# Endocannabinoid System Research: Clinical Evidence Guide > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/endocannabinoid-system-prenatal-substance-use-research/ > **Published:** 2026-04-22T23:10:16-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T11:00:27-04:00 > **Clinical Summary:** Explore endocannabinoid system prenatal substance use research and its clinical evidence on fetal development and maternal health risks. --- #### Clinical Takeaway Clinical Takeaway Prenatal alcohol exposure frequently occurs alongside use of other substances like cannabis, tobacco, and opioids, complicating efforts to isolate alcohol’s specific effects on [fetal development](https://cedclinic.com/prenatal-cannabinoid-exposure-reproductive-health-insights/). Understanding these concurrent use patterns is essential for clinical counseling and risk stratification in pregnant individuals, as polysubstance exposure may produce compounded developmental harm beyond alcohol alone. ### #3 Substance use patterns among individuals who consume alcohol during pregnancy: Results from a US multi-site study. **Citation:** Bakhireva Ludmila N et al. *[Substance use](https://cedclinic.com/stroke-risk-assessment-substance-use/) patterns among individuals who consume alcohol during pregnancy: Results from a US multi-site study.* Drug and alcohol dependence. 2026. PMID: 41797178. **Study type:** Journal Article, Multicenter Study  |  **Topic area:** Pediatrics  |  **CED Score:** 13 Design: 2 Journal: 0 N: 4 Recency: 3 Pop: 3 Human: 1 Risk: 0 **Methodological Considerations:** - Self-reported outcomes — recall and social-desirability bias risk **Abstract:** INTRODUCTION: Prenatal alcohol exposure (PAE) is common and associated with adverse outcomes, yet the impact of concurrent substance use remains poorly understood. Using HEALthy Brain and [Child Development](https://cedclinic.com/rethinking-diagnosis-in-children/) (HBCD) data (n = 1426), we described alcohol use patterns-with and without other substances-and examined factors associated with alcohol use in pregnancy. METHODS: Data were obtained from the HBCD Study public release 1.0, a 27-site longitudinal cohort examining normative development and the effects of four primary substances (alcohol, cannabis, tobacco, and opioids). More-than-minimal PAE was assessed by self-report and ethanol biomarkers. Participants were classified into 3 study groups: a) Alcohol-Only; b) Alcohol-Plus (alcohol with ≥1 other substance); and c) Comparison (alcohol use below the threshold and negative ethanol biomarkers). Correlates of alcohol use were assessed via polychotomous logistic regression contrasting two alcohol-use categories relative to a common reference group. RESULTS: More-than-minimal alcohol use occurred in 12.7% of participants, with 37% of these also using other substances. The most common polysubstance use pattern was a combination of alcohol, cannabis, and/or nicotine, which occurred, in different combinations, among 28% of participants. Maternal [mental health disorders](https://cedclinic.com/cannabinoid-receptor-type-2-schizophrenia/) were positively associated with both Alcohol-Only and Alcohol-Plus use. Higher socioeconomic status (SES) was associated with Alcohol-Only use, whereas lower SES was associated with Alcohol-Plus use. CONCLUSIONS: Over one-third of pregnant individuals who used alcohol also used at least one additional substance. Observed associations with maternal mental health and SES highlight opportunities for targeted policy, enhanced screening, and tailored interventions to support maternal and child health.  |   |  [View on PubMed ↗](https://pubmed.ncbi.nlm.nih.gov/41797178/)[Full Text ↗](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065066/)[DOI ↗](https://doi.org/10.1016/j.drugalcdep.2026.113101) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. 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[Read More](https://cedclinic.com/endocannabinoid-system-prenatal-substance-use-research/) [Endocannabinoid System and Pregnancy: Clinical Evidence](https://cedclinic.com/prenatal-alcohol-exposure-polysubstance-use-clinical-evidence/) Clinical evidence exploring the endocannabinoid system's role during pregnancy and its implications for maternal and fetal health. [Explore Now](https://cedclinic.com/prenatal-alcohol-exposure-polysubstance-use-clinical-evidence/) [Endocannabinoid System Clinical Research: Pregnancy Alcohol Use Study](https://cedclinic.com/prenatal-alcohol-exposure-substance-use-patterns-pregnancy/) Research study focusing on alcohol use during pregnancy and its effects on the endocannabinoid system. [Learn More](https://cedclinic.com/prenatal-alcohol-exposure-substance-use-patterns-pregnancy/) Have thoughts on this? 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