Why we think it’s important 

This study is important because it highlights the increased risks associated with combined cannabis and nicotine use during pregnancy, including higher rates of infant and neonatal death, preterm delivery, and infants being small for gestational age. 

Introduction 

With the increasing legalization of cannabis across the United States, its use during pregnancy has become more prevalent, especially among younger, urban populations. Research has shown that prenatal cannabis exposure can lead to adverse perinatal outcomes such as stillbirth, preterm delivery, and infants being small for their gestational age. Meanwhile, the detrimental effects of nicotine use during pregnancy, including prematurity, low birth weight, and stillbirth, are well documented. However, the combined impact of both cannabis and nicotine use during pregnancy remains underexplored. This blog delves into recent findings from a population-based cohort study that investigates the combined effects of prenatal cannabis and nicotine exposure on maternal and neonatal health outcomes. 

Study Overview 

The study, conducted using data from more than 3.1 million pregnancies in California between 2012 and 2019, assessed the perinatal outcomes associated with combined cannabis and nicotine use compared to either substance alone. Researchers utilized linked hospital discharge data and vital statistics to identify pregnant individuals with a cannabis-related diagnosis or prenatal nicotine use, classifying them into four groups: nonusers, cannabis users, nicotine users, and combined cannabis and nicotine users. 

Key Findings 

  1. Increased Risk with Combined Use: The study found that combined use of cannabis and nicotine during pregnancy was associated with significantly higher risks of adverse maternal and neonatal outcomes compared to either substance alone. Specifically, the combined use group had increased rates of infant and neonatal death, infants being small for gestational age, and preterm delivery.
  2. Higher Rates of Maternal and Neonatal Morbidity: Pregnant individuals using both cannabis and nicotine were found to have higher rates of hypertensive disorders and severe maternal morbidity. Neonates born to these individuals were also more likely to require neonatal intensive care and experience respiratory distress syndrome, hypoglycemia, and bronchopulmonary dysplasia.
  3. Disproportionate Impact on Specific Populations: The study highlighted that individuals who used both substances during pregnancy were more likely to have public insurance or be uninsured, have fewer prenatal visits, and experience mental health disorders, chronic hypertension, and preexisting diabetes. These findings suggest that socioeconomic and health disparities may exacerbate the risks associated with combined prenatal substance use.

Implications for Public Health 

The study underscores the need for more effective public health measures and counseling strategies aimed at reducing combined prenatal use of cannabis and nicotine. Given the significant risks identified, healthcare providers should prioritize preconception and prenatal counseling, emphasizing the benefits of abstaining from both substances to optimize maternal and neonatal outcomes. 

Conclusion 

As cannabis use becomes more widespread, understanding its impact in conjunction with nicotine during pregnancy is crucial. This study provides compelling evidence that combined prenatal exposure to cannabis and nicotine poses a greater risk to both mothers and infants than either substance alone. These findings should guide healthcare practitioners in developing targeted interventions to mitigate these risks and support healthier pregnancies and birth outcomes. 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818383 

“Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure.” (B. A. Crosland, et al., JAMA Netw Open, 2024)