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Information on gestational age was collected from electronic medical records. Marijuana use and tobacco smoking during pregnancy were assessed through a standard questionnaire after birth. Linear and log\u2010linear regression models were used to assess associations between marijuana use with and without tobacco smoking during pregnancy and the outcomes of interest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 8261 mothers, 27.5% had preterm births. About 3.5% of mothers with term deliveries and 5.2% of mothers with preterm births used marijuana during pregnancy. Marijuana use and cigarette smoking were independently associated with a decrease in gestational age by 0.50\u00a0weeks (95% confidence interval [CI] \u22120.87, \u22120.13) and 0.52\u00a0weeks (95% CI \u22120.76, \u22120.28), respectively. Marijuana use during early or late pregnancy was associated with a similar decrease in gestational age by 0.50\u00a0weeks. When we examined the effects on the preterm birth subtypes, simultaneous marijuana use and tobacco smoking were associated with higher risk of spontaneous preterm birth (RR 1.64, 95% CI 1.23, 2.18). The elevated risk was not observed with clinician\u2010initiated preterm birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this high\u2010risk US population, maternal marijuana use and cigarette smoking during pregnancy were independently associated with shorter gestational age. When we examined the effects on preterm birth subtypes, the elevated risk was only observed with spontaneous preterm birth.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12686","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T09:07:03Z","timestamp":1593508023000},"page":"696-705","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Maternal persistent marijuana use and cigarette smoking are independently associated with shorter gestational age"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6785-7867","authenticated-orcid":false,"given":"Nobutoshi","family":"Nawa","sequence":"first","affiliation":[{"name":"Department of Population, Family and Reproductive Health Center on Early Life Origins of Disease Johns Hopkins University Bloomberg School of Public Health Baltimore MD USA"},{"name":"Department of Global Health Promotion Tokyo Medical and 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