The effect of cannabis exposure on pubertal outcomes: a systematic review

Figures & data

Table 1 MEDLINE search strategy

#	Searches
1	Cannabis/
2	exp Cannabinoids/
3	marijuana.mp.
4	cannabi*.mp.
5	marihuana.mp.
6	ganja*.mp.
7	bhang*.mp.
8	or/1–7
9	exp Puberty/
10	pubert*.mp.
11	sex* precoci*.mp.
12	puberty, delayed/or puberty, precocious/
13	Sexual Development/
14	Sexual Maturation/
15	(sexual adj2 (development or matur*)).mp.
16	or/9–15
17	8 and 16
18	remove duplicates from 17
19	18 not (animals/not (humans/and animals/))

Figure 1 Flow diagram of screening process.

Table S1 Preferred reporting items for systematic review and meta-analysis checklist

Section/topic	#	Checklist item	Reported on page #
Title
Title	1	Identify the report as a systematic review, meta-analysis, or both.	1
Abstract
Structured summary	2	Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.	3
Introduction
Rationale	3	Describe the rationale for the review in the context of what is already known.	4–5
Objectives	4	Provide an explicit statement of questions being addressed with reference to PICOS.	5
Methods
Protocol and registration	5	Indicate if a review protocol exists, if and where it can be accessed (eg, Web address), and, if available, provide registration information including registration number.	5 (registration number)
Eligibility criteria	6	Specify study characteristics (eg, PICOS and length of follow-up) and report characteristics (e.g., years considered, language, and publication status) used as criteria for eligibility, giving rationale.	5–6
Information sources	7	Describe all information sources (e.g., databases with dates of coverage and contact with study authors to identify additional studies) in the search and date last searched.	5–6
Search	8	Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.	18 (Table 1)
Study selection	9	State the process for selecting studies (ie, screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).	6
Data collection process	10	Describe the method of data extraction from reports (eg, piloted forms, independently, and in duplicate) and any processes for obtaining and confirming data from investigators.	6
Data items	11	List and define all variables for which data were sought (eg, PICOS and funding sources) and any assumptions and simplifications made.	6
Risk of bias in individual studies	12	Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.	6–7
Summary measures	13	State the principal summary measures (eg, risk ratio and difference in means).	7
Synthesis of results	14	Describe the methods of handling data and combining results of studies, if done, including measures of consistency (eg, I^2) for each meta-analysis.	7
Section/topic	#	Checklist item	Reported on page #
Risk of bias across studies	15	Specify any assessment of risk of bias that may affect the cumulative evidence (eg, publication bias and selective reporting within studies).	7
Additional analyses	16	Describe methods of additional analyses (eg, sensitivity or subgroup analyses and meta-regression), if done, indicating which were pre-specified.	7
Results
Study selection	17	Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.	7, 18 (Figure 1)
Study characteristics	18	For each study, present characteristics for which data were extracted (eg, study size, PICOS, and follow-up period) and provide the citations.	7–8
Risk of bias within studies	19	Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12).	N/A
Results of individual studies	20	For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group and (b) effect estimates and CIs, ideally with a forest plot.	7–8
Synthesis of results	21	Present results of each meta-analysis done, including CIs and measures of consistency.	N/A
Risk of bias across studies	22	Present results of any assessment of risk of bias across studies (see Item 15).	N/A
Additional analysis	23	Give results of additional analyses, if done (eg, sensitivity or subgroup analyses and meta-regression [see Item 16]).	N/A
Discussion
Summary of evidence	24	Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (eg, health care providers, users, and policy makers).	8
Limitations	25	Discuss limitations at study and outcome level (eg, risk of bias) and at review-level (eg, incomplete retrieval of identified research and reporting bias).	10
Conclusions	26	Provide a general interpretation of the results in the context of other evidence and implications for future research.	10–11
Funding
Funding	27	Describe sources of funding for the systematic review and other support (eg, supply of data); role of funders for the systematic review.	12

Note: Adapted from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7):e1000097.¹

Abbreviation: PICOS, participants, interventions, comparisons, outcomes, and study design.

Table S2 Cochrane central register of controlled trials search strategy

#	Searches
1	Cannabis/
2	exp Cannabinoids/
3	marijuana.mp.
4	cannabi*.mp.
5	marihuana.mp.
6	ganja*.mp.
7	bhang*.mp.
8	or/1–7
9	exp Puberty/
10	pubert*.mp.
11	sex* precoci*.mp.
12	puberty, delayed/or puberty, precocious/
13	Sexual Development/
14	Sexual Maturation/
15	(sexual adj2 (development or matur*)).mp.
16	or/9–15
17	8 and 16
18	remove duplicates from 17
19	18 not (animals/not (humans/and animals/))

Table S3 Cochrane database of systematic reviews search strategy

#	Searches
1	[Cannabis/]
2	[exp Cannabinoids/]
3	marijuana.mp.
4	cannabi*.mp.
5	marihuana.mp.
6	ganja*.mp.
7	bhang*.mp.
8	or/1–7
9	[exp Puberty/]
10	pubert*.mp.
11	sex* precoci*.mp.
12	[puberty, delayed/or puberty, precocious/]
13	[Sexual Development/]
14	[Sexual Maturation/]
15	(sexual adj2 (development or matur*)).mp.
16	or/9–15
17	8 and 16
18	remove duplicates from 17
19	118 not (animals/not (humans/and animals/))

Table S4 PsycINFO search strategy

#	Searches
1	Cannabis/
2	exp Cannabinoids/
3	marijuana.mp.
4	cannabi*.mp.
5	marihuana.mp.
6	ganja*.mp.
7	bhang*.mp.
8	or/1–7
9	Puberty/
10	pubert*.mp.
11	sex* precoci*.mp.
12	menarche/
13	menarche.mp.
14	adrenarche.mp.
15	Sexual Development/
16	(sexual adj2 (development or matur*)).mp.
17	or/9–16
18	8 and 17
19	remove duplicates from 18
20	19 not (animals/not (humans/and animals/))

Table S5 Embase search strategy

#	Searches
1	cannabis/
2	cannabinoid/or cannabichromene/or cannabidiol/or cannabinol/or dronabinol/
3	cannabi*.mp.
4	marihuana.mp.
5	marijuana.mp.
6	ganja*.mp.
7	bhang*.mp.
8	dronabinol*.mp.
9	or/1–8
10	exp puberty/
11	pubert*.mp.
12	menarche.mp.
13	adrenarche.mp.
14	delayed puberty/
15	precocious puberty/
16	sex* precoci*.mp.
17	pubarche.mp.
18	thelarche.mp.
19	sexual development/
20	sexual maturation/
21	(sexual adj2 (development or matur*)).mp.
22	or/10–21
23	9 and 22
24	remove duplicates from 23
25	24 not (animals/not (humans/and animals/))

Table S6 Web of science search strategy

(marijuana or cannabi* or marihuana or ganja* or bhang*) AND TOPIC: (pubert* or menarche or adrenarche or sexual development or sexual matur* or sex* preocoicious*) Indexes = SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Timespan = All years

Table S7 SPORTDiscus search strategy

#	Searches
S1	cannabi*
S2	DE “CANNABIS”
S3	marijuana or marihuana or ghanja or bhang
S4	S1 OR S2 OR S3
S5	pubert*
S6	DE “PUBERTY” OR DE “MENARCHE”
S7	menarche or adrenarche Search modes -
S8	sexual maturation
S9	sex* precoci*
S10	sexual N2 (development or matur*)
S11	S5 OR S6 OR S7 OR S8 OR S9 OR S10
S12	S4 AND S11

Table S8 CINAHL search strategy

#	Searches
S1	(MH “Cannabis”)
S2	“marijuana” or “cannabi*” or “marihuana” or “ganja*” or “bhang*”
S3	S1 OR S2
S4	(MH “Puberty+”)
S5	“pubert*” or “menarche” or “adrenarche”
S6	(MH “Puberty, Precocious”) OR (MH “Puberty, Delayed”)
S7	“sex* precocious*”
S8	sexual N2 (development or matur*)
S9	S4 OR S5 OR S6 OR S7 OR S8
S10	S3 AND S9

Table S9 ProQuest dissertations and theses A&I search strategy

Searches
All ((marijuana OR cannabi* OR marihuana OR ganja* OR bhang*)) AND all ((pubert* or menarche or adrenarche or sexual development or sexual matur* or sex* preocoicious*))

MoherDLiberatiATetzlaffJAltmanDGThe PRISMA GroupPreferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA StatementPLoS Med200967e100009719621072

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