In Reply In their letter, Reece and Hulse suggest there may be a correlation between cannabis consumption and gastroschisis based on the high consumption of cannabis in counties where we have found high rates of gastroschisis. To be clear, Reece and Hulse are inaccurate in their statement that we “found rurality was a risk factor for cannabis use.” Instead, we found higher rates of gastroschisis in rural counties.¹ In a follow-up study,² we found that fetal exposure to drugs other than alcohol, cocaine, narcotics, or hallucinogenics (odds ratio [OR], 3.27; 95% CI, 1.05-10.15; P = .04) and other noxious substances (OR, 2.02; 95% CI, 1.29-3.18; P = .002) increased the risk of gastroschisis in univariate analyses. The risk of combined exposure to other drugs and noxious substances persisted even when adjusting for rurality in a multivariate analysis (OR, 1.58; 95% CI, 1.01-2.49; P = .005). These drugs could include cannabis, among others, although this is impossible to determine, given the limitations of International Classification of Diseases, Ninth Revision coding used in this administrative database.

Reece和Hulse在回信中表示，由于我们发现胃抽搐发生率很高的县，大麻的消费量很高，因此大麻的消费与胃痉挛之间可能存在相关性。需要明确的是，里斯（Reece）和霍尔斯（Hulse）在声明中“我们发现农村地区是使用大麻的危险因素”是不准确的。取而代之的是，我们发现农村县的胃chi裂症发病率更高。¹在一项后续研究中，²我们发现胎儿暴露于除酒精，可卡因，麻醉剂或致幻剂之外的药物（优势比[OR]为3.27； 95％CI为1.05-10.15；P  = .04）和其他有害物质（OR，2.02; 95％CI，1.29-3.18; P = .002）在单变量分析中增加了胃裂症的风险。即使在多变量分析中调整了农村状况，仍然存在其他药物和有毒物质共同暴露的风险（OR，1.58； 95％CI，1.01-2.49；P  = .005）。这些药物可能包括大麻等，尽管鉴于国际疾病分类的局限性，无法确定大麻，但该行政数据库使用了第九修订版编码。