Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure

Key Points

Question:  Is in utero exposure to cannabis and nicotine in combination associated with greater adverse outcomes than exposure to either substance alone during pregnancy?

Findings: In this population-based cohort study of more than 3.1 million pregnant individuals, combined use of cannabis and nicotine products in pregnancy was associated with an increased risk of maternal and neonatal morbidity compared with use of either substance alone, including infant and neonatal death, infants small for gestational age, and preterm delivery.

Meaning: These findings suggest that more effective public health measures and counseling prior to conception and during pregnancy are warranted to mitigate the potential for adverse offspring outcomes from combined prenatal cannabis and nicotine use.

Abstract

Importance: The prevalence of cannabis use in pregnancy is rising and is associated with adverse perinatal outcomes. In parallel, combined prenatal use of cannabis and nicotine is also increasing, but little is known about the combined impact of both substances on pregnancy and offspring outcomes compared with each substance alone.

Objective: To assess the perinatal outcomes associated with combined cannabis and nicotine exposure compared with each substance alone during pregnancy.

Main Outcome and Measures: The main outcomes were infant and neonatal death, infants small for gestational age, and preterm delivery. Results were analyzed by multivariable Poisson regression models.

Conclusions and Relevance: These findings suggest that co-occurring maternal use of cannabis and nicotine products in pregnancy is associated with an increased risk of infant and neonatal death and maternal and neonatal morbidity compared with use of either substance alone. Given the increasing prevalence of combined cannabis and nicotine use in pregnancy, these findings can help guide health care practitioners with preconception and prenatal counseling, especially regarding the benefits of cessation. 

(Source: Substance Use and Addiction Medicine | JAMA Network Open | JAMA Network )