To examine associations between in utero marijuana exposure and birth outcomes.
In two separate cohorts (Appalachian, Rocky Mountain), data were collected from medical records. Marijuana exposure was positive based on urine drug screening at delivery, with nonexposed controls matched on multiple factors including other substance exposure.
Marijuana-exposed newborns (n = 531) had significantly worse birth outcomes than controls (n = 531), weighing 218 g less, 82%, 79%, and 43% more likely to be low birth weight, preterm, or admitted to the NICU, respectively, and significantly lower Apgar scores.
Marijuana exposure in utero predicted newborn factors linked to longer-term health and development issues. Effects were not attributable to other comorbidities in this study due to rigorous matching and biochemical verification of marijuana and other drug use. Findings add to growing evidence linking marijuana exposure to adverse birth and longer-term outcomes. Women should be encouraged to avoid marijuana use during pregnancy.
Subscribe to Journal
Get full journal access for 1 year
only $24.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
The Street. History of marijuana: origins, legality and what’s happening in 2018. https://www.thestreet.com/markets/history-of-marijuana-14718715.
Governing. State marijuana laws in 2018 map. http://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html.
Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, et al. Prevalence of marijuana use disorders in the United States between 2001–2002 and 2012–2013. JAMA Psychiatr. 2015;72:1235–42.
Center for Behavioral Health Statistics and Quality. Key substance use and mental health indicators in the United States: results from the 2015 National Survey on Drug Use and Health. NSDUH Series H-51. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.htm.
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. J Am Med Assoc. 2017;317:207–9.
Roberson EK, Patrick WK, Hurwitz EL. Marijuana use and maternal experiences of severe nausea during pregnancy in Hawai’i. Hawaii J Med Public Health. 2014;73:283–7.
Westfall RE, Janssen PA, Lucas P, Capler R. Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against ‘morning sickness’. Complement Ther Clin Pract. 2006;12:27–33.
Fried PA, O’Connell CM. A comparison of the effects of prenatal exposure to tobacco, alcohol, cannabis and caffeine on birth size and subsequent growth. Neurotoxicol Teratol. 1987;9:79–85.
Linn S, Schoenbaum SC, Monson RR, Rosner R, Stubblefield PC, Ryan KJ. The association of marijuana use with outcome of pregnancy. Am J Public Health. 1983;73:1161–4.
Fergusson DM, Horwood LJ, Northstone K. Maternal use of cannabis and pregnancy outcome. BJOG. 2002;109:21–7.
Day N, Sambamoorthi U, Taylor P, Richardson G, Robles N, Jhon Y, et al. Prenatal marijuana use and neonatal outcome. Neurotoxicol Teratol. 1991;13:329–34.
Zuckerman B, Frank DA, Hingson R, Amaro H, Levenson SM, Kayne H, et al. Effects of maternal marijuana and cocaine use on fetal growth. N. Engl J Med. 1989;320:762–8.
Crume TL, Juhl AL, Broosk-Russell A, Hall KE, Wymore E, Borgelt LM. Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. J Pediatr. 2018;197:90–6.
Gunn JK, Rosales CB, Center KE, Nuñez 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.
ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC. Changes in cannabis potency over the last 2 decades (1995–2014): analysis of current data in the United States. Biol Psychiatry. 2016;79:613–9.
Schempf AH. Illicit drug use and neonatal outcomes: a critical review. Obstet Gynecol Surv. 2007;62:749–57.
The authors would like to thank Jesi Hall, MA, for her management of the Appalachian cohort study. The authors also acknowledge support of the Johnson City Junior League, East Tennessee State University, Ballad Health System, and the Department of Obstetrics and Gynecology at the University of Colorado.
The Tennessee site portion of the study was funded in part by a grant from the Johnson City Junior League, and in-kind contributions from the Departments of Pediatrics and Family Medicine, and the Center for Prescription Drug Abuse and Misuse, at East Tennessee State University.. The Colorado site portion of the study was funded in part by support from the Department of Obstetrics and Gynecology, University of Colorado. None of the funding agencies had any role in the conduct of the study nor the interpretation of the findings.
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Bailey, B.A., Wood, D.L. & Shah, D. Impact of pregnancy marijuana use on birth outcomes: results from two matched population-based cohorts. J Perinatol 40, 1477–1482 (2020). https://doi.org/10.1038/s41372-020-0643-z
Prenatal Cannabinoid Exposure: Emerging Evidence of Physiological and Neuropsychiatric Abnormalities
Frontiers in Psychiatry (2021)
The impact of state legalization on rates of marijuana use in pregnancy in a universal drug screening population
The Journal of Maternal-Fetal & Neonatal Medicine (2020)
Regional Anesthesia & Pain Medicine (2020)