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Birth and early developmental screening outcomes associated with cannabis exposure during pregnancy



To compare birth and early developmental screening outcomes for infants with and without in utero cannabis exposures.

Study design

Observational cohort of women receiving prenatal care within a large health system, live birth between October 1, 2015 and December 1, 2017, and at least one infant visit. Cannabis exposure was through routine urine toxicology screen. Preterm birth, small for gestational age (SGA) birth, birth defects, and early developmental screening outcomes were assessed from birth and electronic health record data.


Of 3435 women, 283 (8.2%) had a positive urine toxicology screen. In utero cannabis exposure was associated with SGA birth, adjusted rate ratio (aRR) 1.69 (95% confidence interval [CI]: 1.22–2.34). Abnormal 12-month developmental screens occurred in 9.1% of infants with in utero cannabis exposure vs. 3.6% of those with negative maternal screens, aRR 1.90 (95% CI: 0.92–3.91). Additional birth outcomes were not associated with in utero cannabis exposure.


Exposure to cannabis during pregnancy may adversely impact fetal growth.

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Fig. 1: Identification of cohort, inclusions, and exclusions.


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The authors thank Leslie Kuckler, MPH for assistance with data collection. The authors also thank the HealthPartners Medical Group, under the leadership of Dr Charlie Lais and Dr Jason Maxwell, for implementing changes in prenatal care and documentation of developmental screening in our health system, making this study possible. Finally, the authors also thank the Healthy Beginnings program for promoting drug, alcohol, and tobacco free pregnancies and for providing support for women who screen positive in our health system.


All phases of this study were supported by a grant (U01DD0001035) from the Centers for Disease Control and Prevention [to PAR]. The sponsor was not involved in the study design, data collection, analysis or interpretation of data, writing of the paper, or the decision to submit for publication. Findings of this study represent those of the authors and do not represent the official views of the Centers for Disease Control and Prevention.

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Correspondence to Elyse Olshen Kharbanda.

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Appendix 1: List of major structural birth defects and ICD-10-CM codes by organ system

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Kharbanda, E.O., Vazquez-Benitez, G., Kunin-Batson, A. et al. Birth and early developmental screening outcomes associated with cannabis exposure during pregnancy. J Perinatol 40, 473–480 (2020).

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