Researchers enrolled 417 pregnant women in their first trimester to prospectively track e-cigarette and cannabis exposure alongside maternal-infant outcomes — the first study of its kind in Appalachia.
Prenatal exposure researchers, obstetricians in high-prevalence regions, epidemiologists designing substance use pregnancy studies.
What the researchers found
The Mountain Mama & Baby Study established a prospective cohort of pregnant women in West Virginia, enrolling participants during their first-trimester telehealth visits with nurse navigators. Of 920 eligible women, 417 (45.3%) enrolled — more than double the 20% benchmark the researchers set.
The enrolled participants closely matched non-enrolled women across most sociodemographic characteristics including age, race/ethnicity, and marital status, suggesting the sample is representative of the broader obstetric population in the region.
The study's design addresses key limitations of prior prenatal exposure research: it captures exposure data prospectively in the first trimester (rather than relying on retrospective recall), collects biospecimens for objective exposure verification, and follows participants through delivery to link exposure to specific maternal-infant outcomes. The cohort will establish first and third trimester exposure rates for both e-cigarettes and cannabis in a population with high rates of substance use.
Why it matters
Most research on prenatal cannabis exposure relies on retrospective self-report or birth registry data, both of which underestimate actual use. This prospective design — capturing exposure early in the first trimester before many women even know they're pregnant in other studies — could produce more accurate prevalence estimates and stronger links to outcomes. West Virginia's high substance use rates make it a particularly important population to study.
The numbers in context
920 eligible women, 417 enrolled (45.3%, 95% CI: 42.1–48.6%). Benchmark enrollment rate was 20%. Enrolled and non-enrolled women were similar across most sociodemographic characteristics.
How the study worked
Prospective cohort study enrolling pregnant women during first-trimester telehealth visits at West Virginia University Medicine obstetric clinics. Recruitment via nurse navigators. Self-reported substance use data collected at enrollment with planned follow-up through delivery. Feasibility assessed by enrollment rate and representativeness compared to non-enrolled eligible patients.
Who was studied
N=417 pregnant women in their first trimester, recruited from West Virginia University Medicine obstetric clinics.
What this study cannot tell us
Single-center study in West Virginia, which may not generalize to other populations. The 45.3% enrollment rate, while exceeding benchmarks, means over half of eligible women did not participate. Self-reported substance use at enrollment may still underestimate actual use despite the prospective design. Outcomes data are not yet reported — this paper describes the study design and recruitment feasibility only.
How to read the evidence
Prospective cohort design paper — describes methodology and recruitment feasibility, with exposure and outcome data still forthcoming.
When this study was published
Published in 2026, describing an actively enrolling cohort. Exposure and outcome results are expected in future publications.
The bigger picture
This cohort study joins a growing body of prospective prenatal cannabis research. While animal studies (RTHC-00236, RTHC-00239) and large observational datasets like the ABCD Study (RTHC-00241) have documented associations between prenatal cannabis exposure and offspring outcomes, prospective cohorts with biospecimen collection can bridge the gap between those approaches — providing both the rigor of verified exposure data and the relevance of human outcomes.
Replication
Not stated in abstract.
Funding
Not reported in abstract.
Conflicts of interest
Not reported in abstract.
Questions still open
- What are the first-trimester e-cigarette and cannabis use rates in this Appalachian population? Do objective biospecimen measures confirm or diverge from self-reported use? Will this cohort have sufficient statistical power to detect associations between early cannabis exposure and specific birth outcomes?
Read the original research
Building the Mountain Mama and Baby Cohort: Study Design, Protocol, and Early Prenatal Clinic-based Recruitment Outcomes.
American journal of epidemiology
The American Journal of Epidemiology is a well-respected journal focusing on public health and epidemiological research.
Citation
Gibbs, Bethany Barone; Chmelik, Kathryn; Marshall, Elly M; Henggeler, Waylon K; Olfert, I Mark; Rowan, Shon; Lilly, Christa; Hodder, Sally L; Umer, Amna. (2026). Building the Mountain Mama and Baby Cohort: Study Design, Protocol, and Early Prenatal Clinic-based Recruitment Outcomes.. American journal of epidemiology. https://doi.org/10.1093/aje/kwag030
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