Effect on parental’s cannabis consumption on the risk of sudden infant death syndrome: a systematic review

Bignoto, Lara Lobão Campos; Fernandes, Paula da Costa; Bastida, Ana Cecília Finamore; Alvim, Vitor Fernandes; Grunewald, Sabrine Teixeira Ferraz

doi:10.1590/1806-9304202520240205-en

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REVIEW • Rev. Bras. Saude Mater. Infant. 25 • 2025 • https://doi.org/10.1590/1806-9304202520240205-en linkcopy

Effect on parental’s cannabis consumption on the risk of sudden infant death syndrome: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives: to analyze and synthesize the available evidence on the effect of parental cannabis use on the risk of sudden infant death syndrome (SIDS).

Methods: a systematic review was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library, from inception to December 2023. The search terms included “marijuana,” “cannab*,” “Sudden Infant Death,” “Sudden Infant Death Syndrome,” “SIDS,” “Crib Death,” and “Cot Death.” Study selection was performed independently by two reviewers, with disagreements resolved by a third author.

Results: nine studies were included, all from developed countries. Statistical analyses specifically addressing the association between cannabis use and SIDS were available in seven studies, four of which suggested a positive association. However, limitations included the absence of detailed data on frequency, route, and intensity of cannabis use, with substantial variation in exposure assessment across studies, which hinders comparability.

Conclusions: Although there is evidence of an association between cannabis use and SIDS, methodological limitations prevent us from inferring causality. More robust research is needed to explore the mechanisms underlying cannabis use during pregnancy and postpartum by mothers and fathers in order to inform preventive recommendations.

key words
Cannabis; Marijuana use; Sudden infant death; Infant health

Author, year	Country	Design	Study period	Exposure assessed	Outcomes assessed	n (outcome)	n (controls or missing outcome)	Statistical analysis
Rosen and Johnson,¹⁰ 1988	United States	Prospective cohort	1982 to 1983	Gestational exposure to cannabis was identified by maternal report during prenatal care	SIDS was defined after autopsy	4	61	Of the four children who died from SIDS, 3 were daughters of mothers who used cannabis
Ostrea Jr et al.,¹¹ 1997	United States	Prospective cohort	1988 to1989	Gestational exposure to cannabis was identified by meconium analysis	The cause of death was defined by medical records	11	2,953	For children exposed to drugs of abuse in general: OR = 1.5 (95%CI = 0.46 to 5.01)
Klonoff-Cohen and Lam-Kruglick,¹² 2001	United States	Case-control	1989 to 1992	The children's parents were interviewed about cannabis use from conception to the child's death	SIDS was defined after autopsy report	239	239	Use at conception: aOR=2.2 (1.2 - 2.4), =0.01; Use during pregnancy: aOR=2.0 (1.0 - 4.1), p=0.05; Postnatal use: aOR=2.8 (1.1 - 7.3), p=0.04
Scragg et al.,⁵ 2007	New Zealand	Case-control	1987 to 1990	Exposure to cannabis during pregnancy and postnatal was identified in interviews with mothers	SIDS was defined after autopsy reports and police investigation of alternative causes	393	1,800	Use during pregnancy: aOR=1.18 (95%CI=0.76 to 1.85); Postnatal use: aOR=1.38 (95%CI=0.90 to 2.12)
Claudet et al.,¹³ 2021	France	Retrospective cross- sectional study	2015 to 2018	Cannabis exposure was identified by toxicological analysis after death	SIDS was diagnosed at reference centers in the country, including cases in which toxicological analysis was requested	398	-	Cannabis exposure was identified in 25% of cases
Bandoli et al.,¹⁴ 2022	United States	Retrospective cohort	2005 to 2017	Any maternal diagnosis related to cannabis use1	SIDS was defined by cause of death records2	211	484,905	aOR = 2.7 (95%CI = 1.5 to 5.0)
Hauck and Blackstone,¹⁵ 2022	United States	Case-control	1993 to 1996	Cannabis use during pregnancy	SIDS was defined after autopsy report	195	195	OR = 2.76 (95%CI = 1.28 to 5.93)
MacFarlane et al.,¹⁶ 2022	New Zealand	Case-control	2012 to 2015	Parents of children were interviewed about cannabis use in the last 24 hours	SIDS was defined after autopsy report and police investigation of alternative causes	132	258	OR = 6.41 (95%CI = 0.44 to 94.26)
Bandoli et al.,¹⁷ 2023	United States	Retrospective cohort	2011 to 2018	Any maternal diagnosis related to cannabis use1	SIDS was defined by cause of death records2	1549	3,459.555	aOR = 1.5 (95%CI = 1.2 to 1.9)

Cohort studies	Evaluation criteria⁹
Cohort studies	1	2	3	4	5	6	7	8	9	10	11
Bandoli et al.,¹⁴ 2022	Y	Y	Y	Y	Y	Y	Y	Y	Y	NA	Y
Bandoli et al.,¹⁷ 2023	Y	Y	Y	Y	Y	Y	Y	Y	Y	NA	Y
Ostrea Jr et al.,¹¹ 1997	Y	Y	U	N	U	Y	Y	Y	Y	NA	Y
Rosen and Johnson,¹⁰ 1988	N	Y	Y	Y	N	Y	Y	Y	Y	NA	N
Case-control studies	1	2	3	4	5	6	7	8	9	10
Hauck and Blackstone,¹⁵ 2022	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
Klonoff-Cohen and Lam-Kruglick,¹² 2001	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y
MacFarlane et al.,¹⁶ 2022	Y	Y	Y	U	Y	Y	Y	Y	Y	Y
Scragg et al.,⁵ 2007	Y	Y	Y	U	Y	Y	Y	Y	Y	Y
Cross-sectional studies	1	2	3	4	5	6	7	8
Claudet et al.,¹³ 2021	Y	Y	Y	Y	Y	N	Y	N

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Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[TFN1] ¹
cannabis abuse without dependence; cannabis dependence; cannabis related disorder;

[TFN2] ²
death recorded as “SIDS,” “accidental suffocation or strangulation in bed,” or “unknown cause.” CI = confidence interval; OR = odds ratio; aOR = adjusted odds ratio; SIDS = sudden infant death syndrome.