Alcohol, cocaine, marijuana, and cigarette use during pregnancy: looking at relative harms


While illicit drug use during pregnancy seems to get a larger share of sensationalistic media headlines, research over the past two decades has consistently shown that tobacco and alcohol (the “legal drugs”) are the ones that can cause the most harm during pregnancy.

A recent study by James Janisse and colleagues in Detroit, Michigan looked at this issue by examining the individual and combined impact of alcohol, tobacco, cocaine, and marijuana on low birth weight. (Low birth weight can be caused by a number of factors, including substance use, and is considered an indicator of infant mortality and of later concerns like learning difficulties, hearing and visual impairments, asthma and other chronic diseases).

The researchers found that each of the drugs – alcohol, tobacco, marijuana, and cocaine – had independent and negative effects on outcomes (after controlling for factors like infant sex and mother’s weight). Each of the four substances differed in terms of the way they impacted infant birth weight. For cocaine, the entire effect was due to decreased gestational age at birth, with no direct impact on fetal growth. For marijuana, the entire effect was due to restricted fetal growth. Alcohol and cigarettes both shortened gestational duration and restricted fetal growth.

One of the major findings was that the comparative effect of alcohol, cigarette, cocaine, and marijuana use on birth weight varied by maternal age. For younger women, pregnancy alcohol, cigarette, and cocaine use had a somewhat similar effect on birth weight, with cocaine and smoking having nearly double the impact of marijuana. In contrast, for women aged 30, the impact of alcohol use on birth weight was nearly double that of cocaine use and triple that of marijuana use.

Overall, it was the use of alcohol and/or cigarettes that was clearly more harmful to fetal growth than cocaine use.


Bailey, B.A., McCook, JG., Hodge, A. and McGrady, L. (2012). Infant birth outcomes among substance using women: why quitting smoking during pregnancy is just as important as quitting harder drugs. Matern Child Health J, 16:414–422.

English, D.R., Hulse, G.K., Milne, E., Holman, C.D. and Bower, C.I. (1997). Maternal cannabis use and birth weight: a meta-analysis. Addiction, 92:1553–1560.

Janisse, J.J., Bailey, B.A., Ager, J., and Sokol, R.J. (2014). Alcohol, Tobacco, Cocaine, and Marijuana Use: Relative Contributions to Preterm Delivery and Fetal Growth Restriction. Substance Abuse, 35(1): 60-67, DOI: 10.1080/08897077.2013.804483

Testing pregnant low-income moms for drugs in New York creates outrage and controversy

Pix11 screenshot

A few days ago, Pix11 (part of the CW Television Network) published an article called Outrage as hospitals test pregnant moms for drugs near low-income neighborhoods (Stephanie Tsoflias, December 27, 2012).

The article looks at how pregnant moms across New York are being tested for drug use, specifically marijuana.  Many health care providers are administering the test without women’s consent. In some places, all women are asked to agree to testing; if women refuse, then babies are tested.

The article explores how this practice is not as supportive as one might think. In low-income neighborhoods, all mothers are being tested while in high-income neighborhoods, only women who are clearly under the influence of alcohol and/or drugs are being tested.

More worrisome is how the test results are being used – results are being sent to child protection services, with the implication that the results are an indicator of whether a woman is fit to parent.

While this article is taking a look at marijuana testing, it is directly relevant to those involved with FASD prevention or who are concerned about reducing alcohol use during pregnancy. I’ve blogged in the past about meconium testing which examines a baby’s first stools for evidence of whether a mother consumed alcohol during pregnancy. In Canada, meconium testing has been proposed as part of a comprehensive approach to addressing FASD.

While supporters of universal meconium testing believe that this will help with early identification of FASD in children, there are a lot of unresolved murky ethical issues and, at present, the practice would likely lead to more harm than good. As this article shows, while women in all socio-economic brackets use substances, certain groups of women are unfairly targeted and subject to more invasion of their privacy and are likely to experience adverse outcomes from testing.

See earlier posts on meconium screening: