Health Care Utilization and Developmental Delay Among Infants Exposed to Cannabis In Utero

Abstract

Objective: We examined the association between in utero cannabis exposure and well-child care (WCC) attendance, emergency department (ED) visits, and developmental delay (DD) diagnosis during the first 2 years of life.

Methods: Infants with a meconium drug screen conducted between April 1, 2014 and April 30, 2022 were identified from Carolina Data Warehouse and linked with NC Medicaid claims to create a merged dataset. Infants were categorized as cannabis-exposed (meconium positive for cannabis only) or substance-unexposed (meconium negative and urine absent/negative for all substances). The primary outcome was WCC attendance; secondary outcomes were ED encounters and DD in the first 2 years. Negative binomial and logistic regression were used to examine the association between cannabis exposure and outcomes. The DD subanalysis was conducted over 3 years.

Results: Among 7240 infants with a meconium screen, 5448 infants (75%) were linked to Medicaid. There were 1671 infants with a meconium screen positive for cannabis only and 2599 infants negative for all substances. No difference in WCC or ED visits was observed between cannabis-exposed and substance-unexposed infants. There was a decrease in the odds of DD in the first 2 years among cannabis-exposed infants and no difference at 3 years.

Conclusions: Compared to those unexposed, Medicaid-insured children who were exposed to cannabis in utero have similar WCC attendance and ED use over the first 2 years and similar developmental outcomes at 3 years.

Keywords: development; disparities; health care utilization; in utero cannabis; policy.