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.
OB/GYN providers caring for pregnant patients with opioid use disorder and addiction medicine specialists.
Cannabis declined from 29.8% to 16.5% across trimesters, but tobacco use remained constant
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Preliminary: observational study with self-reported substance use and limited diversity in a moderate-sized sample.
When this study was published
2025 study.
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.
Questions still open
- 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?
Common questions
Do pregnant women on opioids also use cannabis?
Did it matter whether opioids were prescribed or illicit?
Read the original research
Tobacco and cannabis use among pregnant women with prenatal opioid use.
Addictive behaviors, 170, 108442
Citation
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
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