Over 80% of Pregnant Women on Opioids Also Used Tobacco, and Cannabis Use Decreased Through Pregnancy
Among 206 pregnant women with verified opioid use, over 80% also used tobacco products, about 30% used cannabis in the first trimester (declining to 17% by the third), with similar patterns regardless of whether opioids were prescribed or illicit.
Quick Facts
What This Study Found
Tobacco use remained consistently high across all trimesters (no significant decline, p=0.28), including e-cigarette products (p=0.18). Cannabis use decreased significantly from 29.8% in the first trimester to 16.5% in the third (p=0.0003). There were no differences in tobacco or cannabis patterns between those on medication for OUD only versus those using other opioids.
Key Numbers
206 pregnant women, mean age 30.7 years, 81.9% non-Hispanic White, 92.6% public insurance. MOUD-only group: 54.9% tobacco only, 3.3% cannabis only, 26.4% both. Cannabis: 29.8% first trimester to 16.5% third trimester (p=0.0003). Tobacco use consistent across trimesters (p=0.28).
How They Did This
Observational study of 206 pregnant women with biochemically verified opioid use. 98 reported taking only medications for OUD, 108 reported other opioids. Self-reported tobacco and cannabis use assessed overall and by trimester.
Why This Research Matters
Pregnant women with opioid use disorder face compounding risks from polysubstance use. The high rate of tobacco use that does not decline, combined with cannabis use in nearly a third, highlights the need for comprehensive substance use intervention during prenatal care.
The Bigger Picture
The finding that cannabis use declined through pregnancy while tobacco did not suggests pregnant women may be more responsive to messaging about cannabis risks than tobacco risks, or that cannabis cessation is easier during pregnancy than tobacco cessation.
What This Study Doesn't Tell Us
Self-reported substance use may underestimate actual use. Predominantly non-Hispanic White sample with public insurance limits generalizability. Cannot determine whether cannabis reduction was voluntary or due to other factors. Small subsample sizes.
Questions This Raises
- ?Why does cannabis use decline through pregnancy while tobacco does not?
- ?Are current prenatal tobacco cessation programs adequate for this population?
- ?Should prenatal care for OUD patients specifically address polysubstance use?
Trust & Context
- Key Stat:
- Cannabis declined from 29.8% to 16.5% across trimesters, but tobacco use remained constant
- Evidence Grade:
- Preliminary: observational study with self-reported substance use and limited diversity in a moderate-sized sample.
- Study Age:
- 2025 study.
- Original Title:
- Tobacco and cannabis use among pregnant women with prenatal opioid use.
- Published In:
- Addictive behaviors, 170, 108442 (2025)
- Authors:
- Mahabee-Gittens, E Melinda, Mack, Nicole, Bann, Carla M, Newman, Jamie E, Zhao, Junfang, Setchell, Kenneth D R, Stone, Lara, Ambalavanan, Namasivayam, Peralta-Carcelen, Myriam, DeMauro, Sara B, Lorch, Scott A, Wilson-Costello, Deanne E, Poindexter, Brenda B, Limperopoulos, Catherine, Davis, Jonathan M, Merhar, Stephanie L
- Database ID:
- RTHC-07018
Evidence Hierarchy
Watches what happens naturally without intervening.
What do these levels mean? →Frequently Asked Questions
Do pregnant women on opioids also use cannabis?
Yes. About 30% used cannabis in the first trimester, declining to 17% by the third. Most who used cannabis also used tobacco products.
Did it matter whether opioids were prescribed or illicit?
No. Tobacco and cannabis use patterns were virtually identical (p=0.98) between those taking only medications for OUD and those using other opioids.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-07018APA
Mahabee-Gittens, E Melinda; Mack, Nicole; Bann, Carla M; Newman, Jamie E; Zhao, Junfang; Setchell, Kenneth D R; Stone, Lara; Ambalavanan, Namasivayam; Peralta-Carcelen, Myriam; DeMauro, Sara B; Lorch, Scott A; Wilson-Costello, Deanne E; Poindexter, Brenda B; Limperopoulos, Catherine; Davis, Jonathan M; Merhar, Stephanie L. (2025). Tobacco and cannabis use among pregnant women with prenatal opioid use.. Addictive behaviors, 170, 108442. https://doi.org/10.1016/j.addbeh.2025.108442
MLA
Mahabee-Gittens, E Melinda, et al. "Tobacco and cannabis use among pregnant women with prenatal opioid use.." Addictive behaviors, 2025. https://doi.org/10.1016/j.addbeh.2025.108442
RethinkTHC
RethinkTHC Research Database. "Tobacco and cannabis use among pregnant women with prenatal ..." RTHC-07018. Retrieved from https://rethinkthc.com/research/mahabee-gittens-2025-tobacco-and-cannabis-use
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.