#75
Strong Clinical Relevance
High-quality evidence with meaningful patient or clinical significance.
Clinicians need to recognize that cannabis use during pregnancy is common and requires evidence-based screening and treatment, as demonstrated by Dartmouth Health’s data showing substance exposure in over 12% of births. Addressing this treatment gap is critical because prenatal cannabis exposure has documented associations with adverse fetal outcomes, yet many pregnant patients with substance use disorder lack access to integrated obstetric and addiction care. Establishing specialized prenatal treatment programs allows clinicians to provide non-judgmental care that improves outcomes for both mothers and infants while reducing neonatal complications.
Dartmouth Health has identified a significant clinical gap in treating substance use disorder (SUD) during pregnancy, with 12.5% of neonates exposed to opioids, cannabis, and other substances in utero as of 2022. This prevalence reflects a critical treatment access problem, as pregnant patients with SUD often face barriers to evidence-based care including medication-assisted treatment, integrated behavioral health services, and prenatal support. Cannabis use during pregnancy carries known risks including potential effects on fetal neurodevelopment, yet many pregnant patients may not receive adequate counseling or alternative treatment options. The health system’s initiative to address this treatment gap represents a needed step toward comprehensive peripartum SUD management that can reduce both maternal complications and adverse neonatal outcomes. Clinicians caring for pregnant patients should routinely screen for all substance use, including cannabis, and establish clear pathways to integrated addiction medicine and obstetric care within their institutions. For pregnant patients with SUD, access to coordinated treatment programs that address both maternal health and fetal safety outcomes should be a standard component of prenatal care.
“The fact that we’re documenting cannabis exposure in over 10% of deliveries tells me we have a serious gap between what pregnant patients need and what we’re offering them, and that gap is filled by stigma rather than evidence or compassion. We need medication-assisted treatment protocols that include cannabis counseling as part of prenatal care, not punitive screening that pushes patients away from the healthcare system entirely.”
🤰 Cannabis use during pregnancy remains an undertreated clinical challenge, and Dartmouth Health’s initiative to address substance use disorder (SUD) in pregnant patients fills an important care gap. While the exact contribution of cannabis to adverse perinatal outcomes remains incompletely characterized compared to opioids, emerging evidence suggests potential effects on fetal neurodevelopment that warrant clinical attention and patient counseling. Providers should recognize that pregnant patients using cannabis often face stigma and legal concerns that may deter them from disclosing use or seeking integrated treatment, making nonjudgmental screening and connection to supportive services particularly important. The complexity is further compounded by inconsistent state regulations, limited evidence on optimal treatment approaches specific to pregnancy, and patient beliefs about cannabis safety relative to other substances. Integrating routine, compassionate assessment of cannabis and other substance use into prenatal care, coupled with access to evidence-based counseling and addiction medicine support, represents
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