Prenatal Cannabis Use Disorder Was Linked to 86% Higher Odds of Infant Death in a Study of 2.4 Million Births | Research

The takeaway

In a study of 2.38 million California births, prenatal cannabis use disorder was associated with significantly increased risks of preterm delivery, small-for-gestational-age infants, NICU admission, severe maternal morbidity, and an 86% higher odds of infant death.

OB/GYNs, prenatal care providers, pregnant individuals using cannabis, public health officials.

86% higher odds of infant death with prenatal cannabis use disorder (2.4 million births)

What the researchers found

Among 2,380,446 births, 9,144 (0.38%) had prenatal cannabis use disorder. Significant associations were found with gestational hypertension (AOR 1.19), preeclampsia (AOR 1.16), preterm delivery (AOR 1.45), severe maternal morbidity (AOR 1.22), respiratory distress syndrome (AOR 1.16), small for gestational age (AOR 1.47), NICU admission (AOR 1.24), and infant death (AOR 1.86). Stillbirth was not significantly increased (AOR 0.96).

Why it matters

This is one of the largest studies of prenatal cannabis use disorder and perinatal outcomes. The 86% increased odds of infant death is a striking finding that should inform preconception and prenatal counseling, especially as cannabis use in pregnancy becomes more common.

The numbers in context

2,380,446 births. 9,144 (0.38%) with cannabis use disorder. Preterm: AOR 1.45. SGA: AOR 1.47. NICU: AOR 1.24. Severe maternal morbidity: AOR 1.22. Infant death: AOR 1.86. Stillbirth: AOR 0.96 (not significant).

How the study worked

Retrospective cohort using California linked hospital discharge-vital statistics data. Singleton, nonanomalous births 23-42 weeks. Chi-squared tests and multivariable logistic regression adjusting for relevant confounders.

What this study cannot tell us

Observational study cannot prove causation. Cannabis use disorder identified by ICD codes, which captures only diagnosed cases and misses many users. Cannot determine dose, timing, or type of cannabis. Confounding by other substance use or socioeconomic factors possible despite adjustment.

How to read the evidence

Very large population-based cohort with adjusted analyses, limited by ICD-code-based exposure identification.

When this study was published

Published 2023, using California vital statistics data.

The bigger picture

The finding that infant death risk was elevated even after adjusting for confounders is particularly concerning. As cannabis use disorder in pregnancy becomes more prevalent with legalization, these findings have growing public health importance for prenatal counseling and screening.

Questions still open

What is the mechanism by which prenatal cannabis increases infant mortality?
Would early identification and treatment of cannabis use disorder in pregnancy improve outcomes?

Common questions

Does cannabis use during pregnancy increase the risk of infant death?

This study of 2.38 million births found prenatal cannabis use disorder was associated with 86% higher odds of infant death, along with increased risks of preterm birth, small babies, and NICU admission.

How common is cannabis use disorder in pregnancy?

0.38% of births in this California study had documented cannabis use disorder. The true rate is likely higher since many cases go undiagnosed.

Read the original research

Impact of Prenatal Cannabis Use Disorder on Perinatal Outcomes.

Journal of addiction medicine, 17(3), e192-e198

View on PubMed ↗Publisher’s paper ↗

Citation

Prewitt, Kristin C; Hayer, Sarena; Garg, Bharti; Benson, Ashley E; Hedges, Madeline A; Caughey, Aaron B; Lo, Jamie O. (2023). Impact of Prenatal Cannabis Use Disorder on Perinatal Outcomes.. Journal of addiction medicine, 17(3), e192-e198. https://doi.org/10.1097/ADM.0000000000001123