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  • A new study showed that the combined use of cannabis and nicotine during pregnancy was associated with an increased risk of maternal and neonatal morbidity.
  • Experts explained that it’s best to steer clear of both substances while pregnant.
  • It is important to raise awareness that just because cannabis may be legal in some states, it does not mean it is safe during pregnancy.

A new study found that using both cannabis and nicotine products during pregnancy was linked with a greater risk of maternal and neonatal morbidity compared with using just one substance. This included infant and neonatal death, infants small for gestational age, and preterm birth.

The findings were published in JAMA Network Open.

Researchers examined data on pregnant individuals with singleton gestations and gestational ages of 23 to 42 weeks from the California Department of Health Care Access and Information and the California Department of Public Health.

“The most compelling aspect of this study was the increased rate of infant death with co-use, which was four times higher in users of cannabis and nicotine combined compared with nonusers, and nearly two times higher compared with users of either cannabis or nicotine alone,” the study’s corresponding author, Jamie Lo, M.D., M.C.R., told Healthline.

“This information helps inform patient counseling where ideally patients would abstain from using cannabis and nicotine during pregnancy, but for those who are unable to, even avoiding the use of one of these substances can reduce the pregnancy risks that we see when nicotine and cannabis are used together.”

Lo added: “Next steps are to look at the impact of dose, timing (i.e, which trimester), frequency, and mode of cannabis delivery or tobacco-product used on maternal and offspring outcomes. In addition, it would be important to see what longer-term offspring impacts are associated with cannabis and nicotine co-use.”

The dangers of using cannabis and nicotine products during pregnancy

According to the National Institute on Drug Abuse, cannabis is associated with diminished fetal neurological function.

In addition, one study found that nicotine affects how the placenta functions, which interferes with the fetus receiving proper nutrition and oxygen in utero.

Experts agree that it’s best to steer clear of both substances while pregnant.

“While addiction knows no boundaries, and substance use covers a myriad of items, a common patient concern is the use of marijuana and nicotine while expecting,” Dr. Lea McMahon, chief clinical officer at Symetria Recovery, stated.

“I tell my patients that while suffering from substance use disorders, it is important to look forward and concentrate on their continued steps of sobriety. Due to extensive media coverage and published medical reports, it is medically advised that people abstain from both nicotine and cannabis use while expecting.”

Regarding the argument of cannabis vs. nicotine and which one is worse, the medical community finds neither in good standing to award a green light of usage, McMahon explained.

She encourages any patient, pregnant or not, to seek treatment for the entire scope of their substance use disorder while pursuing full-fledged sobriety and a better quality of life.

Alleviating addiction before pregnancy

Pamela Berens, MD, professor and OBGYN at UTHealth Houston, stressed that just because cannabis may be legal in some states, it does not mean it is safe during pregnancy.

“We don’t have sufficient research to know the full implications of cannabis use during pregnancy and lactation. This study highlights some of the safety concerns and the need to better support people to assist them with decreasing their use prior to and during pregnancy and lactation and quitting altogether if that is a possibility for them,” Berens said.

It’s strongly advised to stop cannabis and nicotine use before the start of pregnancy. Attempting to quit any addiction during pregnancy can be dangerous for both the pregnant person and the fetus.

“Regarding nicotine, I tell pregnant patients that patches are not a safe method to alleviate addiction, as these contain a large dose of nicotine and may cause in-utero damage,” McMahon explained.

“In my opinion, the best way to discourage cannabis and nicotine use while pregnant is to abstain from both substances and remove the social acceptance that one is ‘better’ than the other. Especially for anyone trying to overcome substance use disorders, behaviors related to cannabis and nicotine consumption should be avoided as a whole.”


The combined use of cannabis and nicotine during pregnancy was linked to an increased risk of maternal and neonatal morbidity, according to a new study.

Experts noted that it’s best to avoid both substances during pregnancy.

It’s crucial to raise awareness among the public that although cannabis is legal in some states, it doesn’t mean it’s safe for pregnant people to use.