A sweeping new meta-analysis published in JAMA Paediatrics has sounded the alarm on marijuana use during pregnancy, linking it to a wide range of serious health risks for unborn babies — including premature birth, low birth weight, and even perinatal death.
Led by Dr Jamie Lo, an obstetrician and associate professor at Oregon Health & Science University, the study is one of the most comprehensive reviews to date, analysing 51 studies involving more than 21 million pregnancies. The key finding: cannabis use during pregnancy was associated with a 52% higher risk of preterm delivery, a 75% higher chance of low birth weight, and a 29% increased risk of infant death.
“The most striking finding is the increased risk of perinatal mortality — death either during the pregnancy or shortly after,” Dr Lo said.
Lo’s team also cited evidence showing reduced oxygen and blood flow through the placenta in cannabis users, which could severely impair foetal lung development and overall growth.
Despite mounting evidence of harm, cannabis use during pregnancy is on the rise. According to the National Institute on Drug Abuse, usage more than doubled between 2002 and 2017 among pregnant women, particularly during the first trimester — often for recreational, not medical, reasons.
Experts warn this trend may be driven by the false perception that marijuana, being plant-based, is safe.
“I remind my patients that opium and heroin are also plant-based,” said Lo. “Tobacco is a plant, and alcohol is made from plants too — natural does not mean safe.”
Unlike alcohol or opioids, cannabis’s impacts on pregnancy are less well-known, in part because ethical concerns prevent randomised trials on expectant mothers. But scientists are increasingly relying on self-reported data and observational studies, many of which now point to consistent, concerning patterns.
The review used the GRADE system to assess the quality of evidence. Just a year ago, research in this area was rated as “very low certainty”. That’s now been upgraded to “low to moderate”, meaning experts are growing more confident in the findings — though further research is still needed.
“Research is evolving quickly,” said Brianna Moore, an epidemiologist at the Colorado School of Public Health. “This review gives more certainty that prenatal exposure to cannabis is associated with adverse birth outcomes.”
The rising use of marijuana — combined with legalisation in several states — has created confusion among both patients and doctors. Public health messaging has lagged behind legalisation, leaving many without clear guidance.
“Health care providers are poor at counselling due to confusion over conflicting studies,” Lo explained. “We’re trying to change that by producing updated, evidence-based materials for clinicians.”
Cannabis has also been linked to other health risks beyond pregnancy, including stroke, heart attack, cognitive decline, psychosis in youth, and long-term mental health disorders.
In some cases, heavy users experience repeated vomiting episodes and increased emergency hospital visits.
Ultimately, experts agree that avoiding marijuana altogether during pregnancy is the safest course.
“Ideally, it’s best not to be exposed to THC — the psychoactive compound in cannabis — during pregnancy, no matter the form,” Lo emphasised.
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