Maternal Marijuana Exposure, Feto-Placental Weight Ratio, and Placental Histology

Torri D. Metz, Amanda A. Allshouse, Halit Pinar, Michael Varner, Marcela C. Smid, Carol Hogue, Donald J. Dudley, Radek Bukowski, George R. Saade, Robert L. Goldenberg, Uma Reddy, Robert M. Silver

Research output: Contribution to journalArticlepeer-review


Objective Marijuana use is associated with placenta-mediated adverse pregnancy outcomes including fetal growth restriction, but the mechanism remains uncertain. The objective was to evaluate the association between maternal marijuana use and the feto-placental weight ratio (FPR). Secondarily, we aimed to compare placental histology of women who used marijuana to those who did not. Study Design This was a secondary analysis of singleton pregnancies enrolled in a multicenter and case-control stillbirth study. Prior marijuana use was detected by electronic medical record abstraction or cord homogenate positive for 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid. Prior tobacco use was detected by self-report or presence of maternal serum cotinine. Stillbirths and live births were considered separately. The primary outcome was FPR. Association of marijuana use with FPR was estimated with multivariable linear modeling adjusted for fetal sex, preterm birth, and tobacco use. Comparisons between groups for placental histology were made using Chi-square and stratified by live birth and stillbirth, term and preterm deliveries, and fetal sex. Results Of 1,027 participants, 224 were stillbirths and 803 were live births. Overall, 41 (4%) women used marijuana during the pregnancy. The FPR ratio was lower among exposed offspring but reached statistical significance only for term stillbirths (mean 6.84 with marijuana use vs. mean 7.8 without use, p < 0.001). In multivariable modeling, marijuana use was not significantly associated with FPR (p = 0.09). There were no differences in histologic placental features among those with and without marijuana use overall or in stratified analyses. Conclusion Exposure to marijuana may not be associated with FPR. Similarly, there were no placental histologic features associated with marijuana exposure. Further study of the influence of maternal marijuana use on placental development and function is warranted to better understand the association between prenatal marijuana use and poor fetal growth. Key Points Maternal marijuana exposure was not associated with the feto-placental weight ratio. Marijuana exposure was not associated with differences in placental histology. Concerning trend toward lower feto-placental weight ratios among marijuana-exposed stillbirths.

Original languageEnglish (US)
Pages (from-to)546-553
Number of pages8
JournalAmerican Journal of Perinatology
Issue number5
StatePublished - Apr 1 2022


  • feto-placental ratio
  • marijuana
  • placenta
  • stillbirth

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


Dive into the research topics of 'Maternal Marijuana Exposure, Feto-Placental Weight Ratio, and Placental Histology'. Together they form a unique fingerprint.

Cite this