Available online 17 January 2026, 103224

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 two years of life.

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 two years. Negative binomial and logistic regression were used to examine the association between cannabis exposure and outcomes. DD sub-analysis was conducted over three years.

Among 7,240 infants with a meconium screen, 5,448 infants (75%) were linked to Medicaid. There were 1,671 infants with a meconium screen positive for cannabis only and 2,599 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.

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.

International Classification of Diseases

Child Protective Services

University of North Carolina

Current Procedural Terminology

Small for Gestational Age

in-utero cannabis

healthcare utilization

development

disparities

policy

© 2026 Published by Elsevier Inc. on behalf of Academic Pediatric Association