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Prenatal Substance Exposure and Birth Weight: Findings From the HEALthy Brain and Child Development Study

Gretchen Bandoli1, Catherine Psaras1, Ludmila N Bakhireva2

  • 1Department of Pediatrics, University of California San Diego, La Jolla, California.

Pediatrics
|May 25, 2026
PubMed

Insights

Prenatal cannabis and opioid exposure were linked to lower birth weight and smaller size for gestational age in newborns. Nicotine and alcohol exposures did not show significant associations with birth outcomes in this study.

Area of Science:

  • Perinatal health
  • Developmental toxicology
  • Maternal-fetal medicine

Background:

  • Prenatal exposure to substances like nicotine, alcohol, cannabis, and opioids is a significant public health concern.
  • Understanding the impact of these exposures on fetal development is crucial for improving infant health outcomes.
  • Existing literature presents inconsistent findings regarding the effects of various prenatal substance exposures.

Purpose of the Study:

  • To investigate the associations between prenatal exposure to nicotine, alcohol, cannabis, and opioids and key birth outcomes.
  • To estimate the impact of these exposures on gestational age, birth weight, and birth weight for gestational age.
  • To contribute evidence to the understanding of substance use during pregnancy and its consequences.

Main Methods:

  • Utilized data from the HEALthy Brain and Child Development (HBCD) Study, a multisite, longitudinal US study.
  • Assessed substance exposures using maternal self-report, toxicology, and newborn diagnoses.
  • Employed multilevel mixed-effect regression models to estimate associations with birth outcomes.

Main Results:

  • Cannabis (17%) and opioid (5%) exposures were significantly associated with lower birth weight and birth weight centiles.
  • Cannabis exposure was linked to a decrease of 272.2g in birth weight and 8.2 centiles.
  • Opioid exposure was associated with a 295.4g reduction in birth weight and a 14.4 centile decrease.
  • Nicotine and alcohol exposures showed similar trends but did not reach statistical significance.
  • No significant associations were found between any of the studied exposures and gestational age.

Conclusions:

  • Prenatal exposure to cannabis and opioids is associated with reduced birth size, supporting existing, albeit inconsistent, research.
  • These findings highlight the importance of addressing substance use during pregnancy.
  • Future research within the HBCD Study will explore dose-response relationships and long-term childhood outcomes.
Abstract

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