{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:49:24Z","timestamp":1789516164251,"version":"build-2803163510"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"crossref","award":["4500384537"],"award-info":[{"award-number":["4500384537"]}],"id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>With the recent legalization of cannabis in Canada, there is an urgent need to understand the effect of cannabis use in pregnancy. Our population-based study investigated the effects of prenatal cannabis use on maternal and newborn outcomes, and modification by infant sex.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The cohort included 1,280,447 singleton births from the British Columbia Perinatal Data Registry, the Better Outcomes Registry &amp; Network Ontario, and the Perinatal Program Newfoundland Labrador from April 1st, 2012 to March 31st, 2019. Logistic regression determined the associations between prenatal cannabis use and low birth weight, small-for-gestational age, large-for-gestational age, spontaneous and medically indicated preterm birth, very preterm birth, stillbirth, major congenital anomalies, caesarean section, gestational diabetes and gestational hypertension. Models were adjusted for other substance use, socio-demographic and-economic characteristics, co-morbidities. Interaction terms were included to investigate modification by infant sex.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The prevalence of cannabis use in our cohort was approximately 2%. Prenatal cannabis use is associated with increased risks of spontaneous and medically indicated preterm birth (1.80[1.68\u20131.93] and 1.94[1.77\u20132.12], respectively), very preterm birth (1.73[1.48\u20132.02]), low birth weight (1.90[1.79\u20132.03]), small-for-gestational age (1.21[1.16\u20131.27]) and large-for-gestational age (1.06[1.01\u20131.12]), any major congenital anomaly (1.71[1.49\u20131.97]), caesarean section (1.13[1.09\u20131.17]), and gestational diabetes (1.32[1.23\u20131.42]). No association was found for stillbirth or gestational hypertension. Only small-for-gestational age (p = 0.03) and spontaneous preterm birth (p = 0.04) showed evidence of modification by infant sex.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Prenatal cannabis use increases the likelihood of preterm birth, low birth weight, small-for-gestational age and major congenital anomalies with prenatally exposed female infants showing evidence of increased susceptibility. Additional measures are needed to inform the public and providers of the inherent risks of cannabis exposure in pregnancy.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0276824","type":"journal-article","created":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T19:07:37Z","timestamp":1669230457000},"page":"e0276824","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":43,"title":["Cannabis use in pregnancy and maternal and infant outcomes: A Canadian cross-jurisdictional population-based cohort study"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8394-4610","authenticated-orcid":true,"given":"Sabrina","family":"Luke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2242-7868","authenticated-orcid":true,"given":"Amy J.","family":"Hobbs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Riddell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calypse","family":"Agborsangaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1535-5520","authenticated-orcid":true,"given":"Christina","family":"Cantin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Fahey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenny","family":"Der","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Pederson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the National Maternal Cannabis Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"pone.0276824.ref001","year":"2018","journal-title":"Parliament of Canada. Statutes of Canada"},{"key":"pone.0276824.ref002","author":"U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration","year":"2013","journal-title":"Results from the"},{"key":"pone.0276824.ref003","article-title":"Clearing the Smoke on Cannabis: Maternal Cannabis Use during Pregnancy\u2013An Update","author":"AJ Porath","year":"2018","journal-title":"Canadian Centre on Substance Use and Addiction]"},{"key":"pone.0276824.ref004","year":"2018","journal-title":"Statistics Canada"},{"key":"pone.0276824.ref005","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.pharmthera.2017.08.014","article-title":"Cannabis use during pregnancy: Pharmacokinetics and effects on child development","volume":"182","author":"KS Grant","year":"2018","journal-title":"Pharmacology & Therapeutics"},{"issue":"544","key":"pone.0276824.ref006","first-page":"1","article-title":"\u03949-tetrahydrocannabinol exposure during rat pregnancy leads to symmetrical fetal growth restriction and labyrinth-specific vascular defects in the placenta","volume":"10","author":"BV Natale","year":"2020","journal-title":"Scientific Reports"},{"issue":"5","key":"pone.0276824.ref007","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1016\/j.jaci.2017.07.017","article-title":"Prenatal fine particulate exposure and early childhood asthma: Effect of maternal stress and fetal sex","volume":"141","author":"A Lee","year":"2018","journal-title":"Journal of Allergy and Clinical Immunology"},{"key":"pone.0276824.ref008","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.envres.2018.08.019","article-title":"Prenatal nitrate air pollution exposure and reduced child lung function: Timing and fetal sex effects","volume":"167","author":"S Bose","year":"2018","journal-title":"Environmental Research"},{"issue":"2","key":"pone.0276824.ref009","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1046\/j.1365-3016.2000.00247.x","article-title":"Maternal smoking affects fetal growth more in the male fetus","volume":"14","author":"B Zar\u00e9n","year":"2000","journal-title":"Paediatric & Perinatal Epidemiology"},{"key":"pone.0276824.ref010","article-title":"In-utero exposure to cigarette chemicals induces sex-specific disruption of one-carbon metabolism and DNA methylation in the human fetal liver","author":"O Drake AJ","year":"2015","journal-title":"BMC Med 13"},{"issue":"4","key":"pone.0276824.ref011","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.envres.2009.01.009","article-title":"Gender differences in fetal growth of newborns exposed prenatally to airborne fine particulate matter","volume":"109","author":"W Jedrychowski","year":"2009","journal-title":"Environmental Research"},{"key":"pone.0276824.ref012","doi-asserted-by":"crossref","first-page":"e36234","DOI":"10.7554\/eLife.36234","article-title":"Sex-dependent effects of in-utero cannabinoid exposure on cortical function","volume":"7","author":"A Bara","year":"2018","journal-title":"Elife"},{"key":"pone.0276824.ref013","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ntt.2018.06.002","article-title":"Additive drug-specific and sex-specific risks associated with co-use of marijuana and tobacco during pregnancy: Evidence from 3 recent developmental cohorts (2003\u20132015)","volume":"68","author":"SH Massey","year":"2018","journal-title":"Neurotoxicology and Teratology"},{"key":"pone.0276824.ref014","article-title":"Appendix 10.5: Gestational age calculation","author":"PS BC","year":"2014","journal-title":"British Columbia Perinatal Data Registry Reference Manual Perinatal Services BC"},{"issue":"2","key":"pone.0276824.ref015","doi-asserted-by":"crossref","first-page":"E35","DOI":"10.1542\/peds.108.2.e35","article-title":"A new and improved population-based Canadian reference for birth weight for gestational age","volume":"108","author":"MS Kramer","year":"2001","journal-title":"Pediatrics"},{"key":"pone.0276824.ref016","volume-title":"Government of Canada","year":"2013"},{"key":"pone.0276824.ref017","unstructured":"Population Data BC [Internet]. Victoria: University of British Columbia; [cited 2021 Mar 9]. Available from: https:\/\/www.popdata.bc.ca\/secure_data"},{"issue":"6","key":"pone.0276824.ref018","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1001\/jama.2018.21554","article-title":"Using the E-value to assess the potential effect of unmeasured confounding in observational studies","volume":"321","author":"S Haneuse","year":"2019","journal-title":"JAMA"},{"issue":"9","key":"pone.0276824.ref019","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.jogc.2018.11.014","article-title":"Cannabis Use in Pregnancy in British Columbia and Selected Birth Outcomes","volume":"41","author":"S Luke","year":"2019","journal-title":"Journal of Obstetrics and Gynaecology Canada"},{"issue":"7","key":"pone.0276824.ref020","doi-asserted-by":"crossref","first-page":"e208256","DOI":"10.1001\/jamanetworkopen.2020.8256","article-title":"Association of maternal opioid use in pregnancy with adverse perinatal outcomes in Ontario, Canada, from 2012 to 2018","volume":"3","author":"DJ Corsi","year":"2020","journal-title":"JAMA Network Open"},{"key":"pone.0276824.ref021","article-title":"Perinatal Health Reports","author":"Perinatal Services BC","year":"2022","journal-title":"Vancouver: PSBC"},{"key":"pone.0276824.ref022","article-title":"Annual and Biennial Reports","author":"Better Outcomes Registry & Network","year":"2022","journal-title":"Ottawa: BORN"},{"key":"pone.0276824.ref023","article-title":"Perinatal Health Indicators for Canada 2017: A Report from the Canadian Perinatal Surveillance System","author":"Public Health Agency of Canada","year":"2017","journal-title":"Ottawa: ASPC-PHAC"},{"issue":"4","key":"pone.0276824.ref024","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/AOG.0000000000001649","article-title":"Maternal Marijuana Use and Adverse Neonatal Outcomes: A Systematic Review and Meta-analysis","volume":"128","author":"SN Conner","year":"2016","journal-title":"Obstetrics and Gynecology"},{"issue":"4","key":"pone.0276824.ref025","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s00213-008-1422-2","article-title":"The effects of cannabinoids on serum cortisol and prolactin in humans","volume":"203","author":"M Ranganathan","year":"2008","journal-title":"Psychopharmacology"},{"issue":"4","key":"pone.0276824.ref026","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/j.1552-6909.2009.01034.x","article-title":"Are maternal cortisol levels related to preterm birth?","volume":"38","author":"C. Giurgescu","year":"2009","journal-title":"Journal of Obstetric Gynecologic & Neonatal Nursing"},{"issue":"10","key":"pone.0276824.ref027","doi-asserted-by":"crossref","first-page":"e3320","DOI":"10.1371\/journal.pone.0003320","article-title":"Loss of cannabinoid receptor CB1 induces preterm birth","volume":"3","author":"H Wang","year":"2008","journal-title":"PLoS ONE"},{"key":"pone.0276824.ref028","article-title":"Gastroschisis in Ontario, Canada: 2012\u20132018","author":"DK Bourque","year":"2021","journal-title":"Birth Defects Research"},{"issue":"1","key":"pone.0276824.ref029","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/15287390600748799","article-title":"Risk of selected birth defects with prenatal illicit drug use, Hawaii, 1986\u20132002","volume":"70","author":"MB Forrester","year":"2007","journal-title":"Journal of Toxicology and Environmental Health, Part A"},{"issue":"1","key":"pone.0276824.ref030","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13052-014-0085-3","article-title":"Maternal lifestyle factors in pregnancy and congenital heart defects in offspring: review of the current evidence","volume":"40","author":"Y Feng","year":"2014","journal-title":"Italian journal of pediatrics"},{"issue":"5","key":"pone.0276824.ref031","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1111\/ppe.12140","article-title":"Using Bayesian Models to Assess the Effects of Under\u2010reporting of Cannabis Use on the Association with Birth Defects, National Birth Defects Prevention Study, 1997\u20132005","volume":"28","author":"MM van Gelder","year":"2014","journal-title":"Paediatric and Perinatal Epidemiology"},{"key":"pone.0276824.ref032","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.drugalcdep.2018.11.028","article-title":"Beliefs and attitudes regarding prenatal marijuana use: Perspectives of pregnant women who report use","volume":"196","author":"JC Chang","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"9","key":"pone.0276824.ref033","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1093\/pch\/16.9.562","article-title":"Selective serotonin reuptake inhibitors in pregnancy and infant outcomes","volume":"16","author":"AL Jefferies","year":"2018","journal-title":"Paediatrics & Child Health"},{"key":"pone.0276824.ref034","article-title":"Depression (pregnancy): Selective serotonin reuptake inhibitors (SSRIs)","author":"T Marin","year":"2019","journal-title":"JBI Evidence summary"},{"issue":"9","key":"pone.0276824.ref035","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1016\/j.pec.2016.06.003","article-title":"\"Anything above marijuana takes priority\": Obstetric providers\u2019 attitudes and counseling strategies regarding perinatal marijuana use","volume":"99","author":"CL Holland","year":"2016","journal-title":"Patient Education & Counseling"},{"key":"pone.0276824.ref036","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1038\/s41591-020-1002-5","article-title":"Maternal cannabis use in pregnancy and child neurodevelopmental outcomes","volume":"26","author":"DJ Corsi","year":"2020","journal-title":"Nature Medicine"},{"issue":"3","key":"pone.0276824.ref037","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1080\/10926771.2017.1332703","article-title":"Pregnancy as an opportunity for trauma-intervention among women who are addicted to substances","volume":"28","author":"K Puurunen","year":"2019","journal-title":"Journal of Aggression, Maltreatment & Trauma"},{"key":"pone.0276824.ref038","article-title":"Cantin C and the perinatal substance use expert panel of the Champlain Maternal Newborn Regional Program","year":"2017","journal-title":"Lactation and Cannabis Use: Developing a Discussion Guide to Facilitate Informed-Decision Making"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276824","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T19:08:10Z","timestamp":1669230490000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276824"}},"subtitle":[],"editor":[{"given":"Samantha Frances","family":"Ehrlich","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,23]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0276824","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,23]]}}}