# Endocannabinoid System and Pregnancy: Clinical Evidence > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/prenatal-alcohol-exposure-polysubstance-use-clinical-evidence/ > **Published:** 2026-04-25T13:13:49-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T11:54:52-04:00 > **Clinical Summary:** Explore clinical evidence on prenatal alcohol exposure polysubstance use and its impact on fetal development and maternal health. --- #### Clinical Takeaway Prenatal alcohol exposure frequently occurs alongside other substance use, with the combination potentially increasing risks to [fetal development](https://cedclinic.com/prenatal-cannabinoid-exposure-reproductive-health-insights/) beyond alcohol alone. Understanding these concurrent use patterns helps clinicians identify pregnant patients who need comprehensive substance use screening and intervention. This multi-site study provides real-world data on polysubstance exposure during pregnancy to guide clinical counseling and risk assessment. ### #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 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 (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. Health, Longevity, Wellness One-on-One Cannabis Guidance Metabolic Balance [Leave a Message](https://cedclinic.com/contact/) [Metabolic Care](https://cedclinic.com/metabolic/metabolic-how-it-works/) [Medical Consulting](https://cedclinic.com/book/) [Cannabis Care](https://cedclinic.com/book/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) RELATED READING AT CED CLINIC Continue exploring the evidence [Endocannabinoid System Clinical Research: Pregnancy Alcohol Use Study](https://cedclinic.com/prenatal-alcohol-exposure-substance-use-patterns-pregnancy/) Detailed [clinical research](https://cedclinic.com/cannabis-based-therapies-smoking-cessation/) on alcohol use during pregnancy and its effects on the [endocannabinoid system](https://cedclinic.com/endocannabinoid-system-fear-extinction/). [Read More](https://cedclinic.com/prenatal-alcohol-exposure-substance-use-patterns-pregnancy/) [Endocannabinoid System Effects: Cannabis in Pregnancy Study](https://cedclinic.com/maternal-cannabis-use-pregnancy-risks-research/) Study exploring the impact of [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) during pregnancy on the endocannabinoid system and fetal outcomes. [Explore Study](https://cedclinic.com/maternal-cannabis-use-pregnancy-risks-research/) [Endocannabinoid System Research: Cannabis in Prenatal Care](https://cedclinic.com/prenatal-cannabis-polysubstance-use-risks-research/) Research on polysubstance use including cannabis during prenatal care and associated risks. [Learn More](https://cedclinic.com/prenatal-cannabis-polysubstance-use-risks-research/) Have thoughts on this? Share it: [X Share on X](https://twitter.com/intent/tweet?text=Endocannabinoid%20System%20and%20Pregnancy%3A%20Clinical%20Evidence&url=https%3A%2F%2Fcedclinic.com%2Fprenatal-alcohol-exposure-polysubstance-use-clinical-evidence%2F) [in Share on LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fcedclinic.com%2Fprenatal-alcohol-exposure-polysubstance-use-clinical-evidence%2F) [Share on BlueSky](https://bsky.app/intent/compose?text=Endocannabinoid%20System%20and%20Pregnancy%3A%20Clinical%20Evidence%20https%3A%2F%2Fcedclinic.com%2Fprenatal-alcohol-exposure-polysubstance-use-clinical-evidence%2F) [Follow on Instagram](https://www.instagram.com/drbenjamincaplan) [Read more on Substack](https://doctorapprovedcannabis.substack.com/) [Subscribe via RSS](https://cedclinic.com/feed/) ### Related --- ### Verification & Medical Governance - **Lead Clinical Author:** Benjamin Caplan, MD - **Credentials:** Board Certified in Family Medicine (ABFM), Former CMO Canna Care Docs (250,000+ patients supervised), Founder & CMO CED Clinic & CED Foundation, Author of *The Doctor-Approved Cannabis Handbook* (Penguin Random House). - **Clinical Scale:** 350,000+ lifetime evaluations overseen; 81,008-patient Real-World Evidence Registry (`~/.ced_rwe_vault.db`); 125,000+ peer-reviewed study literature observatory (`http://localhost:8768/api/explorer/terminal`). - **License Verification:** Commonwealth of Massachusetts License #240562 (https://checkahealthlicense.mass.gov/). - **NPI Registry:** 1962722637 (https://npiregistry.cms.hhs.gov/provider-view/1962722637). - **Ethics & Data Privacy:** Clinical registry observations adhere strictly to HIPAA Safe Harbor de-identification (45 CFR § 164.514(b)) and criteria for secondary research exemption under 45 CFR § 46.104(d)(4).