Prenatal Cannabis Use Disorder Linked to 40% Higher Risk of Infant Death in First Year | Research

The takeaway

Among 34,544 California births with maternal cannabis use disorder, infant mortality in the first year was 1.0% compared to 0.4% without CUD, with the excess risk driven by perinatal conditions and sudden unexpected infant death.

Obstetricians, pediatricians, and pregnant individuals with cannabis use disorder

1.0% vs 0.4% infant mortality

What the researchers found

Infant death in the first year was more common with maternal CUD (1.0% vs 0.4%; adjusted RR: 1.4, 95% CI: 1.2-1.6). The increased risk was attributable specifically to perinatal conditions and sudden unexpected infant death (SUID). After adjustment for sociodemographics, psychiatric comorbidities, and other substance use, there was no increased risk of infant hospitalizations or emergency department visits.

Why it matters

While previous research has focused on birth outcomes like preterm delivery, this study extends the risk window to the entire first year of life. The link to sudden unexpected infant death is particularly concerning and could inform postnatal monitoring recommendations.

The numbers in context

34,544 births with CUD (1.0% of all births); infant death 1.0% vs 0.4%; aRR 1.4 (95% CI: 1.2-1.6); excess deaths from perinatal conditions and SUID; CUD prevalence increased over study period; no increased ER visits or hospitalizations

How the study worked

Population-based retrospective cohort study of all singleton live births in California from 2011-2018 using hospital discharge data linked with vital statistics. Cannabis use disorder classified from ICD codes. Adjusted for sociodemographic variables, psychiatric comorbidities, and other substance use disorders.

What this study cannot tell us

CUD diagnosed by ICD codes may capture more severe cases than typical cannabis use. Cannot separate the effects of cannabis itself from associated behaviors and socioeconomic factors. Adjusted models may not capture all confounding. No information on postnatal cannabis or other substance use.

How to read the evidence

Large population-based cohort with administrative data and adjustment for multiple confounders, though ICD-coded CUD may not represent typical cannabis use

When this study was published

2023 study

The bigger picture

The finding that excess infant mortality is driven by SUID raises questions about whether prenatal cannabis exposure affects infant arousal responses or whether postnatal factors associated with CUD (smoking, unsafe sleep environments) mediate the risk.

Questions still open

Does prenatal cannabis exposure directly affect infant arousal mechanisms? Is the SUID risk mediated by postnatal factors like co-sleeping or secondhand smoke? Would enhanced safe-sleep education for cannabis-using mothers reduce this risk?

Common questions

Does cannabis use during pregnancy affect infant survival?

This study found that maternal cannabis use disorder was associated with a 40% higher risk of infant death in the first year, primarily from perinatal conditions and sudden unexpected infant death. However, the study cannot prove cannabis itself caused the deaths.

Were infants of cannabis users hospitalized more often?

No. After adjustment for other factors, there was no increased risk of infant hospitalizations or emergency department visits. The excess risk was specifically for infant mortality.

Read the original research

Prenatal cannabis use disorder and infant hospitalization and death in the first year of life.

Drug and alcohol dependence, 242, 109728

View on PubMed ↗Publisher’s paper ↗

Citation

Bandoli, Gretchen; Delker, Erin; Schumacher, Benjamin T; Baer, Rebecca J; Kelly, Ann E; Chambers, Christina D. (2023). Prenatal cannabis use disorder and infant hospitalization and death in the first year of life.. Drug and alcohol dependence, 242, 109728. https://doi.org/10.1016/j.drugalcdep.2022.109728