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

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).

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.

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 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.

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.