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Prenatal Cannabis Use and Neonatal Outcomes: A Systematic Review and Meta-Analysis.

Jamie O Lo1, Chelsea K Ayers2, Snehapriya Yeddala3

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Prenatal cannabis use is linked to increased risks of low birth weight, preterm birth, and small for gestational age. Heavy cannabis use during pregnancy further elevates these risks, with moderate certainty for most outcomes.

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Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Health
  • Public Health

Background:

  • Cannabis use during pregnancy has risen significantly, becoming the most common illicit substance use in the antenatal period.
  • Tetrahydrocannabinol (THC) crosses the placenta, potentially impacting fetal development.
  • Limited definitive data on risks leads to insufficient clinical counseling regarding prenatal cannabis use.

Purpose of the Study:

  • To provide an updated assessment of the association between prenatal cannabis use and pregnancy, fetal, and neonatal outcomes.
  • To adjust for key confounders, including tobacco use.
  • To synthesize evidence from recent cohort and case-control studies.

Main Methods:

  • Updated systematic review and meta-analysis of studies published between November 2021 and April 2024.
  • Inclusion criteria: comparison of cannabis use versus no/less use during pregnancy, with confounder adjustment.
  • Primary outcomes: preterm birth (PTB), small for gestational age (SGA), low birth weight (LBW), and perinatal morbidity.
  • Two independent researchers assessed study eligibility, risk of bias, and certainty of evidence.

Main Results:

  • Analysis of 51 publications (over 21 million patients) revealed increased odds of LBW (OR, 1.75), PTB (OR, 1.52), and SGA (OR, 1.57) associated with prenatal cannabis use.
  • Heavy cannabis use demonstrated stronger associations: higher odds of LBW (OR, 2.36), PTB (OR, 1.95), and SGA (OR, 1.63).
  • A low certainty of evidence suggested increased odds of perinatal mortality (OR, 1.29) with cannabis use.

Conclusions:

  • Prenatal cannabis use is associated with increased risks of LBW, PTB, and SGA with moderate certainty.
  • Evidence suggests a dose-dependent relationship, with heavy use posing greater risks.
  • Further research and clinical guidance are warranted due to the identified adverse fetal and neonatal outcomes.