Our Equity, Diversity, and Inclusion Committee is established with the goal of leading efforts to build a more representative, equitable, and inclusive Center in order to strengthen the quality, relevance, and impact of our research, programs, and services.
The Center is one of 27 sites across the U.S. to receive funding for the planning phase of the HEALthy Brain and Child Development (HBCD) Study. Led locally by Dr. Chambers, the planning phase of the study was intended investigators at the study sites to design recruitment strategies and data collection protocols for a future, large-scale study to evaluate fetal and child neurodevelopment from pregnancy through 9 years of age.
Dr. Chambers is appointed as a member of the Core Scientific/Strategic Advisory Board for the ConcePTION Project, an international consortium established to reduce uncertainty about the effects of medication used during pregnancy and breastfeeding through research and dissemination of evidence-based information to women and their healthcare providers.
Dr. Chambers is named Director of Epidemiology and Community Studies for the Rady Children’s Institute for Genomic Medicine.
Dr. Chambers is appointed to the federal Task Force on Research Specific to Pregnant Women and Lactating Women (PRGLAC), a committee established to advise the Secretary of Health and Human Services (HHS) regarding gaps in knowledge and research on safe and effective therapies for pregnant women and lactating women.
Up to 15% of pregnant women have an anxiety disorder, and 1-4% of them are treated with benzodiazepines (like Valium®, Xanax® or Klonopin®) or z-drugs (like Ambien®). In addition, it’s not uncommon for women with anxiety to also be treated for depression, or for benzodiazepines to be used in combination with a prescription opioid for pain management. But what effects might benzodiazepines and z-drugs, in isolation or in combination with an antidepressant or a prescription opioid, have on longer-term developmental outcomes in a pregnant woman’s baby? Our new study examined this very question.
How did we do it? We accessed a large dataset from the Norwegian Mother and Child Cohort Study, which followed over 41,000 pregnant women from 1999 to 2008 and had child follow-up data from 6 months to 8 years of age. In the study were 4,195 women who before and/or during pregnancy had a depression/anxiety disorder, 5,260 with a sleeping disorder, and 26,631 with a pain-related disorder. We looked at whether the timing of benzodiazepine/z-drug exposure (mid-pregnancy vs. late pregnancy) had any effects on the child’s longer-term development; whether longer vs. shorter duration of use (multiple 4-week vs. 1-week intervals) had any effect; and how the use of benzodiazepines/z-drugs in isolation or in combination with an antidepressant or a prescription opioid affected the child’s development. The child outcomes we looked at were the development of both motor and communication skills as well as attention problems when the children were around 5 years of age.
What did we find? Our findings suggested no increased risk for attention problems or fine motor deficits after benzodiazepine/z-drug exposure at different time points in pregnancy. We also did not find any evidence suggesting there was a developmental risk based on how long the mom used these drugs, nor any increased risk if benzodiazepines/z-drugs were used in combination with either antidepressants or a prescription opioid. There was an increased risk of gross motor and communication deficits among children whose mothers had depressive/anxiety disorders and used benzodiazepines/z-drugs late in pregnancy (week 29 or later), but the deficits were below clinically relevant cutoff points and could be accounted for by the mom’s underlying psychiatric conditions and/or the higher doses she was taking.
So what’s the take-away? Our findings suggest no substantial detrimental risk to child fine motor skills and attention problems after prenatal exposure to benzodiazepines/z-drugs alone or in combination with opioids or antidepressants. While an increased risk of gross motor and communication deficits was found, the deficits were not clinically significant and could be explained by other factors. As with any medication, pregnant women or women planning a pregnancy should talk with their healthcare provider before starting or stopping any medications.
Dr. Miguel del Campo is named director of UC San Diego’s residency program in Medical Genetics and Genomics.
Dr. Chambers starts a two-year term as President of the Organization of Teratology Information Specialists (OTIS), the professional scientific society for experts in the field of birth defects that provides the MotherToBaby information service and conducts MotherToBaby Pregnancy Studies.
MotherToBaby California turns 40! Established in 1978 by Dr. Jones as the California Teratogen Information Service, this service is relied upon by pregnant and breastfeeding parents, healthcare providers, and the general public to provide free, unbiased, evidence-based information about exposures during pregnancy and lactation.
With the legalization of marijuana in several US states, increased use has been seen in pregnant and breastfeeding women for both medicinal and recreational purposes. Although national organizations like the American Academy of Pediatrics recommend breastfeeding mothers do not use marijuana, there has been a lack of current data to support any health or neurodevelopmental concerns in infants as a result of exposure to tetrahydrocannabinol (THC) or other components of marijuana via breast milk.
“Pediatricians are often put into a challenging situation when a breastfeeding mother asks about the safety of marijuana use. We don’t have strong, published data to support advising against use of marijuana while breastfeeding, and if women feel they have to choose then we run the risk of them deciding to stop breastfeeding – something that we know is hugely beneficial for both mom and baby,” said Christina Chambers, PhD, MPH, principal investigator of the study, program director of Mommy’s Milk, and co-director of the Center for Better Beginnings.
Cannabinoids, marijuana’s active compounds, such as THC, like to stick to fat, which is abundant in breast milk. This stickiness has suggested that in women who use marijuana, these compounds can end up in breast milk, raising concerns about their potential effects on nursing babies.
To better understand how much marijuana actually gets into breast milk and how long it stays there, our Mommy’s Milk team conducted a study published online today in the journal Pediatrics. We examined 54 breast milk samples from 50 women who used marijuana either daily, weekly or sporadically – with inhalation being the primary method of intake. THC, the primary psychoactive component of marijuana, was detected in 63 percent of the breast milk samples up to six days after the mother’s last reported use.
“We found that the amount of THC that the infant could potentially ingest from breast milk was relatively low, but in some mothers could be detected as long as six days after the mother last used marijuana. We still don’t know enough about the drug to say whether or not there is a concern for the infant at any dose, or if there is a safe dosing level,” said Dr. Chambers. “The ingredients in marijuana products that are available today are thought to be much more potent than products available 20 or 30 years ago.”
Dr. Chambers believes that the results are a stepping stone for future research. More studies need to be done not only to determine the long-term impact for children, if any, of marijuana in breast milk, but more specifically, “are there any differences in effects of marijuana in breast milk for a two-month old versus a 12-month old, and is it different if the mother smokes versus eats the cannabis? These are critical areas we need answers to as we continue to promote breast milk as the premium in nutrition for infants.”
Study co-authors include: Kerri Bertrand, MPH; Nathan Hanan, PharmD; Gordon Honerkamp-Smith, MS; and Brookie Best, PharmD, MAS, all with UC San Diego.
