Systematically Testing the Evidence on Marijuana

Effects of Prenatal Cannabis Use

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Effects of Prenatal Cannabis Use

Cannabis is the most commonly used federally illegal drug during pregnancy,1 with self-reported use rates of 7% during pregnancy.2,3 Popular methods of cannabis use include smoking, edibles, vaping, and topicals.4 The two most common cannabis compounds found in these products are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Patients frequently report using cannabis during pregnancy mainly to help with nausea, stress, sleep, and appetite changes.5,6

The US Surgeon General, Centers for Disease Control and Prevention, and the American College of Obstetricians and Gynecologists (ACOG) advise pregnant and lactating patients to abstain from cannabis use.1,7,8 Yet due to limited perinatal data and mixed outcomes, patients and healthcare providers may be unsure about safe levels of prenatal cannabis use.9 The main psychoactive component in cannabis is THC, which can cross the placenta and has plausible maternal and fetal effects.

Effects on maternal outcomes

  • There is a possible increased risk of maternal anemia,10 gestational hypertension, pre-eclampsia, and maternal morbidity.11,12
  • Cannabis use is associated with increased nausea and vomiting in early pregnancy, but this may be confounded with patients self-treating nausea symptoms with cannabis.13
  • Cannabis use alone is also associated with higher concomitant mood disorders.14

Effects on perinatal outcomes

  • There is moderate-certainty evidence that prenatal THC exposure is associated with increased odds of low birth weight, preterm birth, and small for gestational age.15
    • There was a dose-response association with increasing likelihood of low birth weight, preterm birth, and small for gestational age with heavier cannabis use.15
  • There is low-certainty evidence for increased odds of perinatal mortality (stillbirth or fetal demise).15
  • Some studies suggest an increased risk of neonatal intensive care admission and infant death.2,10,16-18
  • The limited literature on teratogenicity is conflicting and inconsistent,19 but includes reports of fetal anomalies with maternal THC use such as acrania, gastroschisis, esophageal atresia, and congenital diaphragmatic hernia.20
  • An association with cannabis use and placental abruption has been described.12

Effects on long-term neurodevelopmental outcomes

The data regarding long-term neurodevelopment impacts of cannabis use in pregnancy is also mixed. Some studies have reported an association between prenatal cannabis exposure and neurobehavioral changes, mental health issues, autism spectrum disorder, attention-deficit hyperactivity disorder (ADHD), attention problems, attention scores, and learning disorders.16,21-25 Other studies have not demonstrated an association with childhood cognitive impairments.24,26,27

Clinical considerations

Properties of cannabinoids with plausible therapeutic potential in pregnancy include analgesia, muscle relaxation, immunosuppression, anti-inflammation, anti-allergic effects, sedation, improvement of mood, stimulation of appetite, anti-emesis, lowering of intraocular pressure, bronchodilation, neuroprotection, and antineoplastic effects. However, due to emerging data suggesting also potential adverse effects, currently, the US Food and Drug Administration (FDA) has not approved the use of either THC or CBD for any of these therapeutic uses in pregnancy.

Cannabinoid hyperemesis syndrome (CHS) is important to differentiate from hyperemesis gravidarum. Clinicians should consider CHS in all patients with chronic cannabis use or an atypical course of presumed hyperemesis gravidarum.28

  • Rates of CHS in pregnancy have not been well established due to underreporting and underdiagnosis.
  • Unlike hyperemesis gravidarum, CHS often is associated with intractable emesis relieved by frequent hot bathing or shower and is ultimately treated by abstaining from cannabis for at least 2 weeks.
  • This should also be differentiated from cannabis withdrawal which can have a similar, but different, clinical presentation. Cannabis withdrawal can present with irritability, insomnia, loss of appetite, and abdominal pain.29

How healthcare providers can counsel pregnant patients on cannabis use

There is inadequate counseling on cannabis use in pregnancy.30 ACOG recommends clinicians ask all patients about their use of substances, including cannabis, before conception or in early pregnancy. This can be a standard set of questions asked of all patients as part of the detailed initial prenatal intake visit. Healthcare providers should consider a harm reduction approach when abstinence is not realistic to mitigate potential maternal and neonatal risks by educating patients on cannabis effects during pregnancy and lactation.31 Co-use of nicotine and cannabis is associated with worse maternal and neonatal outcomes, including neonatal death, infant death, small for gestational age, and preterm delivery, and may be an opportunity for harm reduction counseling.32

Bottom Line

Cannabis use during pregnancy may be associated with serious perinatal adverse effects, with no known safe or beneficial level of cannabis exposure during pregnancy. Older studies are limited by methodologic issues, small sample sizes, lack of confirmatory testing, and difficulty controlling for potential confounders. Additionally, the amount and potency of cannabis was variable and often imprecisely defined. Most studies focused on smoked cannabis rather than other delivery methods, and THC in older studies was less potent than current formulations.

Healthcare providers should be nonjudgmental when asking patients about cannabis use, preferably as part of the routine intake information gathering at the initial prenatal visit. A shared decision-making approach with the patient is recommended, discussing potential adverse effects of cannabis use in pregnancy, limitations of safety data, and offer support and harm reduction advice when abstinence is not realistic.

Suggested Citation: Prewitt K, Ryan K, Lo J. Effects of prenatal cannabis use. The Systematically Testing the Evidence on Marijuana Project; 2022; revised March 2026. https://www.cannabisevidence.org/clinician-resources/clinician-briefs/effects-of-prenatal-cannabis-use/

Author Affiliations: All authors are affiliated with Oregon Health & Science University, Portland, OR.

Acknowledgments: Thank you to Laura Borgelt, PharmD, MBA and Kelly Young-Wolff, PhD, MPH for critically reviewing this document.

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References

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