Summary: A new study highlights the compounded risks of using both cannabis and nicotine during pregnancy. The research reveals that simultaneous use of these substances significantly increases the chances of adverse newborn outcomes, such as preterm delivery, small gestational size, and infant mortality.
The researchers emphasize the need for enhanced preconception and prenatal counseling to mitigate these risks. The study’s findings advocate for greater awareness and targeted education to help pregnant individuals understand and manage the dangers of combined substance use.
Key Facts:
- Heightened Risk with Dual Use: Infants born to mothers using both cannabis and nicotine face a fourfold increase in mortality rates compared to non-users, and double that of those using either substance alone.
- Need for Better Counseling: The research underscores the critical need for healthcare providers to discuss the specific risks of combined cannabis and nicotine use during pregnancy.
- Ongoing Research and Interventions: The study supports ongoing efforts like prenatal vitamin C supplementation, which has shown potential in mitigating respiratory issues in children born to smokers.
Source: Oregon Health and Science University
Oregon Health & Science University researchers in a new study report that combined cannabis and nicotine use during pregnancy is associated with significantly higher risk of poor health outcomes for newborns compared with use of either substance alone.
The study, published today in JAMA Network Open, found infants born to mothers who used both substances throughout pregnancy were at greater risk of being small for gestational size, undergoing preterm delivery, or even death.
With approximately half of individuals who use cannabis in pregnancy also using tobacco or nicotine products, the findings suggest the need for more effective clinical counseling early on, during the preconception and prenatal periods, said the study’s corresponding author, Jamie Lo, M.D., M.C.R., associate professor of obstetrics and gynecology (maternal-fetal medicine) in the OHSU School of Medicine and Division of Reproductive and Developmental Sciences at OHSU’s Oregon National Primate Research Center.
“With the growing legalization of cannabis around the country, there is often a perception that cannabis is safe in pregnancy,” Lo said.
“Because we know that many people who use cannabis often use tobacco or nicotine products, we wanted to better understand the potential health implications on both the pregnant individual and the infant.
“There is still a great deal of stigma around the use of substances during pregnancy,” she continued.
“With limited research to support official clinical recommendations, it can be a difficult topic for both patients and providers to navigate. Our hope is that this research supports more open and productive conversations that ultimately result in a healthier pregnancy.”
Researchers evaluated hospital discharge data and vital statistics from more than 3 million pregnant patients with documented cannabis and nicotine use.
Compared with people who didn’t use any substances, those using cannabis or nicotine alone had increased rates of infant and newborn death, small gestational size and preterm delivery — but the risk was even higher when both cannabis and nicotine were used together.
Most notable was the rate of infant death, which was four times higher in users of both cannabis and nicotine compared with non-users. The rate was nearly two times higher compared with users of just cannabis or nicotine alone.
The research team says these findings can help guide health care professionals with preconception and prenatal counseling, especially regarding the benefits of quitting at least one of the two substances.
They also support expanded efforts to educate pregnant people about the risks of cannabis and nicotine.
“We hope that pregnant individuals can abstain from using both cannabis and nicotine products. However, we acknowledge the complexities of individual circumstances may make this goal challenging, and for some patients is simply not realistic,” said Adam Crosland, M.D., M.P.H., assistant professor of obstetrics and gynecology in the OHSU School of Medicine and lead author of the study.
“We always strive to meet people where they are and support patients with evidence-based recommendations and treatment options that are both patient-centered and promote the healthiest outcomes possible.
“Our findings suggest that avoiding use of just one of these substances can decrease the pregnancy risks we see when both substances are used together, which is a critical piece of information providers can highlight when counseling patients.”
The multidisciplinary research team also included Eliot Spindel, M.D., Ph.D., and Cindy McEvoy, M.D., M.C.R., who are investigating how to mitigate the negative respiratory outcomes among children born to parents who smoke during pregnancy.
McEvoy’s team found that vitamin C supplementation to pregnant women unable to quit smoking cigarettes significantly improves airway function and respiratory health in their offspring; moreover, these improved outcomes persist through age 5 and these children are in continued follow-up through adolescence.
Looking ahead, researchers will continue to investigate the effects of combined cannabis and nicotine use — including the influence of potency, frequency and timing — in order to better educate pregnant patients about the harms of use.
Additionally, the team will continue to explore the viability of prenatal interventions, such a vitamin C supplementation, and other treatment options for individuals who are unable to quit smoking during their pregnancy.
Funding: This work was supported by the National Institute on Drug Abuse, part of the National Institutes of Health, under grants DP1DA056493-01 and P51OD011092. The content presented in this release is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.
About this smoking and pregnancy research news
Author: Nicole Rideout
Source: Oregon Health and Science University
Contact: Nicole Rideout – Oregon Health and Science University
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure” by Jamie Lo et al. JAMA
Abstract
Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure
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.
Design, Setting, and Participants
This retrospective population-based cohort study included linked hospital discharge data (obtained from the California Department of Health Care Access and Information) and vital statistics (obtained from the California Department of Public Health) from January 1, 2012, through December 31, 2019. Pregnant individuals with singleton gestations and gestational ages of 23 to 42 weeks were included. Data were analyzed from October 14, 2023, to March 4, 2024.
Exposures
Cannabis-related diagnosis and prenatal nicotine product use were captured using codes from International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification.
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.
Results
A total of 3 129 259 pregnant individuals were included (mean [SD] maternal age 29.3 [6.0] years), of whom 23 007 (0.7%) had a cannabis-related diagnosis, 56 811 (1.8%) had a nicotine-use diagnosis, and 10 312 (0.3%) had both in pregnancy.
Compared with nonusers, those with cannabis or nicotine use diagnoses alone had increased rates of infant (0.7% for both) and neonatal (0.3% for both) death, small for gestational age (14.3% and 13.7%, respectively), and preterm delivery (<37 weeks) (12.2% and 12.0%, respectively).
Moreover, risks in those with both cannabis and nicotine use were higher for infant death (1.2%; adjusted risk ratio [ARR], 2.18 [95% CI, 1.82-2.62]), neonatal death (0.6%; ARR, 1.76 [95% CI, 1.36-2.28]), small for gestational age (18.0%; ARR, 1.94 [95% CI, 1.86-2.02]), and preterm delivery (17.5%; ARR, 1.83 [95% CI, 1.75-1.91]).
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.
