Impact of pregnancy marijuana use on birth outcomes: results from two matched population-based cohorts



To examine associations between in utero marijuana exposure and birth outcomes.

Study design

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.

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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.

Author information




BAB and DLW designed the Appalachian cohort study and oversaw the data collection. BAB supervised the Rocky Mountain database, finalized the datasets for both the Appalachian and Rocky Mountain cohorts, and performed all data analysis. BAB wrote the initial draft of the manuscript, and DLW and DS provided edits and contributed to the final version. DLW and DS provided clinical expertise for the interpretation of the study findings.

Corresponding author

Correspondence to Beth A. Bailey.

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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).

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