wanted to understand the molecular processes that created this opposite reaction.”

For the new study, published in The Journal of Clinical Investigation, the Navedo lab team conducted a series of experiments on the effects of high glucose on cerebral blood vessels and arterial cells that control blood flow. The tests were conducted on a unique genetically modified mouse and two mouse models of diabetes that were developed at UC Davis for studies of cardiovascular health.

The researchers focused on the relationship between PKA and adenylyl cyclase (AC) — an enzyme involved in cyclic AMP (cAMP) production, a cellular messenger with a critical role in vascular cell function. Their results showed that one AC in particular — AC5 — mediated cAMP and PKA activation, triggering increased calcium channel activity and blood vessel narrowing. They also found that AC5 was essential for blood-vessel constriction during diabetes.

The team now hopes to test the effects of the AC5 chain reaction in high-glucose conditions in human cells. This step could confirm it as a treatment target for reducing the vascular complications of diabetes, which can include eye, kidney, cerebral, gastrointestinal and cardiovascular disease.

“We see every day in our clinics the devastating impact of diabetes on the health and lives of our patients,” said co-author Nipavan Chiamvimonvat, the Roger Tatarian Endowed Professor in Cardiovascular Medicine at UC Davis Health. “Our work brings into much clearer focus how high glucose can damage the vascular system and gives us a new target for blocking its effects.”

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Dopamine is a chemical in the brain that is important for learning and memory. Department of Biological Sciences Assistant Professor Christine Lattin, and colleagues conducted this study of wild songbirds showing that dopamine is important in responding to chronic stressors, which can help wildlife conservation efforts in response to environmental stressors such as habitat destruction, natural disasters, extreme weather events and increases in predation.

Lattin, who is the lead author on the study published in Nature’s Scientific Reports, applied a biomedical imaging technology called Positron Emission Tomography, or PET, scans that are used commonly on humans but rarely on wild animals to quantify dopamine receptors in house sparrows.

“This study is exciting because it is the first time PET scans have been used in wildlife to quantify dopamine receptors in the brain. Developing this technique has opened the door to being able to scan animals and release them back into the wild,” she said. “We need to know how these wild birds are coping with stressors and responding to changes to the environment so we can understand how to best protect them.”

In addition to the biomedical imaging, Lattin and colleagues tracked changes in the birds’ body mass and hormone levels, and observed their behavior using a remotely operated video camera to study wild house sparrows’ response to captivity over four weeks. The birds were scanned after being brought in to the lab and then again four weeks later. By using PET scans, they were able to study how the stress of captivity affected the birds over time.

They found that one type of dopamine receptor decreased over time during captivity, which suggests that birds became less resilient to stress over time. The greater the decrease in dopamine receptors, the more they exhibited anxiety-related behaviors such as feather ruffling. All of the wild birds also decreased body mass.

“These physiological, neurobiological and behavioral changes suggest that songbirds are not able to habituate to captivity, at least over short periods of time. It is very important that scientists studying stress in wildlife find more ways to study them in their natural habitat,” Lattin said.

This research complies with all existing laws and regulations and the Ornithological Council’s Guidelines for the Use of Wild Birds in Research.

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