Among 168,589 pregnancies, children of mothers who used cannabis prenatally were 43% more likely to miss their 12-month well-child visit and 36% were missing two or more visits by age 3, compared to 23% of children from non-using mothers.
Pediatricians, obstetricians, and public health professionals working with pregnant cannabis users
168,589 pregnancies analyzed
What the researchers found
Maternal prenatal cannabis use was associated with more missed well-child visits at every time period from birth through 36 months. The strongest association was at the 12-month visit (aRR: 1.43, 95% CI: 1.32-1.54). By 36 months, 35.8% of children born to cannabis-using mothers had missed two or more visits compared to 23.0% of children from non-users.
Why it matters
Well-child visits are critical for catching developmental problems early, especially in children with potential prenatal exposures. Missing these visits means missed opportunities to identify and address any cannabis-related developmental effects.
The numbers in context
168,589 pregnancies; 3.4% screened positive for prenatal cannabis use; 12-month visit aRR: 1.43; 3-year visit aRR: 1.15; 35.8% vs 23.0% missed 2+ visits by 36 months
How the study worked
Longitudinal cohort study of 168,589 pregnancies in Kaiser Permanente Northern California (2011-2018). Prenatal cannabis use defined by self-report or positive urine toxicology. Well-child visits tracked across seven time periods from birth to 36 months. Modified Poisson regression adjusted for covariates.
What this study cannot tell us
Cannot determine why mothers who used cannabis missed more visits. Potential confounders include socioeconomic factors, other substance use, and mental health conditions. Cannabis screening may underidentify users. Single health system limits generalizability.
How to read the evidence
Large population-based cohort with objective cannabis screening, but observational design with potential unmeasured confounding
When this study was published
2023 study
The bigger picture
This creates a double vulnerability: children potentially affected by prenatal cannabis exposure are also less likely to receive the preventive care that could identify and address any resulting developmental issues. Addressing barriers to well-child visit attendance for this population should be a priority.
Questions still open
- What barriers to well-child visit attendance do cannabis-using mothers face? Would targeted outreach improve attendance? Is the missed-visit pattern driven by the same factors that led to prenatal cannabis use?
Common questions
Does prenatal cannabis use affect pediatric care attendance?
Why do cannabis-using mothers miss more visits?
Read the original research
Association between maternal prenatal cannabis use and missed child preventive care visits in an integrated health care delivery system in Northern California.
Preventive medicine, 175, 107716
Citation
Avalos, Lyndsay A; Oberman, Nina; Alexeeff, Stacey E; Croen, Lisa A; Adams, Sara R; Davignon, Meghan; Young-Wolff, Kelly C. (2023). Association between maternal prenatal cannabis use and missed child preventive care visits in an integrated health care delivery system in Northern California.. Preventive medicine, 175, 107716. https://doi.org/10.1016/j.ypmed.2023.107716
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