In Brief |Paediatrics | Addiction Medicine
New Evidence Strengthens Link Between Cannabis Use in Pregnancy and Poor Birth Outcomes
Time to read: 01:53
Time to listen: 04:18
Originally Published: 5 May 2025
Source: JAMA Paediatrics
Type of article: In Brief
MedED Catalogue Reference: MPIB022
Category: Paediatrics
Cross Reference: Addiction Medicine, Neonatal Care
Keywords: cannabis, neonatal outcomes, low birth weight, SGA, preterm
Key Takeaway
This article is a review of recent studies originally published in the JAMA Paediatrics, 5 May 2025 This article does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information.
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Cannabis is the most commonly used illicit drug globally, and its use is rising.
In South Africa, following the 2018 Constitutional Court ruling and the 2024 Cannabis for Private Purposes Act, personal use of cannabis has been decriminalised, shifting public perception and potentially increasing use among vulnerable groups. Studies show that up to 36% of South African youth aged 15–24 report recent cannabis use.1
Substance use during pregnancy is a significant public health concern in South Africa, where the use of multiple substances during pregnancy is common.2 In a survey of 5 232 pregnant women visiting midwife obstetric units in Cape Town, it was found that 36.9% used alcohol and drugs, 34.9% alcohol only, and 1.6% drugs only.3 Furthermore, a substudy of the Safe Passage Study (SPS) of the PASS (Prenatal Alcohol in Sudden infant death syndrome and Stillbirth) Network, on the value of maternal serum alpha-fetoprotein measurements, found that 61% of pregnant women smoked, 55% drank alcohol, and 9% and 5% used marijuana and methamphetamine, respectively.4
These trends underscore the urgency of understanding the potential risks of prenatal cannabis exposure in both global and African settings.
Study Purpose
This systematic review and meta-analysis, published in JAMA Paediatrics on 5 May 2025, aimed to update previous findings by assessing the association between prenatal cannabis use and a range of neonatal outcomes, using newer studies published up to April 2024.
Study Methodology
Meta-analyses were conducted using random-effects models, and outcomes were evaluated using the GRADE system to determine the quality of evidence.
Findings
The study found that cannabis use during pregnancy was significantly associated with:
These results reflect an upgrade in the quality of evidence from low to moderate certainty compared to prior reviews.
Conclusion
Prenatal cannabis use is linked to adverse neonatal outcomes, even when accounting for co-exposures such as tobacco. As cannabis becomes more accessible and socially accepted, especially in settings like South Africa, healthcare professionals should incorporate this evidence into antenatal screening and counselling practices. There is also a pressing need for targeted public health messaging and research to understand use trends better and mitigate risks in local contexts.
References
1. Mahomed, H., & Louw, A. (2024). Prevalence of cannabis use among South African youth aged 15–24. Frontiers in Psychiatry, 15, Article 1328318. https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1328318/full
2. Wechsberg, W. M., Browne, F. A., Carney, T., & Bonner, C. P. (2022). Substance use among pregnant women in Cape Town: Findings from a prospective cohort study. South African Medical Journal, 112(10), 731–736. https://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022001000009
3. Petersen Williams P, Jordaan E, Mathews C, Lombard C, Parry CDH. Alcohol and other drug use during pregnancy among women attending midwife obstetric units in the Cape Metropole, South Africa. Adv Prev Med 2014;2014:871427. https://doiorg/10.1155/2014/871427
4. Odendaal H, Geerts L, Nel D, Brink LT, Hitchcock E, Groenewald CA. Effects of alcohol, cigarettes, methamphetamine and marijuana exposure during pregnancy on maternal serum alpha-fetoprotein levels at 20-24 weeks' gestation. J Pediatr Neonatal Care 2018;8(1):73-82. https://doi.org/10.15406/jpnc.2018.08.00314
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