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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

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


  1. 1.

    Englund J, Zerr D, Pergam S, Kuypers J, Yager J et al. Oseltamivir-resistant novel influenza A (H1N1) virus infection in two immunosuppressed patients—Seattle, Washington, 2009. MMWR Morb Mortal Wkly Rep. 2009;58:893–6.

  2. 2.

    Bilefsky D. Legalizing recreational marijuana, Canada begins a national experiment. New York: New York Times; 2018.

  3. 3.

    Mark K, Terplan M. Cannabis and pregnancy: maternal child health implications during a period of drug policy liberalization. Prev Med. 2017;104:46–9.

  4. 4.

    Saint Louis C. Pregnant women turn to marijuana, perhaps harming infants. New York: New York Times; 2017.

  5. 5.

    Mark K, Gryczynski J, Axenfeld E, Schwartz RP, Terplan M. Pregnant women's current and intended cannabis use in relation to their views toward legalization and knowledge of potential harm. J Addict Med. 2017;11:211–6.

  6. 6.

    Young-Wolff KC, Sarovar V, Tucker LY, Avalos LA, Conway A, Armstrong MA, et al. Association of nausea and vomiting in pregnancy with prenatal marijuana use. JAMA Intern Med. 2018;178:1423–4.

  7. 7.

    Dickson B, Mansfield C, Guiahi M, Allshouse AA, Borgelt LM, Sheeder J, et al. Recommendations from cannabis dispensaries about first-trimester cannabis use. Obstet Gynecol. 2018;131:1031–8.

  8. 8.

    Agrawal A, Rogers CE, Lessov-Schlaggar CN, Carter EB, Lenze SN, Grucza RA. Alcohol, cigarette, and cannabis use between 2002 and 2016 in pregnant women from a nationally representative sample. JAMA Pediatr. 2018;173:95–6.

  9. 9.

    Brown QL, Sarvet AL, Shmulewitz D, Martins SS, Wall MM, Hasin DS. Trends in marijuana use among pregnant and nonpregnant reproductive-aged women, 2002–2014. JAMA. 2017;317:207–9.

  10. 10.

    Shannon S, Louie J, Siniscalchi A, Rico E, Richter D et al. Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection—United States, April–August 2009. MMWR Morb Mortal Wkly Rep. 2009;58:941–7.

  11. 11.

    Ross EJ, Graham DL, Money KM, Stanwood GD. Developmental consequences of fetal exposure to drugs: what we know and what we still must learn. Neuropsychopharmacology. 2015;40:61–87.

  12. 12.

    Grant KS, Petroff R, Isoherranen N, Stella N, Burbacher TM. Cannabis use during pregnancy: pharmacokinetics and effects on child development. Pharmacol Ther. 2018;182:133–51.

  13. 13.

    Conner SN, Bedell V, Lipsey K, Macones GA, Cahill AG, Tuuli MG. Maternal marijuana use and adverse neonatal outcomes: a systematic review and meta-analysis. Obstet Gynecol. 2016;128:713–23.

  14. 14.

    Ko JY, Tong VT, Bombard JM, Hayes DK, Davy J, Perham-Hester KA. Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: a population-based study. Drug Alcohol Depend. 2018;187:72–8.

  15. 15.

    Bailey BA, Byrom AR. Factors predicting birth weight in a low-risk sample: the role of modifiable pregnancy health behaviors. Matern Child Health J. 2007;11:173–9.

  16. 16.

    Chasnoff IJ. Medical marijuana laws and pregnancy: implications for public health policy. Am J Obstet Gynecol. 2017;216:27–30.

  17. 17.

    Volkow ND, Compton WM, Wargo EM. The risks of marijuana use during pregnancy. JAMA. 2017;317:129–30.

  18. 18.

    Goler N, Conway A, Young-Wolff KC. Data are needed on the potential adverse effects of marijuana use in pregnancy. Ann Intern Med. 2018;169:492–3.

  19. 19.

    Oken E, Kleinman KP, Rich-Edwards J, Gillman MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr. 2003;3:6.

  20. 20.

    Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Klein NP, Cheetham TC, Naleway A, et al. Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes. JAMA 2014;312:1897–904.

  21. 21.

    Nordin JD, Kharbanda EO, Vazquez Benitez G, Lipkind H, Vellozzi C, Destefano F. Maternal influenza vaccine and risks for preterm or small for gestational age birth. J Pediatr. 2014;164:1051–7.

  22. 22.

    Kharbanda EO, Vazquez-Benitez G, Romitti PA, Naleway AL, Cheetham TC, Lipkind HS, et al. First trimester influenza vaccination and risks for major structural birth defects in offspring. J Pediatr. 2017;187:234–9.e4.

  23. 23.

    Kharbanda EO, Vazquez-Benitez G, Romitti PA, Naleway AL, Cheetham TC, Lipkind HS, et al. Identifying birth defects in automated data sources in the Vaccine Safety Datalink. Pharmacoepidemiol Drug Saf. 2017;26:412–20.

  24. 24.

    Bordet R, Pu Q, Puisieux F, Deplanque D, Jaboureck O, Leys D, et al. Susceptibility to provoked cerebral infarction is not increased in a rat model of pharmacologically-induced hypertension despite endothelial dysfunction. Fundam Clin Pharmacol. 2000;14:177–86.

  25. 25.

    Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: ages and Stages Questionnaires. J Pediatr Psychol. 1997;22:313–28.

  26. 26.

    Squires J, Twombly E, Bricker D, Potter L. Ages and stages questionnaires. 3rd ed. Baltimore: Paul H. Brookes Publishing; 2009.

  27. 27.

    Squires J, Bricker D, Twombly E. ASQ:SE-2 technical appendix. Brookes Publishing, Baltimore, MD; 2015.

  28. 28.

    Rothstein A, Miskovic A, Nitsch K. Brief review of psychometric properties and clinical utility of the ages and stages questionnaires, third edition for evaluating pediatric development. Arch Phys Med Rehabilit. 2017;98:809–10.

  29. 29.

    Schonhaut L, Armijo I, Schonstedt M, Alvarez J, Cordero M. Validity of the ages and stages questionnaires in term and preterm infants. Pediatrics. 2013;131:e1468–74.

  30. 30.

    American College of O, Gynecologists Committee on Obstetric P. Committee opinion no. 637: marijuana use during pregnancy and lactation. Obstet Gynecol. 2015;126:234–8.

  31. 31.

    Gunn JK, Rosales CB, Center KE, Nunez A, Gibson SJ, Christ C, et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open. 2016;6:e009986.

  32. 32.

    Massey SH, Mroczek DK, Reiss D, Miller ES, Jakubowski JA, Graham EK, et al. Additive drug-specific and sex-specific risks associated with co-use of marijuana and tobacco during pregnancy: evidence from 3 recent developmental cohorts (2003–2015). Neurotoxicol Teratol. 2018;68:97–106.

  33. 33.

    Luke S, Hutcheon J, Kendall T. Cannabis use in pregnancy in British Columbia and selected birth outcomes. J Obstet Gynaecol Can. 2019.

  34. 34.

    Corsi DJ, Walsh L, Weiss D, Hsu H, El-Chaar D, Hawken S, et al. Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes. JAMA. 2019.

  35. 35.

    Goldschmidt L, Richardson GA, Willford J, Day NL. Prenatal marijuana exposure and intelligence test performance at age 6. J Am Acad Child Adolesc Psychiatry. 2008;47:254–63.

  36. 36.

    Goldschmidt L, Day NL, Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 2000;22:325–36.

  37. 37.

    O'Leary C, Zubrick SR, Taylor CL, Dixon G, Bower C. Prenatal alcohol exposure and language delay in 2-year-old children: the importance of dose and timing on risk. Pediatrics. 2009;123:547–54.

  38. 38.

    Folger AT, Eismann EA, Stephenson NB, Shapiro RA, Macaluso M, Brownrigg ME, et al. Parental adverse childhood experiences and offspring development at 2 years of age. Pediatrics. 2018;141:e20172826;

  39. 39.

    Friedrich J, Khatib D, Parsa K, Santopietro A, Gallicano GI. The grass isn't always greener: The effects of cannabis on embryological development. BMC Pharmacol Toxicol. 2016;17:45.

  40. 40.

    Moir D, Rickert WS, Levasseur G, Larose Y, Maertens R, White P, et al. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol. 2008;21:494–502.

Download references


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.

Author information

Correspondence to Elyse Olshen Kharbanda.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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 (2020).

Download citation